Tooth Extraction

This study aims to develop a reproducible rat model for post-traumatic bisphosphonaterelated osteonecrosis of the jaw (BRONJ). In our previous studies using dental extraction as an inducing factor, only 30% -60% of zoledronate-treated animals fulfilled the definition of clinical BRONJ. We modified the zoledronate regimen and introduced repeated surgical extraction to illicit quantifiable BRONJ in all animals. Eighty retired-breeder female Sprague-Dawley rats were divided between the treatment (IV zoledronate; 80 μg/kg/week for 13 weeks) and control (saline) groups. On week 13, the left mandibular first molar was surgically extracted, followed by the second molar a week later. Animals were euthanized at 1week, 2-weeks, and 8-weeks following extraction. The occurrence and severity of BRONJ were scored in each animal based on gross and MicroCT analysis. Parameters of bone formation and osteoclast functions at the extraction site were compared between groups. All zoledronate-treated animals developed a severe case of BRONJ that fulfilled the clinical definition of the condition in humans. Osteoclast attachment continued to be defective eight weeks after stopping the treatment. There were no signs of kidney or liver toxicity. Our data confirmed that repeated surgical extraction (major trauma) by itself consistently precipitated massive bone necrosis in ZA-treated animals, eliminating the need to induce pre-existing infection or comorbidity. These results will be the basis for further studies examining the invivo pathogenesis and prevention of BRONJ.

Normal eruption of primary teeth into the oral cavity begins at about 6 months of child's age. Teeth that erupt prematurely have occasionally been reported in the medical and dental literature and have been referred to as congenital teeth, foetal teeth, pre-deciduous teeth and dentitio praecox. The most affected teeth are lower central incisors and only 1-10% of them are supernumerary teeth. The incidence of natal and neonatal teeth ranges from 1:2000 to 1:3500. The exact etiology has not been proved yet, but there is a correlation between natal teeth and hereditary, environmental factors and some syndromes. The management of the case depends on clinical characteristics of the natal or neonatal teeth, as well as on complications they might cause. The aim of this text is to present a literature review on important aspects of natal and neonatal teeth concerning prevalence, etiology, clinical and histological characteristics, differential diagnosis, complications and management.

The aim of the present study was to compare the effects of intranasal ketamine and midazolam on behavior of 3-6 year-old children during dental treatments. In this randomized cross-over clinical trial, 17 uncooperative children requiring at least two dental treatments were selected and randomly received ketamine (0.5mg/kg) or midazolam (0.2mg/kg) prior to treatment. The other medication was used in the next visit. The children's behavioral pattern was determined according to the Houpt's scale regarding sleep, movement, crying and overall behavior. Physiological parameters were also measured at different time intervals. The data were subjected to Wilcoxon Signed Rank test and two-way repeated measures ANOVA. The frequency of crying decreased significantly following ketamine administration compared to midazolam (P=0.002); movement of children decreased with fewer incidence of treatment interruption (P=0.001) while their sleepiness increased (P=0.003). Despite higher success of...

Introduction: Tooth loss leads to alveolar resorption specially in sagittal direction. Shortage of bone can prevent proper positioning of implants unless volume of bone is increased before implantation. This article demonstrates a procedure for widening the atrophic ridge using the lateral ridge expansion technique which is aimed at the creation of a new implant bed by longitudinal osteotomy of the alveolar bone. The buccal cortex is repositioned laterally using a greenstick fracture, and the space between the buccal and lingual cortical plates is left without any graft material. Case Report: Here we have presented an interesting case report of a split crest technique to expand narrow alveolar ridges for the placement of implants in a 35-year-old female patient. Conclusion: The modified approach for split crest technique to augment narrow alveolar ridges for placement of endosseous implants is devoid of foreign material usage and has a low rate cost, therefore, it can be employed mo...

The immediate placement of dental implants in esthetic areas is a primary challenge for modern implantology. The underlying treatment goal is to preserve the natural periodontal architecture; in recent years, however, a concurrent goal has been to reduce the period between implant placement in the fresh extraction socket and delivery of the definitive restoration, but adequate long-term data are still lacking on the efficacy of this technique. A 3- to 5-year retrospective analysis of 282 dental implants immediately placed into extraction sockets, and temporized with nonoccluding provisional prostheses has been undertaken. All recorded outcomes and complications, as well as a proposed protocol for management of immediate function, are discussed.

