Alveolar Canal Research Articles

Stafne's idiopathic bone cavity: characteristics and imagenological considerations. A review

In 1942, Dr. Edward Stafne presented 35 cases of asymptomatic, clearly defined, round or ovoid radiolucencies occurring near the angle of the mandible, with a greater incidence below the lower dental canal, between the mandibular angle and the roots of the first lower molar, which he referred to as a bone defect. This bone defect later became known by other names.Clinically, Stafne's idiopathic bone cavity (SIBC) is asymptomatic, is usually not palpated intraorally and has no present extraoral signs. Thus, in most cases it is an accidental radiological finding, which appears as a delimited, elliptical or rounded radiolucent image, with a diameter ranging from 1 to 3 cm, and delimited by osteocondensation in the anteroinferior limits. According to the location of the findings, they are classified as; anterior, posterior and branch.This entity should be considered as a variant of normality requiring differential diagnosis to achieve an accurate diagnosis. The present review provides information on the history, and general and radiographic characteristics of SIBC to facilitate diagnosis when presented with this type of findings.

Evaluation of the Ability of Barberry Liquid Extract to Prevent the Formation of Microbial Biofilm by Enterococcus Faecalis: An In Vitro Study

Introduction: Enterococcus faecalis (E. faecalis) is one of the microbes of the normal flora of the oral cavity, which is one of the common factors in the failure of root canal treatment. This in vitro study aimed to evaluate the ability of barberry extract to prevent the formation of microbial biofilm by E. faecalis. Materials and Methods: Initially, E. faecalis was cultured simultaneously with barberry bark and root extract, and biofilm formation was evaluated after 48 h. In the second stage of the active culture of the bacteria (48 h), all root and bark concentrations had similar growth inhibition with the control group. The same results were observed after two weeks. Fluorescence staining with SYPRO® Ruby (Invitrogen, USA, 2010) was used to confirm the formation of biofilm. Subsequently, all samples were examined by fluorescence microscope, and the results were reported using Relative Fluorescence Unit. Results: In the simultaneous cultivation of barberry and E. faecalis, root (30%), growth medium (50%), and bark (30%) had similar growth inhibition with the control group. After adding barberry bark and root extract (48 h), all concentrations of barberry bark and root showed similar growth inhibition with the control group. After two weeks of E. faecalis culture, the results were the same as those of the first group. However, wide and thick biofilms were formed in the samples without treatment and those treated with normal saline. Conclusion: Due to the positive effects of barberry bark and root extract, it can be used to sterilize dental canals and can be considered a suitable alternative to hypochlorite.

Neurosensory Deficits of Inferior Alveolar Nerve Following Impacted Mandibular Third Molar Extraction: Comparison of One-Stage Complete Extraction with Two-Stage Partial Coronectomy Surgical Technique.

Inferior alveolar nerve neurosensory deficit is a worrisome complication of surgical extraction of impacted mandibular third molars. A novel approach using two-stage partial coronectomy has been proposed as an alternative surgical procedure to reduce this complication. This study compared neurosensory deficits of inferior alveolar nerve following impacted mandibular third molar extraction using one-stage complete extraction with the two-stage partial coronectomy technique. Subjects with mesioangular or horizontal impacted mandibular third molar with an intimate relationship with inferior dental canal who met the inclusion criteria were recruited for the study. Subjects were divided into one-stage and two-stage partial coronectomy techniques. The subjects were evaluated for the presence of inferior alveolar neurosensory deficit, and the relationships of neurosensory nerve deficit with sex, age and type of impaction. Neurosensory deficit was observed in 5 subjects (7.8%), with all cases seen in the one-stage group. This difference was statistically significant (p = 0.03). The relationship between the incidence of neurosensory deficit and age, sex, type of impaction, surgical difficulty, operating time and root morphology was not statistically significant (p > 0.05). Findings from this study suggest partial coronectomy compared to one-stage complete extraction reduces the incidence of Inferior alveolar nerve neurosensory deficit.

