Structural Features of the Mental Foramen in a Saudi Subpopulation: A Retrospective CBCT Study

Introduction. Accurate and precise knowledge about the position, size, and shape of the mental foramen (MF) are critical in avoiding procedural complications. The MF’s anatomical features vary among different ethnic groups, and various radiographic techniques have been used to determine these variations. Aims. To evaluate the MF’s shape, vertical and horizontal positions, and distance from the border of the mandible. To evaluate the differences among genders as they pertain to the right and left sides of the mandible and research the bilateral symmetry regarding the same variables. Materials and Methods. Cone beam computer tomography (CBCT) scans of 155 Saudi patients (69 males and 86 females) who visited the college of dentistry’s clinics were obtained from the college database for this retrospective study. All the scans were analyzed by 3 calibrated examiners. The data collected was analyzed statistically, and results were obtained. Results. The MF was located under the mandibular second premolar in 56.9% of cases, whereas in 26.9% of cases, it was located between the first and second mandibular premolar. The most prevalent position was below the level of the apices of the mandibular premolar teeth (87.2%). The round shape was most frequent (44.9%) compared to the H-oval (34.7%) and V-oval (20.4%). The V-oval shape was more frequent in males, while the H-oval shape was more frequent in females. The average distance from the center of the MF to the mandibular border was 14.03 ± 1.58 mm , with males exhibiting a greater distance than females. Overall, there were no significant differences between the bilateral symmetry and the right and left sides for all parameters. Conclusion. The most common position of the MF was under the root apex of the mandibular second premolar, with an average distance of about 14 mm from the border of the mandible. The position and shape of the MF were the same bilaterally in the majority of individuals.

The enlargement of the maxillary ostium after balloon sinuplasty evaluated by a novel measuring technique from 3D CBCT images

Our aim was to evaluate the effects of balloon sinuplasty on the size of the ostium in the maxillary sinuses in patients with chronic rhinosinusitis from cone beam computer tomography (CBCT) scans of the sinus. This is a blinded retrospective trial in patients who had undergone balloon sinuplasty of the maxillary sinus. CBCT scans were taken and SNOT-22 Quality of Life questionnaire completed before and 12 months after the operation. The size of the maxillary ostium was measured from the CBCT scans three-dimensionally. The association of changes in the SNOT-22 scores of the ostium was analysed. We discovered that the balloon sinuplasty increased the size of the maxillary ostium in all dimensions. The changes were statistically significant (p<0.05) in the axial diameter and the ostium area. The number of patent ostia increased after the intervention. The association between SNOT-22 score and ostium patency were statistically significant before the operation. Our conclusion is that the threedimensional measuring technique provides a reliable method to evaluate ostium dimensions. Balloon sinuplasty increased the size of the maxillary ostium and the result was maintained for 12 months after the operation.

EVALUATION OF EFFICACY OF DEMINERALIZED FREEZE DRIED BONE ALLOGRAFT WITH AND WITHOUT PLATELET-RICH FIBRIN IN THE TREATMENT OF INTRABONY DEFECTS BY CONE BEAM COMPUTED TOMOGRAPHY: A CLINICAL AND RADIOGRAPHIC STUDY

Background: Eventhough the combination of DFDBA (demineralized freeze dried bone allograft) with PRF (platelet-rich fibrin) has been attempted in periodontal practice with significant results, assessment of the intrabony defect and defect bone fill largely done with two-dimensional imaging modalities. Three dimentional analysis of the intrabony defect and defect bone fill has not been attempted with cone beam computer tomography (CBCT). The present study evaluated the efficacy of DFDBA with and without PRF in the treatment ofintrabony defects by CBCT. Methods: 60 defects in systemically healthy patients ranging from 18 to 50 years of age will be included in the study.30 defects were treated with PRF+DFDBA and 30 defects were treated with DFDBA alone. The study will include the assessment of clinical parameters involving probing depth (PD), relative attachment level(RAL), full mouth bleeding scores(FMBS),plaque index and gingival index from baseline to 3 , 6, 9 months. Hard tissue changes will be assessed radiographically by evaluating defect fill and defect resolution by CBCT at baseline& 9 months. Results: The results of the present study are statistically significant in both groups in terms of clinical and radiographical parameters (P < 0.001). In inter-group comparison, there was a statistically significant greater PD reduction and attachment gain while there was not significant reduction in terms of PI, GI, FMBS, defect fill and defect resolution in DFDBA+ PRF group. Conclusion: DFDBA along with PRF failed to provide additional value in terms of defect fill and defect resolution over DFDBA alone.