Alveolar osteitis commonly called as dry socket, alveolalgia osteomyelitis, fibrinolytic osteitis and localized osteitis alveolalgia. It is commonly seen after tooth extraction mainly in third molar extraction. It is a severely painful condition characterized by dislodgement of the blood clot that forms in the socket, leading to exposure of bone. The aproximity in incidence for all routine extraction is 3% and for impacted Mandibular third molar it reaches upto 30%. This review aims to provide an in-depth understanding of dry socket (alveolar osteitis) including it's pathophysiology, risk factors, prevention strategies and clinical management.

The purpose of this study is to determine the type and frequency of pathological conditions around third molar teeth among randomly selected patient's records in Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh. Totally, 281 patient panoramic radiographs were selected with detectable pathology among 570 files of patients seen in oral and maxillofacial surgery clinics 2 years retrospectively. Almost 17-55 years age (mean age 25.43) was selected. The following radiographs were analyzed for all pathology associated impacted teeth; dental caries, bone resorption, periodontitis, and apical pathology. The study found caries, external bone resorption and periodontitis are highly frequent to mesioangular and horizontal in mandibular impacted third molar compared to maxillary impacted third molar. Overall result evaluated that tooth #28 related periodontitis is significant (P = 0.021), and tooth #38 related bone resorption, tooth #48 related root caries,...

Purpose: To evaluate the soft and hard tissue response to orthodontic implant site development (OISD) (ie, forced extraction), to measure the amount of tissue that was regenerated and its relationship to the amount of orthodontic vertical tooth movement, to evaluate the tissue response in teeth with different degrees of periodontal attachment loss, to understand the limits of OISD, and to evaluate the implant survival rate. Materials and methods: A total of 32 hopeless teeth were treated with OISD, and 27 implants were placed in 13 patients consecutively. The level of periodontal attachment on the teeth to be extracted, amount of augmented alveolar bone, changes in soft tissue volume, and the rate of orthodontic tooth movement were recorded. Results: Mean values after OISD were as follows: orthodontic extrusive movement, 6.2 ± 1.4 mm; bone augmentation, 4 ± 1.4 mm; coronal movement of the gingival margin, 3.9 ± 1.5 mm; coronal movement of the mucogingival junction, 2.1 ± 1.3 mm; keratinized gingival augmentation, 1.8 ± 1.1 mm; gingival thickness (buccolingual dimension) augmentation, 0.7 ± 0.4 mm; recession, 1.8 ± 1.2 mm; bone augmentation/orthodontic movement ratio (efficacy), 68.9% ± 17.3%; gingival augmentation/orthodontic movement ratio (efficacy), 65.2% ± 19.9%; and pocket depth reduction, 1.8 ± 0.9 mm. The implant survival rate was 96.3%. Conclusions: OISD was a viable treatment for these hopeless teeth to regenerate hard and soft tissues. Its efficacy was about 70% for bone regeneration and 60% for gingival augmentation. The residual attachment level on the tooth was not a limitation. OISD might be a valuable treatment option to regenerate tissues for implant site development in patients in need of conventional orthodontic therapy.

The aim of this research was to verify clinically and histologically whether an excessively large horizontal and vertical gap distance of an implant placed into an immediate extraction socket would osseointegrate coronally at the implant-socket interface without primary flap closure, a bone graft, or a barrier membrane. An immediate implant and straight-profile healing abutment were placed at the palatal aspect of the extraction socket replacing a nonrestorable maxillary left canine. The residual horizontal defect measured 4.2 mm buccolingually and was allowed to heal by secondary intention. The implant was loaded after 5 months and biopsied after 10 months of placement, using the coronal portion of the buccal bone. The histologic section of the coronal aspect of the implant interface revealed intimate bone contact to the first thread. There was reestablishment of the implant biologic width coronal to the bone contact with connective tissue and junctional epithelium. This case report provides clinical and histologic proof that the immediate placement of implants into extraction sockets with an intact buccal wall allows healing and osseointegration despite a large gap distance and without primary flap closure, a bone graft, or a barrier membrane.

Background: One or more tooth/teeth may fail to erupt fully or fail to erupt at all into the oral cavity due to one reason or the others, such a tooth is termed impacted tooth. Indication for extraction of impacted third molar teeth has generated some levels of controversy in the literature. While some reported Caries, some reported pericoronitis, and other pathologies as the main indication for extraction of impacted third molar teeth. Objective: To determine the indications for the extraction of impacted mandibular third molars in the oral surgery clinic of oral and maxillofacial surgery department in University College Hospital (UCH) Ibadan, Nigeria. Materials and Method: A retrospective study of all the patients who presented at the Oral Surgery clinic in UCH Ibadan between 1997 and 2018 was carried out. Necessary information was extracted from the Oral Surgery daily record book and the patient case file. Variable extracted include Age, Gender, Tribe, presenting complaint, Diagn...