ASSESSMENT OF MANDIBULAR 3RD MOLAR APICES TO THE INFERIOR DENTAL CANAL USING CONVENTIONAL RADIOGRAPHY AND CBCT

Conventional radiographs provide only a 2 dimensional view of complicated three dimensional structures. The proximity, angulations, location of impacted teeth, related to the IAN can be adequately determined using conventional 2-D periodical and panoramic radiographs. Computed tomography necessitates the administration of a high dose radiation, especially when the slice width is shortened to increased cost are the negative aspects of computed tomography compared with conventional imaging.
 Cone beam computed tomographies are becoming more readily available for use in maxilla facial applications. CBCT provides better image quality of teeth and their surrounding structures, compared with conventional CT and offers high spatial resolution. CBCT seems to be more accurate data about inferior alveolar canal. Hence the present study was undertaken to assess and select roots of third molar with close proximity to inferior dental canal in panoramic radiograph having radiographic signs of darkening of root, disruption of canal cortex and canal deviation and to evaluate the same roots with CBCT using trans axial and coronal sections which is angulated parallel to long axis to tooth, axial and coronal sections for proximity of inferior dental canal with the apices of third molar root.
 Keywords: CBCT, IAN

Anatomical Variations of Mandibular Canal Using Cone-Beam Computed Tomography - A Retrospective Study

Background: Precise anatomy and course of mandibular canal is important to obtain the desired outcome of different mandibular surgical procedures and circumvent various surgical complications. This study aimed to document the presence, frequency, and type of mandibular canal variations using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images of 100 patients with a total of 200 sides (right and left) were obtained retrospectively from the database of Government Dental College and Hospital, Mumbai. The presence and type of mandibular canal variation were evaluated and classified according to Naitoh et al. classification (2009) along with Rashsuren et al. modification (2014). Prevalence rates were determined according to gender, side of the mandible, and type. Morphometric analysis of the mandibular canal variations was made. Statistical analysis with Chi-square, analysis of variance (ANOVA), and Scheffe's tests were performed. Results: Mandibular canal variations were found in 13% of patients and 8% of total sides. Type I dental canal (37.50%) was the most common type of accessory canal followed by Type II retromolar canal (31.25%), Type III forward canal type (25%), Type V trifid canal (6.25%), and Type IV buccolingual canal (0%). The retromolar canal had the maximum length and diameter and most of the accessory mandibular canals (60%) had a diameter of more than 50% of that of the main canal. Conclusion: Bifid mandibular canal was the most common anatomical variation of the mandibular canal found in this study with dental canal type being the most frequent type. To avoid iatrogenic injuries, a presurgical detailed evaluation of the mandibular canal using CBCT was suggested.

The Prevalence and Anatomical Variations of Bifid Mandibular Canal in a Sample of Egyptian Population Using CBCT. A Cross-Sectional Study

Aim: Detection of the prevalence of bifid mandibular canal and classification of its types in the Egyptian population. Methodology: Radiographic examination of 329 mandibular sides was done using Planmeca Promax 3D Mid CBCT machine. The scans varied depending on patients’ sizes (according to the manufacturer’s recommendations) using different FOVs with the same voxel size (0.4 mm (400 μm)). The bifid the mandibular canal was observed and classified according to Naitoh`s classification (retromolar, dental, forward, and buccolingual canals). In addition, the prevalence of location of accessory canal types and the mean distance to the alveolar ridge and teeth were reported. Results: In 329 hemimandibles, there were 101 bifid canals (30.7%) and 37 trifid canals (11.2%). The dental canal type was the most common (43.3%), followed by retromolar canal type (33.7%), forward canal type (17.2%), and buccolingual canal type (5.7%). The forward canals and the dental canals had statistically similar mean distances of 11.1 ±2.1 and 11.1±2.5 mm respectively. The accessory canals were at a significantly longer mean distance (12.1±1.6 mm) to the alveolar crest in the premolar area compared to distance in the molar area (10.9 ± 2.3 mm). Retromolar canals showed a significantly longer distance of 13.8± 4.4 mm. Conclusions: Examination of the mandibular canal is mandatory by surgeons to minimize the chance of missing any accessory branches, since its prevalence was more than 40% with 21.3 % presented with bilateral manifestation.

