TRATAMENTO E ANÁLISE HISTOPATOLÓGICA DE ODONTOMA COMPLEXO: RELATO DE CASO

Odontoma is a benign calcifying odontogenic tumor of unknown etiology, although local trauma, genetic factors, and chronic inflammation may be related. They are classified into compound and complex types, depending on the morphological, radiographic and histological characteristics. Clinically they hardly show signs or symptoms, and, when present, are related to delayed tooth eruption, cortical bone expansion and tooth displacement. Although radiographic exams are complementary, most cases of odontomas reported in the literature are found on routine radiographs. The diagnostic hypothesis is confirmed by histopathological examination that shows evidence of the presence of enamel, dentin, cementum and pulp tissue arranged in the form of denticles (compound) or a disorganized mass (complex). The treatment consists of surgical excision of the lesion. The aim of this article was to report a clinical case and histopathological analysis of a complex odontoma associated with an unerupted tooth, located on the left side in the posterior region of the maxilla, discovered by routine radiographic examination of a 57-year-old male patient. The treatment was surgical excision of the lesion, removal of the unerupted tooth and histopathological examination, which confirmed the diagnosis of complex odontoma. The case was followed-up clinically and radiographically for one year and showed no recurrence.

Overdentures Supported by Mini or Conventional Implants-effect on Patient Satisfaction and Bone Resorption Rates. A Randomized Clinical Trial

AIM: The aim of the study was to assess the difference between patient satisfaction and bone height changes of mini-implant supported overdentures in comparison with conventional implant after bone expansion technique. METHODS: This randomized clinical trial contains 36 edentulous participants with thin mandibular ridges randomly divided to receive 2 mini-implants, or 2 conventional implants after ridge splitting, both treatments were done in the inter-forminal area of the anterior mandible. Then, the patients received mandibular overdentures with ball and socket attachments. At base line, after 6 and 12 months of loading the implants, patients’ satisfaction was evaluated using visual analog scale, in addition to bone height changes using Soredex DIGORA Optime Classic software. RESULTS: There was statistically significant difference in the overall satisfaction between the mini-implants and the conventional implants group; the amount of bone height changes in the mini-implant group was statistically significant less than the conventional implant group at base line, 6 and 12 months. CONCLUSION: Treatment with two mini-implants provides high level of satisfaction and less bone height changes in a follow-up period of 12 months in comparison to conventional implants after ridge expansion.

Massive Dentigerous Cyst within the Anterior Part of The Mandible: A Case Report

Dentigerous cysts are the most common developmental odontogenic jaw cysts, associated with crowns of an Unerupted tooth. Usually, they occur in the second and third decade of life with a male predilection. They are frequently asymptomatic and mostly discovered incidentally on routine dental radiographic examination. Its growth is slow, and can reach a considerable size causing bone expansion and displacement of teeth. Mandibular lower third molars are the most frequently effected teeth; dentigerous cysts involving impacted mandibular canines are rarely reported. Surgical enucleation with extraction of the associated tooth is the standard treatment for dentigerous cyst, marsupialization is recommended for large lesions. We report a rare case of a large dentigerous cyst in a 62-year-old male patient, associated with impacted left mandibular canine, extending from the retro-molar area of left side crossing the midline to the 2nd premolar in the other side, that was successfully treated by marsupialization followed by enucleation and removal of the impacted tooth.

Bone remodeling around implants placed after socket preservation: a 10-year retrospective radiological study

Background To evaluate and compare the long-term clinical and radiological outcomes of post-extraction sockets after ridge preservation either with porcine xenograft or collagen alone. Patients underwent single-tooth extraction in the posterior mandible. Fresh extraction sockets were filled with pre-hydrated cortico-cancellous porcine bone or collagen sponge. Two or 3 months later, a ridge expansion technique with immediate implant positioning placement was performed. Primary (alveolar width changes) and secondary outcomes (adverse events and long-term maintenance of buccal plate covering the implant) were evaluated. Results Thirty-four women and 20 men were selected: 30 implants (group A) placed into healed post-extraction sockets grafted with porcine bone and 24 (group B) into sockets filled with a collagen sponge. There was a significant loss in width in both groups from the first and second surgery (ranging between 2.7 mm and 4.5 mm). The ridge splitting with bone expansion resulted in significant long-term increases in width for both procedures and implant sites. Non-significant differences in alveolar width were registered between the groups at 10-year follow-up even if the analysis of the implant buccal bone coverage suggested that group A had significantly worst results. Conclusions Porcine bone group had significantly better short-term outcomes with lower long-term maintenance of the buccal plate.

Central Odontogenic Myxoma: A Radiographic Analysis

Objective. This study aimed to determine the radiographic characteristics of odontogenic myxomas (OMs) and their associations. Materials and Methods. The study enrolled radiographs of patients taken between 2005 and 2019 with a confirmed histopathological diagnosis of central OM. OM radiographic features were evaluated, including location, border, locularity, involved area, the number of included teeth, root resorption, tooth displacement, bone expansion, bone perforation, and periosteal reaction. Fisher’s exact test was used for statistical analysis. Results. Significant associations were found between the OM border and the affected jaw ( p = 0.036 ), locularity ( p = 0.036 ), involved areas ( p = 0.009 ), and bone perforation ( p = 0.036 ). OMs with an ill-defined border were associated with maxillary lesions, multilocularity, dentate areas, and cortical bone perforation. The number of included teeth (2 or fewer or 3 or more) was significantly associated with locularity ( p = 0.010 ), involved area ( p = 0.045 ), and bone expansion ( p = 0.010 ). Larger OMs including 3 or more teeth, were associated with a multilocular appearance, dentate areas, and bone expansion. Conclusion. The border of OM and the number of included teeth are related to other radiographic appearances. Understanding these relationships could help in treatment decisions and help better understand the nature of OM.