Introduction: Lidocaine plus epinephrine is the most common anesthetic drug used in dentistry which has important cardiovascular side-effects like increase in blood pressure and cardiac arrhythmia. The goal of this study was to evaluat cardiovascular effects of one cartridge of 2% lidocaine + 1:80000 epinephrine. Methods and Materials: 60 Cases without any systemic diseases who had been admitted for right and lower molar tooth extraction were studied. For all of them, inferior alveolar nerve was blocked with one cartridge of %2 lidocaine + 1:80000 epinephrine. Blood pressure and pulse rate were measured with Omron digital sphigmomanometer (model M4) and recorded in 5 stages (At the admit time until 10 minutes after injection), and compared with together. The findings of our study showed that injection of one Cartridge of 2% lidocaine + 1:80000 epinephrine has negligible effects on blood pressure and pulse rate. Discussion: Because of the minimum cardiovascular effects of one cartridge of %2 lidocaine + 1:80000 epinephrine in healthy cases, it seems tobe safe for patients with mild cardiovascular disease.

Intraoral disease is common in horses. The anatomical characteristics of the equine head severely limit the direct observation of premolar and molar dentition and surrounding soft tissue. A commercial intraoral camera manufactured for human dentistry facilitates the identification and documentation of equine intraoral anatomy, disease, and therapy.

Bisphosphonates are used widely for variety of bone condition, most notably IV bisphosphonates in the treatment of metastic bone lesion and oral bisphosphonates for osteoporosis. They constitute a group of drugs capable of modulating bone turnover and reducing its remodeling when an excessive resorption occurs. In the last few years, due to their extensive use, many cases of complications associated with their use have been published. This paper provides recent knowledge on general characteristics of these drugs and their mechanism of action, pathogenesis, as well as their relevance to dentist.

Chronic exposure to elevated ambient air levels of nitrous oxide during nitrous oxide/ oxygen (N2O/2) sedation can result in deleterious side effects to dentists and auxiliary staff. A sampling survey was done in the outpatient dental clinic at the Hospital for Sick Children to determine whether airborne nitrous oxide (N2O) gas concentrations were within established regulatory limits. The effectiveness of 2 scavenger mask systems, the Matrix Medical single-mask system and the Porter/Brown double-mask system, for reducing airborne contamination in a clinical environment during the treatment of pediatric dental patients was compared in a pilot study. The results indicated that the double-mask system more effectively minimized N2O exposure during N2O/O2 sedation of outpatients for a variety of clinical pediatric dental procedures.

Injury to the barrier tissue initiates a rapid distribution of myeloid immune cells from bone marrow, which guide sound wound healing. Bisphosphonates, a widely used anti-bone resorptive drug with minimal systemic side effects, have been linked to an abnormal wound healing in the oral barrier tissue leading to, in some cases, osteonecrosis of the jaw (ONJ). Here we report that the development of ONJ may involve abnormal phenotypic plasticity of Ly6G+/Gr1+ myeloid cells in the oral barrier tissue undergoing tooth extraction wound healing. A bolus intravenous zoledronate (ZOL) injection to female C57Bl/6 mice followed by maxillary first molar extraction resulted in the development of ONJ-like lesion during the second week of wound healing. The multiplex assay of dissociated oral barrier cells exhibited the secretion of cytokines and chemokines, which was significantly modulated in ZOL mice. Tooth extraction-induced distribution of Ly6G+/Gr1+ cells in the oral barrier tissue increased ...

Background: The pathological mechanism of osteonecrosis of the jaw (ONJ) is unknown. Results: Mouse ONJ-like lesions exhibited epithelial hyperplasia associated with ␥␦ T cells of mouse or human origin. Conclusion: ␥␦ T cells may modify the oral disease phenotypes of ONJ. Significance: ONJ pathogenesis may involve multiple mechanisms separately leading to the development of osteonecrosis or oral epithelial abnormality. Osteonecrosis of the jaw (ONJ), an uncommon co-morbidity in patients treated with bisphosphonates (BP), occurs in the segment of jawbone interfacing oral mucosa. This study aimed to investigate a role of oral mucosal barrier ␥␦ T cells in the pathogenesis of ONJ. Female C57Bl/6J (B6) mice received a bolus zoledronate intravenous injection (ZOL, 540 g/kg), and their maxillary left first molars were extracted 1 week later. ZOLtreated mice (WT ZOL) delayed oral wound healing with patent open wounds 4 weeks after tooth extraction with characteristic oral epithelial hyperplasia. ␥␦ T cells appeared within the tooth extraction site and hyperplastic epithelium in WT ZOL mice. In ZOL-treated ␥␦ T cell null (Tcrd ؊/؊ ZOL) mice, the tooth extraction open wound progressively closed; however, histological ONJ-like lesions were identified in 75 and 60% of WT ZOL and Tcrd ؊/؊ ZOL mice, respectively. Although the bone exposure phenotype of ONJ was predominantly observed in WT ZOL mice, Tcrd ؊/؊ ZOL mice developed the pustule/fistula disease phenotype. We further addressed the role of ␥␦ T cells from human peripheral blood (h-␥␦ T cells). When co-cultured with ZOL-pretreated human osteoclasts in vitro, h-␥␦ T cells exhibited rapid expansion and robust IFN-␥ secretion. When h-␥␦ T cells were injected into ZOL-treated immunodeficient (Rag2 ؊/؊ ZOL) mice, the oral epithelial hyperplasia developed. However, Rag2 ؊/؊ ZOL mice did not develop osteonecrosis. The results indicate that ␥␦ T cells are unlikely to influence the core osteonecrosis mechanism; however, they may serve as a critical modifier contributing to the different oral mucosal disease variations of ONJ.