Patterns of Root Morphology of Mandibular Third Molars and Their Clinical Implications in a Cohort of Sri Lankan Patients

Background: Mandibular third molar surgeries garnered recognition as one of the common treatment procedures provided by Oral & Maxillofacial practices across the globe. Mandibular third molars are not only impacted, often giving rise to bothering issues to patients ranging from pain to difficulty in opening mouth but create challenges in their surgical removal. Postoperative complications of those surgeries such as pain, swelling, trismus and alveolar osteitis (dry socket) could be prevented and controlled by meticulous preoperative assessment of tooth-related and patient-related factors. Pattern of root morphology could be one important tooth- related factor connected to difficulties and subsequent postoperative complications of mandibular third molar surgeries. Aim: Against this backdrop, the aim of this study was to explore the patterns of root morphology of mandibular third molars and to elucidate their associations with selected attributes of the surgeries, self-reported preoperative pain and selected postoperative complications among a cohort of Sri Lankan patients. Materials & Methods: A hospital based, descriptive cross-sectional study was conducted among 715 patients (represented wider age range from adolescents to older adults) who underwent surgical removal of mandibular third molars at the Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. Of extensive socio-demographic, clinical and radiological investigation data collected, those data on root morphology and numbers of roots, inferior dental canal relationship, self-reported preoperative pain, duration of the surgery, flap design, tooth sectioning and postoperative pain and swelling complications were used for the present analysis. Data entry and analysis was done using SPSS-21 Statistical Software Package. Results: Based on our findings on patterns of root morphology, straight two roots were the most common (34.4%) across all age groups, followed by convergent two- roots (19.3%) fused straight- roots (16.3%) and distally curved two- roots (13.8) among Sri Lankan patients. Almost half (46.8%), of patients had inferior dental nerve canal placed away from mandibular third molar roots. Moreover, root morphology was significantly associated with presence of preoperative pain, duration of the surgery as well as occurrence of postoperative swelling (p<0.05). Conclusions: Patterns of root morphology of mandibular third molars may implicate on certain processes of their surgical removal and its outcomes. Therefore, careful preoperative assessment of root morphology and related factors of those teeth becomes useful in tailored patient care for minimal postoperative complications, better patient experience and quality-of-life.

Foreign body surgery in the inferior alveolar nerve canal following endodontic treatment

Endodontic treatment can result in the extrusion of dental sealant material beyond the apex of a tooth. Dental sealant materials are known to have potentially cytotoxic properties and can cause damage to biological structures. This article describes the case of a patient who had experienced a sustained painful dysaesthesia of the left inferior alveolar nerve as a result of extrusion of material beyond the apex of the tooth into the nerve canal, and the surgical approach taken to directly treat the nerve and improve her symptoms. CPD/Clinical Relevance: Awareness of the potential and sustained effects of dental sealant material on biological tissue, as well as the proximity of important anatomical structures, such as the inferior alveolar nerve, will help practitioners in the safe treatment of patients. Additionally, an awareness of the signs and symptoms of foreign body reactions within soft tissues will aid diagnosis and prompt onward referral for specialist treatments.