The retrieval of a surgical blade broken within the alveolar bone during minimally traumatic tooth extraction

Minimally traumatic tooth removal is the norm for removing teeth when a dental implant is planned at that site. The quantity of available bone is the primary requisite to place an implant. The initial use of a scalpel blade to widen the periodontal space followed by the use of luxators is one of the techniques that is being followed for atraumatic extraction. A case of accidental breakage of a number 11 scalpel blade while attempting tooth removal and the method adopted in removing this portion of the blade without further bone destruction is reported here. The authors have not found any previously published cases, reporting the breakage of a scalpel blade during the bone expansion procedure and its management.

Complete unilateral vision loss and optic nerve cupping from metastatic prostate cancer to the optic canal

A 71-year-old man, living with metastatic castrate-resistant prostate cancer to the lymph nodes, spine and skull, presented with acute on chronic left eye vision loss. Examination revealed no-light-perception vision, a relative afferent pupillary defect and optic disc cupping. MRI brain revealed optic canal narrowing from metastatic sphenoid bone expansion and extraosseous tumour compressing the intracanalicular optic nerve. The optic disc cupping and excavation without significant pallor of the remaining neuroretinal rim was likely secondary to chronic compression of the optic nerve. The patient was treated with radiation therapy, but did not regain vision and was referred to palliative care as his condition continued to worsen. As patients live longer with advanced cancer, there is a greater risk of metastasis to atypical areas of the body including the optic nerve. This case demonstrates the unique combination of optic disc cupping from optic canal metastasis due to prostate cancer.

Navigated Antral Bone Expansion (NABE): a prospective study on 35 patients with 4 months of follow-up post implant loading

Background The insertion of dental implants in the atrophic posterior maxilla can be a challenge. One option is to modify the residual native bone in preparation for proper, prosthetically-driven implant placement. The procedure presented in this study is called Navigated Antral Bone Expansion (N.A.B.E). This procedure employs the use of a navigation system to plan and guide the initial pilot drilling, bone expansion, final site preparation, and implant insertion. The aim of this study was to compare the distance between the alveolar ridge and the sinus floor measured before and after the surgery performed using the N.A.B.E. technique. Methods Thirty-seven partially edentulous patients who were candidates for implant supported restoration in the posterior maxilla, with a bone height ranging from 4 to 7 mm were enrolled. The N.A.B.E procedure was used to increase the bone height. Paired-samples t-test evaluated the distance between the alveolar ridge and the sinus floor measured before and after surgery. The occurrence of post-surgical complications, and the angular deviation between the planned osteotomy and the actual placed implant trajectories were evaluated. Results Out of the 37 consecutive patients enrolled in the study, 35 were considered in the data analyses. Patients’ bone height after surgery compared to the bone height before surgery showed a statistically significant increase (p < .0005) of 3.96 mm (95% CI, 3.62 mm to 4.30 mm). No post-operative complications were observed in the 35 patients. The mean angular deviation between the planned osteotomy trajectory and the placed implant trajectory ranged between 12.700 to 34.900 (mean 25.170 ± 5.100). Conclusions This study provides evidence that N.A.B.E. technique is able to provide a significant bone increase, and could be considered an alternative method to the management of the atrophic posterior maxilla with a minimally invasive approach.

Hybrid Lesion of Ameloblastoma and Adenomatoid Odontogenic Tumour (AOT): Report of Two Cases from a Tertiary Referral Hospital in Sub-Saharan Africa

Introduction: Hybrid lesions are lesions showing the combined histopathological characteristics of two or more previously recognized odontogenic tumours and /cysts of different categories. Hybrid lesions do exist because of close interrelationship of several odontogenic lesions and also because odontogenic tumors and cysts can arise at any stage of odontogenesis. The objective of this study was to present 2 cases of hybrid odontogenic tumour that is composed of adenomatoid odontogenic tumour (AOT) and ameloblastoma. Case Reports: Case 1: A 33year old female patient with a bucco-lingual swelling in the left mandibular premolar-molar-ramus regions of 13years duration. The lesion measured about 15x5x3cm, it is non tender. Surgical specimen revealed hybrid lesion of granular cell type ameloblastoma and AOT. Case 2: An 18year old female patient with a painless right mandibular molar-ramus swelling of 10years duration. Mandibulectomy specimen measured about 11 cm x 8.5 cm x 5 cm and was found to be hybrid lesion of acanthomatous ameloblastoma and AOT. Conclusion: Both cases had a very long clinical duration and showed more buccal bone expansion with barely noticeable lingual bone expansion. With such clinical scenarios, a suspicion of hybrid tumour should be made.