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement.

There are several factors to consider while a tooth is to be replaced with an implant in the anterior region and achieving an esthetic result is even more challenging. We must evaluate numerous criteria to achieve the optimal esthetics. This article details a technique to replicate the soft tissue support and thus replicate the gingival margin position developed with the provisional restoration to achieve high functional and esthetic results.

Socket grafting with a bone graft substitute immediately after extraction is essential to preserve the ridge architecture for implant placement. Several bone graft substitutes have been tested for their ability to effectively regenerate osseous tissue in the sockets. Evidence suggests that socket bone typically regenerates during a period of 6 to 8 months or longer, depending on several factors including the original ridge dimensions, type of graft, and the overall systemic health of the individual. The purpose of this study is to histologically evaluate the bone regeneration potential of a novel synthetic calcium phosphosilicate putty (CPS) graft substitute. After extraction of the involved teeth, CPS putty graft was placed, and the sockets were covered with a collagen plug. Cores were taken from 20 patients for histological evaluation prior to implant placement. Ten cores were processed decalcified with hematoxylin and eosin (H&E) stain and the remaining 10 were processed undecalc...

The aim of vertical augmentation of the alveolar ridge is to restore resorbed alveolar ridges. This technique is critical to the placement of dental implants in a favorable position and the enhancement of restoration esthetics. The present report describes a technique for surgical preservation of the anterior maxillary process using maxillary bone from the surgical site and raising a soft tissue rotated palatal flap. Maxillary lateral incisor extraction and periapical surgery of the central incisors were first carried out. Two bone cores were harvested from the neighboring buccal vestibular region and placed in the sockets of the lateral maxillary incisors. After 3 months, implants were placed; 12 weeks later, the prosthetic restorations were cemented. There were no complications after 2 years of follow-up. This technique constitutes a viable approach for preserving the anterior sector alveolar ridge with the posterior placement of dental implants.

A review of the literature is made to evaluate factors that influence probing depth and attachment level on the distal aspect of the lower second molar (L2M) following extraction of a lower third molar (L3M). The PubMed database was searched for studies published between 1997 and March 2009 using the following keywords: mandibular third molar, distal periodontal defect, distal probing depth, distal attachment level, flap design. Randomized prospective studies, with a minimum follow-up of three months for which the full text could be obtained, and that indicated the attachment level and/or probing depth on the distal surface of the L2M in both the preoperative and postoperative periods were included. In the studies obtained, flap design had no influence on distal probing depth or distal attachment level of the L2M following extraction of an L3M. Curettage of the distal radicular surface of the L2M, together with oral hygiene control by the dentist, reduced probing depth values. Various authors recommend bone regeneration techniques in patients with a distal periodontal defect prior to extraction. The placing of membranes (resorbable or nonresorbable) is not justified; however, the use of demineralized bone powder or platelet-rich plasma gel reduces the distal probing depth and attachment level of the L2M.

Background: The antioxidant and anti‐inflammatory hormone melatonin is secreted by saliva into the oral cavity, where it may protect the mucosal and gingival tissues from radical damage. To date, no studies have addressed the potential beneficial role of melatonin in the acute inflammatory response that follows oral surgical interventions, especially tooth extractions. The aim of this study was to determine whether tooth extraction induces changes in plasma oxidative stress levels, and whether melatonin treatment may counteract these changes.Methods: Maxillary and mandibular premolars and molars of 16 adult Beagle dogs were extracted under general anesthesia. Eight dogs were treated with 2 mg melatonin placed into the alveolar sockets, whereas the other eight dogs received only vehicle. Lipid peroxidation (LPO) and nitrite plus nitrate (NOx) levels were determined in plasma, whereas glutathione (GSH) and glutathione disulfide (GSSG) levels and glutathione peroxidase (GPx) and reduct...