The analysis of the subjective image quality of a dental radiogram obtained with a digital and film detector

Introduction: Today film-based technologies are largely abandoned in dental radiology. New technologies based on digital detectors are being adopted. This change is part of the global digitalization of radiological procedures. A person operating the radiological device needs to be educated and well informed about radiological procedures and technologies, as well as to know how the system operates and to be sure about the dose required for the adequate image quality. The awareness of radiation doses received by patients is necessary for the estimation of risk from ionizing radiation.Material and methods: The aim of this study was to evaluate whether patient doses in intraoral dental radiology affect image quality. The study included subjective analysis of radiological image quality for an intraoral x-ray device with possibility to use both digital and film detector. Subjective assessment of image quality is performed according to criteria taken from the literature and is expressed using the Likert scale, grade 1–5. In order to improve the quality of inferential statistics related ratings to detector quality and image quality were collected, thus introducing two variables: the detector quality index and the technique quality index.Results: Z-test proportions column shows that the number of grades four given as a contrast score is significantly higher in the RVG detector (65%) compared to the film (40%). There is also a significant difference in the number of given grades five as a rating of the apex preview. The share of grades five in film is 19%, while in RVG it is 42%. It is similar in the evaluation of the preview of the dental canal, where there is also a significant difference in the number of given grades five, so that the share in the film is 11% and in RVG 35%.Conclusion: Analysis of the subjective quality of the radiological image in devices for intraoral radiography with the possibility of recording using digital and film detectors indicates that the digital detector is superior to film in low contrast resolution, apex and dental canal preview.

Evaluation of the Effect of Various Powers of the Diode Laser in Microcrack Formation in the Wall of the Dental Root Canal by Scanning Electron Microscope (SEM)

Background: The laser is utilized for the removal of the smear layer, cleaning and disinfecting the dental canal. Recently, diode laser has been offered with a wavelength of (635-980nm) for cleaning and disinfecting the dental root canal. Objective: There is not adequate evidence for microcrack formation when using diode lasers with different powers. Therefore, the present study was conducted in order to analyze various powers of a diode laser in microcrack formation in dental root canals. Methods: In this experimental study, 100 mandibular incisor teeth that were extracted because of periodontal disease were selected. Using stereo-microscope, the presence of crack and fracture of the root was evaluated before and after canal instrumentation. Then, samples were randomly divided into 10 groups (10 samples in any group) based on different powers of laser and canal to be humid or dry under laser radiation. The laser was utilized for 10s puls within three iterated times. The samples were cross-sectioned after disinfection with a diode laser at 3 and 6mm length from the dental apex. Sections were observed under a scanning electron microscope and images were taken. Results: The frequency of microcracks is increased at the distance of (3-6mm) from the dental apex by an increase in laser power level from 2 to 4w (P&lt;0.05). Similarly, results showed that the probability of microcrack formation under dry condition than the humid condition at the distance of 3mm from the dental apex might increase to 6.606 times and at the distance of 6mm from the dental apex increase to 4.978 times more. Conclusion: The optimal power of diode laser in the wavelength of (980nm) for cleaning and disinfecting of the root canal with the minimum damage on hard periodontium tissue is 1.5w.

Endodontide Kullanılan Nikel-Titanyum Atık Eğelerin Sülfürik Asit Liçi İşlemleri ile Geri Kazanımı

Nickel - titanium based alloys are widely used as a root canal files in dental canal treatment in endodontics. According to the Turkish Ministry of Health, approximately, two million root canal treatments were applied yearly in Turkey. Ni-Ti rotary files have been used for 80 % of these endodontic root canal treatments. Rotary files contain 55-60 wt.% nickel and 40-45 wt.% titanium. Ni-Ti endodontic files can be recovered by hydrometallurgy, which is an economical way, instead of treating them as medical waste. The aim of this study is to provide economical hydrometallurgical recycling of metallic wastes that cannot be recovered by direct melting. Nickel and titanium based endodontic rotary files were recovered via using different leaching techniques in high corrosive environments such as dissolution in concentrated acid, baking in sulfuric acid and hydrothermal treatment in concentrated sulfuric acid. The acid concentration, temperature and time parameters were optimized for concentrated sulfuric acid leaching in autoclave. The acid baking method is a simple system more efficient than the pure dissolution in acid. At the end of the hydroxide structures dehydration, TiO2 (anatase) and NiO powders were obtained. Moreover, under pressure within non-stirring autoclave the rotary file is completely dissolved with a cost-effective two-step process. Thus, an efficient recycling process has been created for waste Ni-Ti alloy tooth files.

