Adenoid Ameloblastoma in the Posterior Maxillary Region: A Case Report

Adenoid ameloblastoma is a hybrid odontogenic tumour showing histopathological features of both ameloblastoma and adenomatoid odontogenic tumour (AOT), with approximately 40 cases reported in the literature. The aims of the report are to illustrate the diagnostic challenges of adenoid ameloblastoma using three new cases and to analyze evidence in literature to consider adenoid ameloblastoma as a new sub type of ameloblastoma. A literature review was performed with the key words-adenoid ameloblastoma, hybrid/composite odontogenic tumours, hybrid ameloblastoma and adenomatoid odontogenic tumour, ameloblastoma with inductive changes, dentinoid and dentinoma to select the cases compatible with the diagnosis of adenoid ameloblastoma. Out of the 40 cases reported in literature, 31 cases with sufficient information and 3 new cases were analyzed. Out of the 34 adenoid ameloblastomas majority of tumours (76.5%) occurred in adults with age ranging from 25 to 55years. Slight female predilection with a male:female ratio of 0.9:1 was observed. Approximately, 64.7% occurred in the mandible. Radiologically, 82.4% of adenoid ameloblastomas presented as radiolucent lesions while 47.1% occurred with ill-defined margins and cortical perforation at diagnosis. Histopathologically, 70.8% of tumours presented as plexiform ameloblastomas, while duct like structures/glandular structures were the commonest feature supportive of adenomatoid odontogenic tumour observed in overwhelming majority of 95.9% of adenoid ameloblastomas. 91.6% of tumours showed inductive change in the form of dentinoid. Further, 45.4% of the tumours developed at least one recurrence following surgical excision. The report presents literature review based evidence to show the existence of adenoid ameloblastoma, which is demographically similar to conventional ameloblastoma but with histopathological differences and presenting with higher rate/multiple recurrences, indicating its biological aggressiveness. Thus, we would like to propose the inclusion of adenoid ameloblastoma as a sub type of ameloblastoma in the next revision of the WHO odontogenic tumour classification.

Adenoid ameloblastoma (AdAM) is a frequently recurrent tumor that shows hybrid histological features of both ameloblastoma and adenomatoid odontogenic tumor (AOT). AdAM is expected to be classified as a new subtype of ameloblastoma in the next revision of the World Health Organization (WHO) odontogenic tumor classification. However, whether AdAM is a histologic variant of ameloblastoma or AOT remains unclear. To establish a new category, genetic evidence indicating the tumor category is necessary. We present a case of a 23-year-old Japanese woman with AdAM who underwent genetic/DNA analysis for ameloblastoma-related mutation using immunohistochemical staining, Sanger sequencing, and next-generation sequencing (NGS) analyses with reliable clinicopathological evidence. Immunohistochemical expression of BRAF p.V600E was diffusely positive for both ameloblastoma- and AOT-like components. Sanger sequencing and NGS analyses showed missense mutations in BRAF p.V600E (c.1799T > A), a gene that is commonly altered in ameloblastomas but not in KRAS, another gene associated with AOT. This case report is the first to provide genetic evidence on the ameloblastomatous origin of AdAM with a BRAF p.V600E mutation. A larger series of AdAM groups' molecular testing is needed to aptly classify them and prognosticate the best treatment.

Dental implant primary stability in different regions of the Jawbone: CBCT-based 3D finite element analysis

Adenoid ameloblastoma (AA) was recently recognised as a separate tumour type in the most recent World Health Organisation (WHO) classification of head and neck tumours. This decision has been considered controversial by several groups, who have described AA as a subtype of ameloblastoma, a hybrid odontogenic tumour or to fall within the spectrum of other recognised odontogenic tumours, including dentinogenic ghost cell tumour and adenomatoid odontogenic tumour. Here we review the reasons for the WHO decision to classify AA as a separate tumour type. We also critique molecular and histological findings from recent reports published since the WHO classification. While acknowledging that the classification of tumours is constantly evolving, the balance of current evidence suggests that AA should remain a distinct tumour type, and not a subtype of ameloblastoma, pending further molecular characterisation.