Development of Custom Anatomic Healing Abutment Based on Cone-Beam Computer Tomography Measurement on Human Teeth Cross-Section

Introduction: Nowadays, the final success of implantation is not only based on obtaining osseointegration of the implant but is also determined by achieving a satisfactory aesthetic effect of the soft tissues surrounding the implant, which can be defined as an aesthetic integration. The process of obtaining this aesthetic integration already begins at the stage of placing the healing abutment, which allows us to obtain the emergence profile necessary for our prosthetic reconstruction. Materials and Methods: The study used cone-beam computer tomography (CBCT) scans of 51 patients. The measurements of the maxillary teeth (central incisor, lateral incisor, canine, first premolar, and first molar) were performed from cross-sections of the individual teeth at the transition zone to design a custom anatomic healing abutment milled from zirconium and luted to the non-index Ti-base. Results: The obtained results allowed to design and create the shape of the anatomic healing abutment. Conclusions: The use of laboratory-produced anatomical healing abutments is possible and may allow to obtain the desired and planned emergence profiles of prosthetic restorations. In addition, it might be a method of reducing work time at the dental chair but further clinical trials are necessary.

Evaluation of Retromolar Canals using Cone Beam Computer Tomography/ Avaliação do canal retromolar por meio de tomografia computadorizada de feixe cônico

The aim of this study was to evaluate the prevalence, location and clinical implications related to the presence of the retromolar canal (RMC) on cone beam computed tomography(CBCT). CBCT images of patients from Latin America Institute for Dental Research and Education - Curitiba,Pr,Brazil, was performed from June/2008 to February/2013. The interpretation was performed by a calibrated examiner, according to the criterias: presence, location and classification of the RMC variation, as well as, measurements of horizontal distances of the RMC in relation to the buccal bone cortical and diameter of these canals. A total of 751 CBCT images were interpreted: 486(64.7%) from females and 265 (35.3%) from male patients, with mean age of 54.57 (±13.23) years. The presence of RMC was observed in 58 (7.7%) patients, 23 men and 35 women. A total of 1502 hemi- mandibles were analyzed. The RMC was identified in 69(4.6%) hemi-mandibles, 44(63.8%) from females and 25(36.2%) from males. Thirty (42.8%) RMC were observed on the right side and 40 (57.2%) on the left one. The type B1 (n=33; 47.1%) was the most common, followed by the type A1 (n=18;25.7%). The mean diameter of RMC was 0.97mm (±0.44), and the mean distance between retromolar foramen and the buccal cortical of the mandible was 4.12mm (±1.35). There were no significant differences between the distances and genders, and distances and sides (p 0.05). The prevalence of RMC was 7.7% in the studied sample; they were predominantly unilateral and showed to be type B1.

Cone Beam Computer Tomography and Histological Evaluation of Dental Follicle of Impacted Lower Third Molar Germs in Teens: A Histo-Radiographic Correlation Study in a Case Series

