RECURRENCE OF ANEURYSMAL BONE CYST OF THE MANDIBLE: A CASE REPORT

Аneurysmal bone cysts are benign osteolytic lesions with rapid growth, thin walls containing numerous blood-filled cavities. They occur mainly in the pediatric population but are rarely diagnosed in the facial skeleton. Although benign, the condition can be locally aggressive and cause significant weakening of the affected bone structure. This case report presents a 14-year-old boy with Burkitt's tumor (Non-Hodgkin's lymphoma), previously diagnosed with an aneurysmal bone cyst a year ago. He was admitted for treatment at the Clinic of Maxillo-Facial Surgery of the University Hospital "St. George" Plovdiv due to pain and swelling in the left molar area of the mandibula, dating from 2 days. A recurrence of an aneurysmal bone cyst measuring 55/25 mm, which does not require resection of the mandible, was found. After a decision for surgical removal of the formation, under general anesthesia, and preparation of a three-cornered mucoperiosteal flap, the mandibular bone, which is lysed and thinned by the formation, was trepanned. The roots of the affected teeth were resected, and the formation was extirpated. A gauze drain was placed in the formed cavity, and the wound was sutured. Drug therapy included Cefotaxime 2x1.0 - 10 days, starting 3 days before surgery, and Paracetamol 2x1 – 3 days, 2 days before and 1 day after surgery. Prophylactic examinations were scheduled on day 3, 7, 10, 15 after the operation, as well as 3, 6, and 12 months post-op, due to the recurrent nature of the formation.

Risk Factors for Failure of Hard Palate Mucoperiosteal Flap Repair of Acquired Oronasal Communication in Dogs: A Pilot Study

The objective of this retrospective pilot study was to describe potential risk factors for failure of hard palate mucoperiosteal flaps (HPF) transposed for closure of oronasal communication. Dogs (n = 28) with acquired oronasal communication defects were included in the study population. Functional success of an HPF was determined by visual inspection at the last examination and lack of clinical signs. Risk factors for HPF failure including age, sex, body weight, presence of neoplasia at the time of surgery, presence of neoplasia after surgery due to incomplete or narrow margins, use of CO2 laser, previous surgeries in the same location, HPF blood supply, size of the HPF as a percentage of the total area of the hard palate mucoperiosteum, and distance traveled by the apex of the HPF were evaluated using descriptive statistics and unadjusted logistic regression modeling. Seven out of 28 (25%) hard palate flap procedures resulted in persistent oronasal communication and were considered failures. Body weight (Median: 17 vs. 25 kg, OR = 0.94, 80% CI = 0.90, 0.99), presence of neoplasia at the time of surgery (86 vs. 57%, OR = 4.50, 80% CI = 1.01, 20.06), HPF area (Median: 0.49 vs. 0.41, OR = 84.40, 80% CI = 1.66, 4,298) and apex travel distance (Median: 2.06 vs. 0.67, OR = 5.15, 80% CI = 2.14, 12.38) were associated with flap failure. Within this sample, the presence of neoplasia at the time of initial surgery, increasing the area of the HPF, and distance traveled by the HPF apex were associated with a greater odds of HPF failure. Further studies with larger sample sizes are needed to confirm repeatability of these results. HPFs remain a viable surgical option for closure of oronasal communication. Careful surgical planning, strict adherence to surgical principles, and awareness of anatomical limitations can increase the likelihood of success.

Accidental Injection of EDTA Instead of Anesthesia Solution during Root Canal Treatment: Case Report

Summary Background/Aim: Many irrigation solutions are used during root canal treatment. It is unacceptable to confuse irrigation solutions with anesthetic solution and inadvertently inject the patient. After such an error, local and systemic serious complications can be seen in the patient. The purpose of this case report is to show how careless use of etilendiamin tetraacedic acid (EDTA) can result in important complications, and offer some treatment methods for curing symptoms resulting from such complications. Case Report: A 17% EDTA solution, was inadvertently injected in the buccal mucosa of a 20-year-old male during routine root canal treatment. Severe pain, bleeding and mucosal swelling occurred shortly after the injection. Irrigation with saline was performed by sliding the mucoperiosteal flap at the injection site. Then the flap was sutured primary. At the control one week later, there were no areas of necrosis in the patient, but ecchymosis occurred. Decalcified areas were not detected in dental volumetric tomography examination. Conclusions: The dentists must apply the precautions of EDTA irrigation solution during the root canal treatment and manage the treatment of this clinical complication.

“NIMS” nasal mucoperiosteal flap for sublabial trans-sphenoidal surgical defect repair: A new technique under microscope

Background: CSF rhinorrhea is a known complication that may occur after cranial base surgery, especially the trans-sphenoidal approaches to sellar tumors. It may occur following both microscopic and endoscopic procedures. Over a period, the balance has tilted toward endoscopy due to development of pedicled Hadad flap. Microscopic trans-sphenoidal surgery (TSS) continues to be performed in our institute as well as many other centers across the world due to familiarity of technique and unavailability of endoscopic equipment. Despite the fairly widespread use of this surgery, literature is devoid of any description of a local mucosal flap for repair of the surgical defect in microscopic TSS. Methods: We herein described the procedure and our experience of harvesting such flap in 42 patients operated for pituitary adenomas in our department between September 2016 and February 2020, through microscopic sublabial TSS. Results: All 42 of the patients included in this study underwent excision of pituitary tumors (macroadenomas). Thirty-nine (n = 39) patients were undergoing 1st time surgery, while three (n = 3) of these patients were undergoing second surgery following an earlier trans nasal trans-sphenoidal route. None of our cases have reported CSF leak postoperatively. Conclusion: This study attempts to highlight to ardent/obligate microscopic surgeons that a local vascularized flap can be harvested for repair of skull base defect and prevent postoperative CSF leak in microscopic sublabial TSS.

Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a dreaded complication in patients with compromised bone metabolism. The purpose of the present study was to examine the occurrence of ARONJ and its related factors among patients with a history of antiresorptive therapy undergoing tooth extraction using preventive protocols at a Swiss university clinic. Data were retrospectively pooled from health records of patients having received a surgical tooth extraction between January 2015 and April 2020 in the Clinic of Cranio-Maxillofacial and Oral surgery, University of Zurich. A total of 970 patients received an extraction with flap elevation or wound closure during this period. A total of 104 patients could be included in the study. Furthermore, variables including age, gender, smoking, risk profile, choice, indication and duration of antiresorptive therapy, number of extractions, extraction site, surgical technique, choice and duration of antibiotics as well as the presence of postoperative inflammatory complications were assessed. Overall, 4 patients developed ARONJ (incidence of 3.8%) after tooth extraction at the same location, without previous signs of osteonecrosis. Preventive methods included predominantly primary wound closure using a full thickness mucoperiosteal flap and prolonged perioperative antibiotic prophylaxis. In accordance with current literature, the applied protocol showed a reliable outcome in preventing ARONJ when a tooth extraction is required.

Conservative Treatment of Complicated Crown Fracture and Crown-Root Fracture of Young Permanent Incisor—A Case Report with 24-Month Follow-Up

The complicated crown-root fracture of young permanent teeth is an uncommon traumatic dental injury that is usually treated in a complex way and is demanding not only for the dentist but even for the treated child. In this case report, we present the conservative treatment of a maxillary central incisor in a 10-year-old boy after a traumatic dental injury. Treatment included partial pulpotomy and adhesive fragment reattachment after reflection of the mucoperiosteal flap. The patient was fully asymptomatic at 24-month follow-up, with an aesthetically acceptable outcome. Vital pulp therapy and adhesive fragment reattachment can be a viable treatment option for complicated crown-root fractures, especially when treating immature permanent teeth.

Piezoelectric driven mandibular ridge split technique with immediate implant placement: A case report

Narrow dentoalveolar ridges pose a major challenge for the successful placement of endosseous implants. This case report focuses on a Piezoelectric driven mandibular Ridge Split technique without vertical osteotomy for an immediate implant placement in a narrow alveolar ridge measuring 3.0mm. Following anaesthesia, a mucoperiosteal flap was elevated after giving a mid-crestal incision distal to 35 along the entire edentulous ridge. Then, with the help of a micro-saw and horizontal spreaders, an osteotomy site of required diameter was achieved. Finally twist drills were used and implants were placed in the expanded site. Clinically, healing was uneventful with no step defect in the expanded buccal bone and the final occlusion obtained was satisfactory. The Piezo-electric driven Ridge Split technique promises to be a minimally invasive option for horizontal augmentation of narrow alveolar ridges- predictability within a short interval of time and with minimal risk of fracture.

A Split Mouth Study on Crestal Bone Architectural Changes by Flapped and Flapless Implant Surgical Procedures

Background: Rehabilitations by dental implants have often been utilized as an efficient procedure for restoring missing teeth. For implant placement two types of surgical methods are well documented. Conventional surgical approach involves raising a mucoperiosteal flap to gain access and see the underlying alveolar bone, instead there is this procedure which does not involve the reflection of the flap. Both the techniques are known to have their individual benefits and shortcomings. The present study was aimed to evaluate the longitudinal comparison and evaluation of hard tissue changes around endosseous implants placed using flapped as well as flapless surgical procedures in mandibular first molar region. Materials and Methods: A total of 10 healthy patients with bilateral mandibular first molar were involved in the study and 20 endosseous implants were inserted (10 in each group). Radiographic assessment was done for deviations in the marginal bone levels on both mesial and distal side and their average value was calculated at 1 month, and 3 months. All these parameters were statistically analyzed using the paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05. Results: During the 3 months observation period, the change in crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less reduction in the crestal bone height compared to the flap group. Conclusion: Both flap and the flapless techniques of endosseous implant placement had statistically significant effect on peri-implant bone loss over the 3 month period.

Classification and types of flaps in endodontic surgery

The success of endodontic surgeries can be significantly associated with the selected dental flap. Many flaps have been reported among studies in the literature with variable frequencies of advantages and disadvantages and with different indications for each flap. This literature review discusses the most commonly reported types of endodontics flaps along with the reported advantages and disadvantages, in addition to the uses, applications, and most probable indications and contraindications for each designed flap. Among the reported flap designs, clinical success and favorable outcomes were observed with the ones that limited the damage to the root-attached tissues. Moreover, crestal bone loss has been reported to be minimal when using the full mucoperiosteal flap designs. Many previous studies have reported that using triangular and rectangular flap designs has been associated with favorable events regarding crestal bone loss, with the observed complete healing of the resorption damaging events and absent alternations of the heights of the crestal bone that were potentially affected. Further details of each flap design are provided within the full manuscript of this article based on the obtained evidence from previous investigations.