The Characteristics of Adjacent Anatomy of Mandibular Third Molar Germs: A CBCT Pilot Study in Patients with Osteogenesis Imperfecta.

(1) Objectives: The aim of our study was to investigate the anatomical features of lower third molar and its adjacent anatomical connections in type I Osteogenesis Imperfecta (OI) patients through cone beam computed tomography (cbct). (2) Methods: The study was conducted among 25 patients, 13 patients with type I OI and 12 control patients (individuals with no disorders and no treatment); average age was 15.44 ± 2.06, 23 third molar germs for each group. The germs have been compared to the parameters using the Mann-Whitney test. A chi-square test was also used to investigate the correlation between the status case/control and tooth development stage. (3) Results: Mann-Whitney test showed significant differences between cases and controls: diameter of the tooth germ in toto (U = 93.5; p < 0.001), tooth development stage, (U = 145; p < 0.01), roots length (U = 44.5; p < 0.01), cementoenamel junction diameter (U = 157.5; p < 0.05), size of the pulp chamber (U = 95.5; p < 0.05). Type I OI is not associated with the relationship between the germ of mandibular third molar and alveolar canal on axial plane (χ2 = 4.095; p = 0.129), and parasagittal (χ2 = 4.800; p = 0.091). The association between type I OI and relationship with the germ of mandibular third molar and alveolar canal on the coronal plane has been significant (χ2 = 9.778; p < 0.05) as the perforation of the lingual cortical bone in the region of mandibular third molar tooth germ (χ2 = 11.189; p < 0.01). (4) Conclusions: The results confirm the cbct accuracy in the evaluation of bone density in type I OI patients giving also the opportunity to study the tridimensional anatomy of germs and the adjacent anatomical structures in order to avoid any perioperative complications.

Passive medialization of the inferior alveolar nerve to facilitate implant placements in a patient with severe atrophic posterior mandible.

Placing implants in the edentulous jaw of an individual with severe posterior mandibular atrophy is challenging due to the insufficient bone height above the inferior alveolar nerve canal. The different reconstruction techniques available cause extensive morbidity, are costly, and require prolonged treatments. In here we report a case series of patients treated with a new minimally invasive technique to facilitate implant placement in patients with severely atrophied posterior mandible.

Combined bending–torsion testing device for characterization of shape memory alloy endodontic files

Design has an important influence on mechanical response of endodontic instruments made of shape memory alloys. The experimental and numerical prediction of their thermomechanical response is necessary to improve their behavior during operating inside root canal. Due to the curved and tapered shape of the dental canal, endodontic files are subjected to rotating bending during the root canal preparation phase. These rotative bending could ever be combined with torsion when the instruments are engined in the root canal. Bending and torsion tests available in the standard ISO 3630-1 do not take into account this combined loading leading to a response different from the one obtained by superposition of separated bending and torsion loadings. This article details the design and the realization of bending–torsion testing device particularly adapted to shape memory alloy endodontic files. It allows to control the torsion and the bending rotations in a separate or a combined way. Qualification tests using this bending–torsion testing device on NiTi wires showed a good agreement between the experimental and the simulated responses. Finally, this bending–torsion testing device allowed to analyze the response of various NiTi endodontic files, currently used in endodontics, subjected to bending, torsion, and combined bending–torsion loadings. Obtained results showed clearly that combined bending–torsion loading changes significantly the shape memory alloy file response.

Assessing the Prevalence and Morphological Characteristics of Bifid Mandibular Canal Using Cone-Beam Computed Tomography - A Retrospective Cross-Sectional Study.