Noise-induced hearing loss (NIHL) is a common occupational disorder. Previous studies have investigated the role of hearing deprivation in mood disorders, especially depression. The aim of this study was to elucidate the relationship between NIHL and depression in employees of an iron ore plant. This was a cross-sectional study on 409 employees with at least one year of job experience. In order to assess the association between noise exposure and NIHL with depression, and based on the results of audiometry, employees were categorized into three groups: without noise exposure, with noise exposure and without hearing loss, and with noise exposure and hearing loss. The Beck depression inventory II (BDI-II) was used to assess the degree of depression. Demographic data and the BDI-II scores were compared among the three groups. The Mean±SD age of the participants was 34.43±7.8 years. The BDI-II score was significantly higher in employees with noise exposure (with and without hearing loss) than in employees without noise exposure (P<0.001). Categorical analysis of the BDI-II score showed a significantly higher prevalence of normal patients in patients among those without noise exposure compared to the two other groups (P<0.05). The results of this study showed that depression was more prevalent in employees with exposure to noise in their workplace, regardless of suffering from NIHL, than in employees without noise exposure.

This clinical trial explored the clinical and radiographic dimensional changes of the alveolar ridge in the first 4 months after tooth extraction in combination with the application of Leukocyte- and Platelet Rich Fibrin (L-PRF). Eighteen single rooted maxillary and mandibular sockets were filled with L-PRF without soft tissue closure. Clinical measurements (bone sounding) were performed using a customized acrylic stent and radiographic measurements were accomplished using Cone Beam Computed Tomography (CBCT), immediately after tooth extraction and after 4 months. The clinical observations indicated a mean horizontal resorption of 1.18±2.4mm (p=0.8) at the crest, 1.25±2.0mm (p=0.57) and 0.83±2.0mm (p=0.78) at 2mm and 4mm apical to the crest, respectively. The buccal plate demonstrated a mean vertical loss of 0.44±3.5mm (p=0.9), the centre of the socket had a significant filling of 5.72±3.6mm (p=0.0001) and the oral cortical plate had a mean vertical gain of 0.09mm±1.57mm (p=0.9). Th...

Orthodontic camouflage in patients with slight or moderate skeletal Class III malocclusions, can be obtained through different treatment alternatives. The purpose of this paper is to present a treatment that has not been described in the literature and which consists of the extraction of lower second molars and distal movement of the posterior segments by means of mandibular cervical headgear (MCH) and fixed appliances as a camouflage alternative. The force applied by the MCH was 250 gr per side (14hr/day). The total treatment time was 1 1/2 years. the extraction of lower second molars along with the use of mandibular cervical headgear is a good treatment alternative for camouflage in moderate Class III patients in order to obtain good occlusal relationships without affecting facial esthetics or producing marked dental compensations.

Indexación: Web of Science; Scielo.RESUMEN: Ninguna técnica de preservación alveolar ha logrado conservar totalmente las dimensiones iniciales del reborde, luego de la extracción dentaria. Se ha reportado falta de evidencia científica y de estudios prospectivos que utilicen los alvéolos post exodoncia como control. El objetivo de este estudio fue comparar clínica e imagenológicamente las variaciones dimensionales del reborde óseo utilizando diferentes técnicas de preservación alveolar en un periodo de 6 a 8 semanas post exodoncia. Se recolectaron 10 pacientes con indicación de exodoncia de cuatro premolares por indicación de ortodoncia, usando un diseño de maxilares divididos. Un lado experimental (dos alvéolos) y el otro lado como control (dos alvéolos). Se observó que existieron diferencias significativas (p&lt;0,05) de reabsorción ósea entre el grupo experimental superior con el grupo control superior. El 33,3% se los alvéolos experimentales presentaron algún tipo de exposición d...

BackgroundImpaction of third molars is often found in dental practice. Since reported in history on the discovery of the mandible bone 13.000–15.000 BC, research on dental impaction continues to grow. In the modern population, the highest prevalence is found in the impaction of mandibular third molars. There is a limited study regarding the impact pattern of mandibular third molars.ObjectiveTo investigate the impact pattern of mandibular third molars in populations in Surabaya and the surrounding area in East Java, Indonesia.MethodsA retrospective, cross-sectional study was conducted to investigate the impact patterns of mandibular third molars from the medical record data of patients at the Maxillofacial Oral Surgery Clinic of the Dental Hospital of Universitas Airlangga from July 2017-June 2019. Data were processed by age group, sex, angulation type, level position, complaint, indication was performed odontectomy and analyzed using chi-square significance of p-value ≤ 0.05.Results...