Clinical study of immediate implant placement in posterior maxillary region assisted by dynamic real-time navigation: A randomized controlled trial

Background. The maxilla and mandible are two distinct anatomical structures that differ significantly in terms of functional loading, embryological development, and cortical-cancellous bone ratios In clinical practice, infiltrative anesthesia is often sufficient for the maxilla and anterior mandible, but regional anesthesia is frequently required for the posterior mandible. Study aims to provide objective and reproducible data to support the indirect clinical observations of bone structural differences in local anesthesia applications and surgical planning via fractal analysis. Methods. In panoramic radiographs, a total of 8 regions of interest were selected from the right and left apical regions, including 2 anterior maxillae, 2 posterior maxillae, 2 anterior mandibles, and 2 posterior mandibles. These were evaluated for fractal dimension using the box counting method with ImageJ software. Results. When evaluated according to these four regions, the fractal dimension ranking was highest in the mandibular posterior region and lowest in the maxillary anterior region. Notably, the maxillary posterior region has a lower mean value for trabecular organization compared to the mandibular anterior region. According to the Tukey post hoc test, there is no statistically significant difference between the maxillary anterior and posterior regions. However, the differences between all other regions are statistically significant. In all regions of interest fractal values of male individuals were higher than females. Conclusion. This study demonstrated that differences in sex related and regional trabecular organization between the maxilla and mandible, as well as within the same jaw, can be revealed quantitatively using fractal analysis applied to apical regions of interest obtained from panoramic radiographs, in a low radiation imaging technique and open access software in terms of maximum accessability.

ObjectiveThis study aims to determine the anatomical relationship between the posterior superior alveolar artery (PSAA) and the lateral wall of the maxillary sinus during preoperative radiological evaluations in the posterior maxillary dental region, as well as to evaluate the prevalence of PSAA and its potential associations with sinus pathologies.Materials and methodsThis retrospective study is based on the analysis of Cone-Beam Computed Tomography (CBCT) data from 510 sinuses of 255 patients. The visibility of the PSAA vascular canal, artery diameters, vertical distance between the alveolar crest and the artery, and the distance to the sinus floor were measured in coronal sections. Additionally, the relationships between sinus pathologies and septa within the sinuses and the PSAA were evaluated.ResultsPSAA was detected bilaterally in the majority of patients (70.2%). Sinus pathologies and the presence of septa were also examined, revealing that 36.9% of the sinus pathologies were bilateral. Chi-square analyses showed no statistically significant relationship between gender and the presence of PSAA. Female patients had a higher incidence of sinus pathologies compared to males (p = 0.002). No significant relationship was found between the presence of PSAA and septa.ConclusionsThis study highlights the importance of considering the anatomical position and prevalence of the PSAA during preoperative radiological evaluations in the posterior maxillary region. This study identified the PSAA as predominantly located in the lateral wall of the maxillary sinus, an anatomical feature of critical importance during preoperative radiological evaluations to minimize vascular complications.Clinical trial numberNot applicable.

This study aimed to investigate the effects of cigarette smoking on periodontal conditions in specific tooth regions of older Thai men. There were 272 current smokers, 714 former smokers, and 477 non-smokers enrolled in the present study. Differences between groups in the mean probing depth or attachment loss were compared using ancova. The relationship between smoking exposure or cessation duration and periodontal conditions was examined using linear trend analysis. Smokers had deeper pockets and attachment loss than non-smokers. The greatest differences between smokers and non-smokers were observed in the maxillary posterior palatal region, where current smokers had 0.88 mm greater attachment loss than non-smokers, compared to 0.36-0.60 mm observed in other tooth regions. Among the current smokers, there was a trend towards an increase in attachment loss with increasing smoking exposure in the maxillary posterior regions. However, it was not statistically significant. Among the former smokers, a better periodontal condition was observed, depending on the length of time since smoking cessation; this was most pronounced in the maxillary posterior palatal region. The palatal site of maxillary posterior teeth was the area most affected by cigarette smoke. The results suggest a possible local effect of smoking in addition to its systemic effects.

To summarize and evaluate the clinical effectiveness of the pedicled buccal fat pad combined with a mucoperiosteal composite flap in preventing and closing oroantral fistula. This study included a total of 12 patients who underwent closure of surgical incisions following treatment of posterior maxillary lesions using a pedicled buccal fat pad combined with a mucoperiosteal composite flap. In all cases, the pedicled buccal fat pad was placed beneath the local mucoperiosteum to form a composite flap for incision closure. The retrospective analysis encompassed patients' baseline data, including age, gender, diagnosis, clinical symptoms, imaging characteristics, surgical procedures, and treatment outcomes. Additionally, the analysis included an evaluation of the local functional outcomes in the operative area. Among the 12 patients, there was an equal distribution of males and females (1∶1 ratio), with an average age of (35.83±20.17) years. Among them, 8 cases had cystic lesions in the maxillary posterior region, 3 cases had oroantral fistula, and 1 case had maxillary comminuted fracture. All patients (100%) underwent surgery involving the maxillary posterior dental region adjacent to the maxillary sinus. Preoperative symptoms included swelling, pain, halitosis, and occlusal disorder. CT imaging revealed that bone destruction in the posterior maxilla frequently affected multiple teeth, often with impacted teeth, and showed a close association with the maxillary sinus. Buccal bone resorption or destruction was the predominant feature in the operative area, and after removal of the diseased teeth, limited buccal bone remained. Wound closure was achieved using a buccal fat pad/mucoperiosteal composite flap technique. During the follow-up period, all 12 patients healed successfully, with no occurrences of oral-nasal fistula. Additionally, no significant changes in buccal morphology or vestibular groove were observed. The use of a pedicled buccal fat pad combined with a mucoperiosteal composite flap is effective in sealing and preventing oroantral fistula, improving clinical symptoms in cases involving oroantral fistula and maxillary posterior bone resorption during surgery.