Objectives:To evaluate the prevalence, location and configuration of bifid mandibular canals so as to avoid injury to the nerve and inadequate anesthesia during surgical procedures.Materials and Methods:CBCT scan of 203 patients (125 males and 78 females) was evaluated for the presence and the type of the bifid mandibular canal. They were classified according to Nortje et al. The prevalence rates were determined according to gender, location, and type of bifid mandibular canal. Statistical analysis was performed using IBM SPSS software version 24.Results:The prevalence rate of bifid mandibular canals was found to be 10.3% with 12.8% in males and 6.4% in females. The Chi-square test reveals there is a statistically significant difference between the different locations of bifid mandibular canals and most of the canals were present on the right side. The most frequent type of bifid mandibular canal observed was type II dental canal (38.1%), followed by type III forward canal (28.6%), type I retromolar canal (14.3%), and type IV buccolingual canal (14.3%).Conclusion:CBCT is suggested for a detailed evaluation and identification of bifid mandibular canals before any surgical procedures to avoid post-operative complications.

Bifid mandibular canals: CBCT assessment and macroscopic observation

The bifid mandibular canal is an anatomical variation, which causes anesthetic failure and surgical accidents occasionally. The purpose of this study is to observe the prevalence and anatomical location of bifid mandibular canals, providing clinical value in reducing the occurrence of surgical accidents and postoperative complications. A total of 321 outpatients were selected in this study. Their CBCT images were observed, and the prevalence of bifid mandibular canals as well as the composition ratios of each branch type was evaluated according to the classification of Naitoh. The bifid mandibular canals and their branches' diameter, length, horizontal distance to the buccal/lingual wall of the mandible, and vertical distance to the mandibular alveolar ridge were measured. Furthermore, 194 dry adult mandibles from the Department of Oral Anatomy and Physiology of Tianjin Medical University were observed to evaluate the prevalence and the average diameter of retromolar foramina. Of all the 321 patients, 84 (26.17%) cases of bifid mandibular canals and 105 (16.36%) sides of unilateral bifurcation were observed. Based on Naitoh's classification, the retromolar canals were the most common types (46.67%), followed by the forward canals (40.00%), the dental canals (10.48%) and the buccolingual canals (2.86%). In 194 dry adult mandibles, 23 cases (11.86%) and 29 sides (7.47%) of retromolar foramina were found and the average diameter of retromolar foramina was 0.94 ± 0.30mm. More than a quarter of the population has the bifid mandibular canal, which is a potential factor of the onset of surgery accidents. CBCT is an effective method to identify the branches of mandibular canals. Preoperative CBCT examination can help reduce various postoperative complications.

Inferior alveolar nerve injury assessment after surgical removal of mandibular third molar.

To assess the nerve injury (inferior alveolar nerve) after surgical removal of mandibular third molars under local anesthesia. Study Design: Observational study. Setting: Oral &amp; Maxillofacial Surgery Department LUMHS Jamshoro/Hyderabad. Period: From 11th November 2015 to 10th May 2016. Material &amp; Methods: This study consisted of one hundred patients. Inclusion criteria’s were patients with impacted mandibular third molar, patient’s age from 18 to 45years and irrespective of gender. Exclusion criteria were patients younger than 18yrs of age of above 45 years, patients having neurological disorders, medically compromised patients, patients receiving radiotherapy or chemotherapy, patients with known allergy to local anesthesia, patients having pathology due to mandibular third molars, patients radiographicaly root is very near to inferior dental canal. Results: Out of 100 patients incorporated in this research 66 were male (66%) and 34 female (34%). The mean age was 29+3.20 years. Common indication of extraction were recurrent pericoronitis 52(52%) cases followed by deep caries/ pulpitis in 28(28%) cases, orthodontic reason in 11(11%) cases and caries to adjacent tooth in 9(9%) cases. Third molar impaction according to winter’s classification were Mesioangular in 54(54%) cases followed by Horizontal in 26(26%) cases and Vertical in 11(11%). Radiographic showed Narrowing of root in 21% cases and narrowing of inferior dental (ID) canal 20% cases, followed by diversion of ID canal in 16 % cases, deflection of root 14 % cases and darkening of root in 11% cases. After surgical removal of mandibular third molar, the inferior alveolar nerve injury was observed in 6(6%) cases. Conclusion: We conclude that inferior alveolar nerve paresthesia occurs in 6% after surgical removal of mandibular third molars.