In patients at risk because of heart disease, bacteremias induced by invasive dental treatments have been reported as a cause of bacterial endocarditis (BE) - a serious disorder that continues to involve a high mortality. As a result, different scientific societies have supported recommendations for the administration of antibiotics prior to invasive dental treatments, in order to neutralize bacteremia. In this context, the recommendations of the American Heart Association (AHA) are the most widely used in our setting. Advances in our knowledge of the etiopathogenesis of bacterial endocarditis have placed increasingly less importance on invasive dental treatments as a causal factor (the AHA again reduced the number of cases in which antibiotic prophylaxis is recommended, on occasion of its latest guidelines update in 2007) - with increasingly greater importance being placed on factors associated with hygiene and oral health. The present study offers a critical review of the relation...

OBJECTIVES Patients with the low-dose long-term aspirin regime have a severe risk of excessive bleeding during surgery, placing them at risk of &quot;adverse thrombotic events&quot;. This study aims to evaluate the bleeding in patients undergoing minor oral surgery procedures without stopping daily low-dose aspirin therapy. METHODOLOGY A descriptive cross-sectional hospital-based investigation involved the patient with minor oral surgery at &quot;Altamash Institute of Dental Medicine, Karachi, Pakistan&quot; from mid-April 2021 to mid-June 2021, who were between the age group 30 to 75 with a low-dose aspirin regime. The data was collected via a questionnaire to record the variables, i.e. duration of aspirin, postoperative medications, platelets count, clotting time, normal bleeding time, and intraoperative bleeding time.  RESULTS 51 patients, of which 32 were males while 19, were females. The normal bleeding time was comparatively analyzed with the intraoperative bleeding time using...

combined with bromocriptine in the treatment of mixed GH-PRL adenoma, 1 as far as I know, our medical record is the first case in which complete remission was achieved with bromocriptine alone. CONCLUSION In short, surgery is not necessarily the first choice for patients with mixed GH-prolactinoma, especially those with large adenoma size and Knosp grade 3 or above. Patients can try oral dopamine receptor agonists (bromocriptine) for treatment, but long-term follow-up of GH and PRL is required after remission.

Maxillary canine ectopia is an anomaly of the mixed dentition which can and should be diagnosed early and treated interceptively wherever possible. Various radiographic markers have been associated with canine ectopia, and these are significant aids to a thorough clinical examination, in order to diagnose ectopia. A cross sectional study was carried out on a sample of 465 mixed dentition panoramic radiographs in order to establish the prevalence of maxillary canine ectopia according to a set of radiographic markers. The sample of radiographs included patients with dental ages between 10 and 12 years of age. 404 radiographs displayed signs of canine ectopia according to the markers studied. Non- resorption of the root of the primary canine was the most common marker (63%) found. This was followed by overlap in 25.2% of cases, whilst increased angulation of the developing canine was the least prevalent (4.7%). Non-resorption showed a statistically significant association with distal o...

Piezocision-assisted orthodontic treatment is an innovative, minimally invasive surgical technique designed to help achieve rapid orthodontic tooth movement. Microsurgical interproximal openings are made in the buccal gingivae to let the piezoelectric knife create the bone injury that will lead to transient demineralization and subsequent accelerated tooth movement. When this procedure was first described, cuts were made simultaneously at the maxilla and the mandible. In recent years, the technique has evolved to a more staged approach, with selected areas or segments of the arch demineralized at different times during orthodontic treatment to help achieve specific results. The purpose of this article was to report the use of sequential piezocision in the correction of a Class III malocclusion, in a total treatment time of 8 months. (

Background: Regeneration of the interproximal papilla remains a
challenging, unpredictable aspect of periodontal surgery. This lack of
predictability could be attributed to decreased blood supply, increased
distance between the underlying bone and contact point, and limited
surgical access that is inherently involved with the interdental space. This
two case report series proposes a novel approach, the Cul-de-Sac technique,
to reestablish the papilla, either with or without connective tissue grafting.
Methods: Following non-surgical therapy, two periodontally stable patients
underwent the following surgical therapy to address class II interproximal
recession defects between #7 and #8. Two divergent “butt-joint” incisions
were made at mesiobuccal and distobuccal line angles of adjacent teeth,
extending beyond the mucogingival junction. The flap and papilla were
released then advanced coronally to the contact point, creating a dead-end
space beneath the papilla. Based on soft tissue thickness and the defect’s
interproximal recession classification, the space beneath the papilla was
filled with a harvested connective tissue graft for Patient 2; Patient 1 did
not receive a graft. Simple interrupted sutures at an oblique angle were
used to secure the flap in this coronal position, filling the recession area.
Results: Both Case 1 and 2 achieved favorable, esthetic results at 6 weeks
and 2 weeks, respectively.
Conclusions: This “Cul-de-Sac” technique offers an additional surgical
method to rebuild a recessed interdental papilla. Additional research is
needed to assess the long-term results and its use with other recession
defects.

