Total Oral Rehabilitation with Dental Implants in an Elderly Patient with Concomitant Diseases: a Case Report

We report a case of restoration of the masticatory and phonetic functions of a senior patient with comorbidities who receives systemic medication and lacks sufficient bone volume for implant placement in the accurate position. X-ray shows severe asymmetric atrophy of the mandible, especially on the right sight, which affects the location of the mandibular canal. This greatly limits and complicates the restoration of the masticatory and phonetic functions with conventional prostheses. Adequate management of medication and long-term disease control of the patient allow safe surgery for tooth extraction and placement of intraosseous implants in the jaw bones.

Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery

Background: Pre-operative radiographic assessment of the anatomical relationship between the roots of the mandibular third molar and the inferior alveolar nerve (IAN) is a must to minimize the risk of IAN injury during surgery. Objectives: To compare the radiographic signs of digital orthopantomogram (OPG) and cone-beam computed tomography (CBCT). An additional objective was to assess the cortex status between the mandibular canal and third molar on CBCT images in relation to the demographic characteristics, region (right or left side), and angulation of mandibular molar. Methodology: In this retrospective study, a total of 350 impacted mandibular third molars with a close relationship between the inferior alveolar canal (IAC) and impacted mandibular third molars on digital OPG were further referred for CBCT imaging for assessment of the position of the mandibular canal. The study was conducted between August 2018 and February 2020. Digital OPGs were evaluated for radiographic signs like interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. The age and sex of patients, site of impacted third molar, Winter’s classification of mandibular third molar, position of IAC relative to impacted molar, and the radiographic markers of OPG were assessed for cortical integrity using CBCT. Chi square testing was applied to study the values of difference and binomial logistic regression was done to assess the factors associated with cortication. Statistical significance was set at p ≤ 0.05. Results: Among 350 patients, 207 (59.1%) were male and 143 (40.9%) were female with a mean age of 36.8 years. The most common OPG sign was interruption of white line, seen in 179 (51.1%) cases. In total, 246 cases (70.3%) showed an absence of canal cortication between the mandibular canal and the impacted third molar on CBCT images. Cortication was observed in all cases with a combination of panoramic signs which was statistically significant (p = 0.047). Cortication was observed in 85 (50.6%) cases where IAC was positioned on the buccal side, 11 (16.9%) in cases of inferiorly positioned IAC, and just 8 (7.6%) for cases of lingually positioned IAC which was statistically significant (p = 0.003). Statistically insignificant (p > 0.05) results were noted for cortex status in CBCT images with regards to the age, sex, site, and angulation of impacted third molars. Conclusion: CBCT imaging is highly recommended for those cases where diversion of the mandibular canal is observed on OPG and when the roots are present between canals.

Minimum size and positioning of imaging field for CBCT-scans of impacted lower third molars: a retrospective study

Background Cone-beam Computed Tomography (CBCT) is widely used for preoperative 3D imaging of lower third molars. Hence, for this imaging indication, the present study aimed to define the minimum field-of-view (FOV) size and its optimum placement, to decrease radiation exposure, and highlight the need of computer-assisted FOV centering technique for dental CBCT devices. To facilitate proper placement of image field, lower second molar was chosen as reference. Methods The retrospective study included 50 CBCT-scans of 46 patients with mean age of 34 years. Based on the lower second molar, a three-dimensional coordinate was formed and the location of mandibular canal (MC) and the dimensions and locations of the lower third molars, and possible associated pathological findings were assessed. Accordingly, the FOV size and position for third-molar imaging were optimized, while ensuring encompassment of all relevant structures. Results The minimum cylindrical volume, covering lower third molars and MC, was 32.1 (diameter) × 31.6 (height) mm, placed in relation to the second molar crown, top 2.2 mm above cusp tips, anterior edge 6.7 mm in the front of the most distal point of the crown, and lingual edge 7.9 mm on the medial side of the lingual wall. Conclusions The optimized FOV for lower third molars was smaller than common standard small FOVs. We recommend using FOV volume 3.5∅ × 3.5 cm for third molars without associated pathology. Accurate FOV protocols are essential for development of new CBCT-devices with computer-assisted and indication-specific FOV placement.