The purpose of this report is to provide a brief literature review of the bone-added osteotome sinus floor elevation (BAOSFE) procedure and to present a case utilizing this technique. Implant placement in the posterior maxillary region is often compromised due to anatomic limitations. In clinical situations where there is inadequate vertical bone dimension, the BAOSFE technique can be employed to increase bone height and allow placement of implants with an appropriate length dimension. A case of a 60-year-old female with inadequate vertical bone dimension in the area of an extracted #13 is presented. The BAOSFE technique was performed which facilitated the placement of a 3.75 X 13 mm implant. Anatomic limitations such as inadequate vertical bone dimension in the posterior maxillary region may result in placement of shorter implants. Sinus floor elevation (SFE) procedures using a crestal approach such as the BAOSFE, in certain selected cases, can effectively and predictably increase bone height. The BAOSFE technique is an excellent procedure that can overcome limitations associated with the posterior maxillary region.

Currently, a new non-subtractive drilling technique, called osseodensification (OD), has been developed. It involves using specially designed drills with large negative cutting angles that rotate counterclockwise, causing expansion through plastic bone deformation, thus compacting the autologous bone to the osteotomy walls, which improves the primary stability of the implant.The present systematic review aimed to determine whether the OD technique can increase the primary stability of dental implants in the posterior maxilla region as compared to the conventional drilling (CD) technique.Five databases were searched up to June 30, 2022. The inclusion criteria embraced observational clinical studies, randomized and non-randomized controlled trials, human studies in vivo, comparing OD and CD, with the measurement of the primary stability of implants in the posterior maxilla region by means of the implant stability quotient (ISQ). The tools used to assess the risk of bias were RoB 2 and the NewcastleOttawa Scale (NOS).Seven articles met the inclusion criteria, with 4 classified as having a low risk of bias and 3 with a moderate risk of bias. The OD technique consistently demonstrated an average ISQ value of 73 KHz across all studies, whereas CD yielded an average value of 58.49 kHz (p < 0.001 for 5 articles).It can be concluded that in comparison with CD, OD improves primary stability at baseline in low-density bone, such as the maxilla.

Periodontitis is an infectious inflammatory disease that is caused by the bacteria of dental plaque resulting in the progressive destruction of the tissue supporting the teeth, that is gingival, periodontal ligament, cementum and the alveolar bone. The progression of the disease is accelerated by tobacco consumption. The aim of this study is to find the pattern of tooth mobility in smokers and non smokers. This retrospective study was conducted in a Private dental college, chennai. The sample size was 100, with 50 smokers and 50 non smokers. The data was collected from the hospital digital database. It was observed that tooth mobility in smokers was prevalent in the posterior region (16%) (p&lt;0.05) and in the maxilla and both the jaws (11% &amp; 23% respectively). Tooth mobility in smokers was commonly seen in the posterior region of maxilla (10%) and anterior region of mandible (20%) for which the P value was found to be statistically significant (&lt;0.05). For non-smokers, there was an increased tooth mobility observed in the anterior region of the mandible (34%) for which the P value was found to be statistically significant (&lt;0.05). Within the limits of the study, it can be concluded that smoking causes increased periodontal destruction to the surrounding tissues, with tooth mobility and loss commonly observed in the posterior regions of maxilla and posterior region in both the jaws. Thus, Progression of disease can be prevented by early diagnosis and by tobacco cessation programmes.

Dentinogenic ghost cell tumor revisited from a single institution in China with focus on adenoid ameloblastoma-like features

Unicystic ameloblastoma: a case of mistaken identity

Endodontic procedural errors: Analysis of images from cone beam computed tomography