Evaluation of Mandibular Third Molar Region in a Turkish Population Using Cone-Beam Computed Tomography.

To evaluate impacted mandibular third molar tooth region and obtain linear measurements using CBCT images and to assess the relationship between the impacted third molar and the mandibular canal. CBCT scans of 351 patients (208 females, 143 males) were assessed. Age, gender, and impaction site were recorded for each patient. The relationship of third molars with the vertical axis of second molars, 2nd molar resorption and the relationship between third molar apices and the mandibular canal were assessed. In addition, the distance between ramus and second molar, mesiodistal width of the third molar, the angle between third molar and second molar, and width of the third molar capsule were measured. Binary Logistic Regression, Chi-Square Test, and General Linear Model were used for statistical analysis. The highest percentage of impaction was found for mesioangular followed by transversal and vertical. The transversal impacted third molars revealed a significant association with adjacent second molar root resorption (p<0.001). There was a statistical significance between the second molar resorption and distance between ramus and second molar (p<0.001). The mesioangular impacted third molars revealed significant relation with the mandibular canal (p<0.05). The most frequent variation found was the dental canal followed by the retromolar canal. In general, higher measurement values were obtained for men when compared to women (p<0.05). CBCT assessment of the third molar region provided useful information regarding impacted mandibular third molar surgery operations.

MULTILOCULAR RADIOGRAPHIC ASPECT IN ODONTOGENIC KERATOCYST: CASE REPORT

A 63-year-old black male patient reported intraoral drainage and palpation pain in the right mandibular body region with no complaints of paresthesia. The ipsilateral gingival margin was invaginated without any expansion of the cortical bone when a clinical examination was made. In the tomographic examination, alveolar bone resorption with a multilocular pattern was observed with hypodense interior, well-defined hyperdense margins, anteroposterior growth in mandibular body to the right up to the ascending branch on the same side, and involvement of the inferior alveolar nerve canal, suggesting an ameloblastoma diagnosis. After an incisional biopsy, the histopathologic report revealed an odontogenic keratocyst. Decompressive treatment with rigid latex device was used to allow reduction of the cystic cavity to facilitate removal, decrease the rate of recurrence, and not compromise the sensitive innervation of the affected region. However, periodic radiographic examination is necessary to follow up and define the surgical moment for enucleation.

Evaluation of the outcome of various laser therapy applications in root canal disinfection: A systematic review.

Any successful endodontic therapy requires elimination of the endodontic biofilms through meticulous root canal disinfection methods. Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are the most common effective irrigants, in removing smear-layer from the coronal and middle thirds of the dental canals but reduced considerably towards the apical one third. In recent years, newly alternative treatment modalities have been proposed, including high-power lasers and antimicrobial photodynamic therapy (aPDT). Our work was conducted to evalaute the outcome of root canal disinfection in relation to the efficacy of various treatment modalities. Furthermore, every effort was made to present an overview of the aPDT outcomes, as a model for this application, and to propose laser parameters protocol with positive results. The electronic databases PubMed was searched from January 2013- January 2019. Our inclusive criteria based on laser therapy applications, as a model for root canal disinfection. The search terms utilised various combinations as follows: photodynamic therapy or antimicrobial photodynamic therapy or photoactivated disinfection or light activated disinfection or laser activated disinfection or laser therapy, and endodontic. The results of this systematic review concluded that the effectiveness of aPDT and various laser wavelengths protocols, in removing endodontic biofilms from infected root canals, remains unattainable. Study concluded that the combination of aPDT with antimicrobial irrigants could provide a synergetic effect. However, due to the heterogeneity of the selected studies and their limitations, in terms of lack of standardised protocol or discrepancy in the methodology, authors suggest further validated approaches to achieve optimal outcomes.