The dental follicle (DF) is the tissue that surrounds the crown of the developing tooth. In X-ray, images it appears as a radiolucent area. The removal of an impacted mandibular third molar is a common procedure in oral surgery. The radiographic evidence of pathology, commonly defined as a pericoronal radiolucency measuring at least mm 2.5 mm in any dimension, is accepted for the extraction of impacted mandibular third molars. Mesioangular impactions are usually more closely placed to the inferior alveolar canal, and the use of cone beam computer tomography (CBCT) before the removal of impacted mandibular third molars has been reported to be appropriate in these cases. The aim of this study was to evaluate the microscopic features of radiographically normal DFs associated with mesioangular impacted mandibular third molars examined through CBCT. Thirteen mesioangular impacted third molars from ten patients (5 males and 5 females, mean age ± SD: 15.1 ± 1.66) with a maximum width of the DF <2.5 mm, as digitally established by CBCT, were included in this study. All the DFs associated with the removed third molars were examined histologically through the analysis of different variables. The mean (±SD) and range of the maximum width of the DFs were 1.35 (±0.47) mm and 0.71–2.21 mm, respectively. Nine (69.23%) DFs showed odontogenic remnants, five (38.46%) showed focal squamous metaplasia and eight (61.53%) mild mesenchymal myxoid degeneration. The maximum width of the DF failed to show any significant correlation with all the histological variables considered in this study. Aware of the limited number of patients included in this study, the histo-radiographic correlation in our case series confirm data in the literature, according to which normal pericoronal imaging may be associated with DF tissue changes/variations that in turn are potentially associated with the development of pathologies including odontogenic cysts and tumors. Whether these changes/variations are enough to make prophylactic germectomy of impacted third molars the standard by themselves remains to be established. However, they require accurate correlations with the radiographic data for the appropriate histologic assessment of a DF.

Effect of Antibacterial Root Canal Sealer on Persistent Apical Periodontitis

The infection of Enterococcus faecalis and its interacting microorganisms in the root canal could cause persistent apical periodontitis (AP). Antibacterial root canal sealer has favorable prospects to inhibit biofilms. The purpose of this study was to investigated the antibacterial effect of root canal sealer containing dimethylaminododecyl methacrylate (DMADDM) on persistent AP in beagle dogs for the first time. Persistent AP was established by a two-step infection with Enterococcus faecalis and multi-bacteria (Enterococcus faecalis, Lactobacillus acidophilus, Actinomycesnaeslundii, Streptococcus gordonii). Root canal sealer containing DMADDM (0%, 1.25%, 2.5%) was used to complete root canal filling. The volume of lesions and inflammatory grade in the apical area were evaluated by cone beam computer tomography (CBCT) and hematoxylin-eosin staining. Both Enterococcus-faecalis- and multi-bacteria-induced persistent AP caused severe apical destruction, and there were no significant differences in pathogenicity between them. DMADDM-modified sealer significantly reduced the volume of periapical lesion and inflammatory grade compared with the control group, among them, the therapeutic effect of the 2.5% group was better than the 1.25% group. In addition, E.faecalis-induced reinfection was more sensitive to the 2.5% group than multi-bacteria reinfection. This study shows that root canal sealer containing DMADDM had a remarkable therapeutic effect on persistent AP, especially on E. faecalis-induced reinfection.

Uncovering and Autonomous Eruption of Palatally Impacted Canines—A Case Report

The impaction of permanent maxillary canine is a common clinical occurrence, and it is observed in 2% of patients who require orthodontic treatment. This case report describes a new orthodontic-surgical approach through the use of CO2 laser, for the exposure of the palatally impacted canines. A 13-year-old female referred to our observation to make an orthodontic examination because of the maxillary primary canines’ persistence in upper arch. Orthopanoramic X-ray showed impaction of both permanent maxillary canines. The family history revealed that the patient’s mother had the same orthodontic problem. Cone Beam Computer Tomography (CBCT) was requested to plan the surgical-orthodontic treatment. Surgical exposure of the impacted canines was performed using a CO2 laser and subsequent periodontal pack application. No orthodontic devices were applied for impacted teeth traction on dental arch. Canines’ movement was monitored at 1, 8 and 16 weeks post-surgery with photo and intraoral scanner CS3500 (CS3500®, Carestream Health, Atlanta, GA, USA). When canine crowns were completely erupted on palatal side, the alignment in the arch with indirect bonding technique was performed. Complete disimpaction of canine crowns was obtained in only four months. As reported in the literature, this case confirms that impacted canines’ exposure to CO2 laser has advantages if compared with traditional surgery: no bleeding during and after the procedure, decontaminant effect on the surgical area, no suture, and a fast spontaneous eruption. Conclusions: The pre-orthodontic uncovering and autonomous eruption of palatally impacted maxillary canines provides simplified, predictable, and more aesthetic outcomes. Furthermore, a significant positive factor is that there is no need to carry out the orthodontic traction of the impacted element, undoubtedly better compliance by the patient during the next alignment phase with the fix orthodontic appliance.