The term transposition is used to refer to an interchange in the position of 2 adjacent teeth within the same quadrant of the dental arch.In complete transposition, both the crowns and the entire root structures of the involved teeth are found parallel in their transposed positions. In incomplete transposition (also called "pseudo" or "partial" transposition) the crowns may be transposed while the root apices remain in their normal positions. Unilateral transposition has been reported more often than bilateral transposition, with the left side being somewhat more frequently involved than the right side. The only dental anomaly that has an apparent association with maxillary canine-lateral incisor transposition is increased third molar agenesis.Treatment of maxillary canine-lateral incisor transposition depends on many factors like the condition of the root of central incisors, shape of lateral incisors, need of extraction because of either severe crowding or profile improvement, etc. Here, we are going to present the management of a rare case report of maxillary right lateral incisor-canine pseudotransposition with minimum available space and agenesis of mandibular third molars.

Camera digital SLR NIKON 3200 Patients included: 1. Were of Indian origin. 2. Were older than 18 years of age. 3. Those referred for orthodontic evaluation. Patients excluded: (1) With previous orthodontic treatment or plastic or orthognathic surgery. (2) With any systemic medical condition. 25 subjects (females and males; referred to as the Study Group) who were selected from patients who visited our institution for orthodontic treatment, and 25 additional age and sex matched subjects (the Control Group). The distribution of subject's ages and sexes presented in Figures and respectively.

Approaching bone defects of jaws treatments, hard and soft tissue augmentation could be considered as a goal for clinicians when performing dental implant placement. The increase in patients who want cosmetic treatment puts practitioners in an awkward position when choosing the best therapy to obtain the most desirable results. A private dentist referred a young patient to the Department of Implantology in Milan in order to place implants in the upper jaw. Radiographic evaluation of the two upper anterior incisors confirmed that the teeth had a poor prognosis The anterior ridge volume was clinically analyzed and several therapeutic choices were evaluated. Rapid extractions and immediate implant positioning were not considered due to the vertical and horizontal components of the bone defect. Therefore, the surgical team decided on increasing the bone volume by using slow orthodontic teeth extrusion technique. After 3 months of orthodontic treatment, the angular intra-bony defects of 1.1 tooth was completely healed. Implant guided positioning, associated with a small bone graft, showed optimal results at the time of healing screw placement. The soft tissue conditioning was obtained by a provisional acrylic crown. The final application of two integral ceramic crowns showed excellent aesthetic results. Radiographic investigation at a 24 month follow-up confirmed the integration of the dental implants and the recovery of the bone defects. Several safe surgical techniques are available today for reconstructing atrophic jaws. However, the same technique applied on the posterior area did not give the same predictable results as in the anterior areas of the jaw.

Particularly in the premaxillary area, the stability of hard and soft tissues plays a pivotal role in the success of the rehabilitation from both a functional and aesthetic aspect. The present case report describes the clinical management of a localized alveolar ridge atrophy in the area of the upper right canine associated with a thin gingival biotype with a lack of keratinized tissue. An autogenous bone block harvested from the chin associated with heterologous bone particles was used to replace the missing bone, allowing for a prosthetic driven implant placement. Soft tissues deficiency was corrected by means of a combined epithelialized and subepithelial connective tissue graft. The 3-year clinical and radiological follow-up demonstrated symmetric gingival levels of the upper canines, with physiological peri-implant probing depths and bone loss. Thus, the use of autogenous tissues combined with biomaterials might be considered a reliable technique in case of highly aesthetic demanding cases.

The decision-making process of complex clinical cases should involve multiple specialists to obtain a predictable result on a long-term basis. In view of the above, the present report is aimed at describing the multidisciplinary management of a partially edentulous female patient presenting with a severely compromised residual dentition. To improve function and aesthetics, the treatment combined multiple extractions, temporary rehabilitation with a complete removable denture, guided bone regeneration and implant insertion, soft tissue management, tooth alignment, and restorative dentistry. Thus, several dental branches were embraced during the treatment phases, including oral surgery and implantology, periodontology, orthodontics, and prosthodontics. The involvement of different specialists ensured the achievement of a good result from biological, functional, and aesthetic aspects. The patient was satisfied with the final outcome. In conclusion, to meet the patient’s expectations pa...