Mandibular Canal Location and Cortical Bone Thickness in Males and Females of Different Age Groups: A Cone-beam Computed Tomography Study

AIM: The purpose of the study was to measure and compare the prevalence of mandibular canal (MC) location variations in regard to mandibular first molars in both genders at different age groups. METHODS: A retrospective study was performed on 80 cone-beam computed tomography scans. Distance between MC and apical apices of first molars, buccal and lingual cortical plates was measured in both sides. RESULTS: 80 scans with 160 sides were analyzed. Distances was measured bilaterally for all scans with mean (5.22 ± 0.77) in men versus (4.1 ± 0.7) in women at group age 31–40 apical to apices of first molars. The mean was (3.77 ± 0.62) in men versus (2.81 ± 0.47) in women at same age group at buccal side, lingually the mean was (4.02 ± 0.67) in men versus (3.67 ± 0.26) in women in the same age group. CONCLUSION: Our study showed that there were decrease in measurements in older age group in both genders and in female groups more than male groups but with no statistical significant difference.

Analysis of the mandibular canal course using unsupervised machine learning algorithm

Objectives Anatomical structure classification is necessary task in medical field, but the inevitable variability of interpretation among experts makes reliable classification difficult. This study aims to introduce cluster analysis, unsupervised machine learning method, for classification of three-dimensional (3D) mandibular canal (MC) courses, and to visualize standard MC courses derived from cluster analysis in the Korean population. Materials and methods A total of 429 cone-beam computed tomography images were used. Four sites in the mandible were selected for the measurement of the MC course and four parameters, two vertical and two horizontal parameters were measured per site. Cluster analysis was carried out as follows: parameter measurement, parameter normalization, cluster tendency evaluation, optimal number of clusters determination, and k-means cluster analysis. The 3D MC courses were classified into three types with statistically significant mean differences by cluster analysis. Results Cluster 1 showed a smooth line running towards the lingual side in the axial view and a steep slope in the sagittal view. Cluster 2 ran in an almost straight line closest to the lingual and inferior border of mandible. Cluster 3 showed the pathway with a bent buccally in the axial view and an increasing slope in the sagittal view in the posterior area. Cluster 2 showed the highest distribution (42.1%), and males were more widely distributed (57.1%) than the females (42.9%). Cluster 3 comprised similar ratio of male and female cases and accounted for 31.9% of the total distribution. Cluster 1 had the least distribution (26.0%) Distributions of the right and left sides did not show a statistically significant difference. Conclusion The MC courses were automatically classified as three types through cluster analysis. Cluster analysis enables the unbiased classification of the anatomical structures by reducing observer variability and can present representative standard information for each classified group.

Influência da curetagem alveolar na cicatrização após exodontia em cães

Effects of curettage on the healing pattern of extraction wounds and their surrounding structures of the mandibular canal and nerve were observed and compared after extraction of mandibular third molars from dogs, the right alveoli having been submitted to a thorough curettage. New bone deposition on the upper and lateral walls of the mandibular canal was observed, surrounding and squeezing the nerve.

Radiographic assessment of impacted mandibular third molars

The surgical remedy of problems related to lower jaw 3 molars is related to common surgical risks like contamination, haemorrhage, pain and swelling. Certain unique risks are related with such surgery, specifically inferior alveolar and lingual nerve harm as these are adjacent vital structures. Risk assessment calls for an entire understanding of dental factors that can impact the care of these characteristic structures. Preoperative radiographic assessment warrants to provide data about the tooth itself, its encompassing bone, the neighbouring dentition, and related anatomical structural systems. Parameters that ought to be assessed are level of impaction, root formulations, angulation of the enamel, number of roots, root morphology, related pathology and, most importantly, the relation some of the crown/roots and the mandibular canal. An appropriate imaging method for 3 molars ought to display the complete 3rd molar and the mandibular canal below it. In this mini review, we elaborate on the generally used radiographic assessment methods of mandibular 3rd molars.