Objective: The aim of this study was to evaluate the efficiency of two local hemostatic agents administered with a preoperative dose of replacement therapy in patients with bleeding disorders undergoing oral surgery. Material and Methods: The study included 21 patients that were randomly divided into 3 groups. Patients in Group 1 (n = 7) received preoperative replacement therapy and postoperative fibrin sealant applied to the surgical site. Patients in Group 2 (n = 7) received preoperative replacement therapy and postoperative tissue adhesive applied to the surgical site. Patients in Group 3 (n = 7) were given replacement therapy pre-and postoperatively. Results: Postoperative bleeding was not observed in 17 of the 21 patients, including 5 in Group 1 (71.42%), 6 in Group 2 (85.71%), and 6 in Group 3 (85.71%). Hemorrhagic complications occurred in only 4 of the 21 patients. The use of fibrin sealant and tissue adhesive was beneficial, as they reduced the level of factor concentrates used for replacement therapy and resulted in rapid hemostasis at the surgical site, facilitating the ability to perform serial surgical procedures concurrently.

The presence of non-sufficient bone height and width requires an increase in the amount of bone available to insert an implant. Different materials are described in the literature, and the “custom-made bone graft approach” is a modern option which currently requires a preoperative stage of studying the bone defect and designing the implant. SmartBone® (SB®) mimics the characteristics of healthy human bone. Thanks to the strong performance, high workability, resistance and shape retention of SB®, it is possible to obtain SmartBone® on DemandTM, a bone graft uniquely shaped exactly to patient specifications, produced by following the data precisely and contoured to the bone defect site. The aim of this study was to determine the success over 7 years following a customized SmartBone® on DemandTM, a xeno-hybrid bone graft and installation of implants in a maxillary horizontal and vertical atrophy. This case study presents the diagnosis for a 60-year-old male patient requesting the rehab...

Introduction Facial cellulitis and abscesses are common in public health problems and early recognition and management is critical, as they are becoming more severe with a noticeable increase in hospitalization. Aim of work detection of factor affecting outcome in the management of cervicofacial infections and complication to reduce associated mortality and morbidity. Patient and method This study was a prospective study which was conducted at Sohag University Hospital, General Surgery Department. It included patients with cervicofacial infection of odontogenic or non-odontogenic origin either localized or diffuse infection attended to at the Oral and Maxillofacial Surgery Clinic or the Accident and Emergency Unit from October 2016 to October 2017. Results This study included 35 cases, the submandibular space was the most common single site affected (11-34.29%), followed by bilateral or multi-space involvement presented (13-37.14%) of study patients, Diabetes mellitus was the most common associated co-morbidity among study population (12-34.29%), and other systemic diseases (6-17.14%). Conclusion Diabetes, bad general condition, impaired laboratory parameters including an elevated blood sugar level and metabolic acidosis at time of admission were found to be significant risk factors for development of post intervention complications and/ or delayed recovery.

Background Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations. The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool and Newcastle-Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup metaanalyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool. Results A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low. Conclusions Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth.

An approximately 9-month-old fox (Pseudalopex vetulus) was presented with malocclusion and deviation of the lower jaw to the right side. Orthodontic treatment was performed using the inclined plane technique. Virtual 3D models and prototypes of the head were based on computed tomography (CT) image data to assist in diagnosis and treatment.

Background: Dry socket (DS) or fibrinolytic osteitis is a relatively common complication that can occur following tooth extraction. This study aimed to determine the prevalence of DS and identify its associated predictive and mediating variables. Material and Methods: This study is classified as prospective observational, cross-sectional, and multicenter. Patients were consecutively selected in accordance with established criteria for tooth extraction. Data on patient demographics, surgical procedures and postoperative outcomes were collected. Nominal variables were analyzed using the Chi-Square Test, while associations involving ordinal values or considering counts or layers were examined using the Kendall's Tau-B Test or Mantel-Haenszel Test for trend. The GLM Mediation Model was employed to investigate potential mediation or indirect effects or potential underlying mechanisms of predictive variables on the development of DS. Two-tailed significance level of p ≤0.05 was considered statistically significant. Results: A total of 1,357 patients undergoing routine dental extractions were included. DS was observed in 13 patients (prevalence of 1%). DS was associated with younger patients (under 50 years old), longer procedures, and the presence of surgical accidents, but only when mediated by surgical complexity. Smoking, particularly in com-