Anterior Mandible Research Articles

Utilizing Nasolabial Local Flap in Management Proliferative MRONJ: A Case Report

This case report demonstrates utilization of nasolabial flap for reconstruction a large soft tissue defect associated with osteo-necrotic anterior mandible in highly infiltrative aggressive MRONJ. Immediately after the operation, healing of the lesion was optimized and patient become symptom free

Influence of Voxel Size on Evaluation of Trabecular Bone Microstructure on Human Mandibles: A CBCT study

Purpose: This study aims to assess the effect of voxel size on trabecular microstructural evaluation onhuman cadaver mandiblesusing cone beam computed tomography (CBCT) images.
 Methods: Twenty two Volumes of Interest were obtained from to human cadaver mandibles which were scanned in three different voxel sizes using CBCT. Scanning performed in 0.125 mm (Group 1), 0.2 mm (Group 2) and 0.3 mm (Group 3) voxel sizes. Regions of interest are calculated in both mandibles for both voxel sizes which are adjusted from apical third of all interdental alveolar trabecular bone from anterior and posterior mandible. Trabecular thickness (Tb. Th); trabecular separation (Tb. Sp); Bone Volume/Total Volume (BV/TV) values were obtained using plug in BoneJ of the software ImageJ. The results were evaluated statistically in software IBM SPSS Statistics 21. 
 Results: Trabecular thickness and trabecular separation showed significant difference between first and the third and the second and the third groups (p=0.000), while first and second group did not. BV/TV values showed no significant difference between whole groups. 
 Conclusion: Beside microstructural analysis is not their first purpose CBCT images carry knowledge about trabecular bone microstructure could be a valuable bone quality assessment tool. High correlation between values with 0.125 mm and 0.2 mm and low correlation between values with 0.125 mm and 0.3 mm voxel sizes suggest that; this knowledge is clinically more valuable when voxel size is 0.2 mm or thinner.

Diversity of an Odontogenic cyst of Jaws – A case report with literature review

A dental lesion called a lateral periodontal cyst (LPC) can appear on a tooth's lateral radicular surface. Standish and Shafer described LPC for the first time in 1958. The mandibular premolars are where this cyst is most frequently found, however it has also been noted in other places too. The average age of incidence is 52 years, and there is no preference for any race or gender. It is frequently found during routine radiography examinations. The remnants of dental lamina in the alveolar bone are most likely the histogenetic source of LPC. The lateral periodontal cyst is surgically removed, and there is no risk of recurrence. The present article aims to present a case of Lateral periodontal cyst in anterior mandible in a young female patient with added literature review.

A Rare Tumor of The Oral Mucosa, Myopericytoma: Case Report

Myopericytoma (MPC) is defined as a benign mesenchymal neoplasm consisting mostly of oval spindle-shaped myoid-like cells with perivascular growth. Apart from being a rare lesion in all anatomical regions of the body, it is extremely rare in the oral and maxillofacial region and only a limited number of cases have been reported in the literature. We present here the case of MPC in a 42-year-old female patient who had a painless, enlarging lesion in the anterior mandible. Intraoral examination of the lesion revealed a smooth, nonwhite, pedunculated, fibrotic, painless, and nonbleeding lesion in the lingual aspect of the anterior mandible. Histopathologic examination revealed a tumor consisting of spherical/nodular structures composed of spindle cells and hemangioperistomatous vascular structures in the form of staghorn. These tumor cells showed no signs of malignancy. On immunohistochemical examination, the tumor cells were positive for CD34 and SMA. SMA Protein was also focally positive in nodular structures formed by spindle cells and tumor stroma. S-100 protein was negative in the lesion. To our knowledge, this is the second case of MPC that occurred in the mandibular gingiva.

Elongated Mental Spine with Two Lingual Foramina in the Mandible of A Kurdish Woman: A Case Report

The mental spines are bony prominences found in the lingual surface of anterior mandible, and usually they are arranged in two groups, superior pair and inferior pair. Mostly they are asymptomatic, but sometimes they may interfere with the prosthodontic treatment or with some surgeries. The lingual foramen can be found in different locations around the mental spines, and they are very important vital organ because they transmit nerves and arteries, which may cause a serious problem during some types of surgeries in this region such as implant placement. Here, we report a case of 55-year-old, Kurdish woman with elongated superior mental spine with bilaterally lingual foramina located distally to lower central incisors, that have been seen during a routine CBCT scan. The length of the spine was 6.4 mm, the height was 5.5 mm and the width was 1.9 mm. So, any dentist wants to perform any type of surgery in sublingual and submental regions should be careful of such anatomical variations.

MANDIBLE RECONSTRUCTION WITH FREE ILIAC CREST GRAFT AFTER AMELOBLASTOMA RESECTION: A CASE REPORT

Ameloblastoma is a benign neoplasm from the odontogenic epithelial tissue found in the maxillary bones. Ameloblastoma resections result in bone defects. Therefore, grafts are well indicated for rehabilitation. We report a case of a 29-year-old female patient with tumefaction at the anterior mandible. Histopathologic analysis showed a multicystic ameloblastoma. According to the tomographic examination, the lesion measured approximately 2.3 × 1.6 cm in diameter. We decided to perform a marginal tumor resection associated with mandibular reconstruction by an autogenous graft from the iliac crest, fixed with titanium plates. Currently, the patient is undergoing a 7-month postoperative follow-up, showing graft integration and satisfactory bone volume, with no signs of lesion recurrence. Thus, it is observed that this type of graft is considered a good option for maintaining the function and esthetics of patients after resection.

CENTRAL GIANT CELL GRANULOMA ASSOCIATED WITH CENTRAL OSSIFYING FIBROMA: REPORT OF AN UNUSUAL CASE

We contribute with an uncommon case of central giant cell granuloma associated with central ossifying fibroma (CGCG-COF) in the mandible of a 38-year-old female patient. Clinically, painless swelling of 10 months' duration was detected in the anterior mandible, exhibiting prominent lingual cortical expansion. Imaging exams revealed an ill-defined multilocular mixed radiolucent-radiopaque lesion in the tooth-bearing area, measuring approximately 4 cm, causing root displacement of the lower incisors, canine, and premolars and causing exuberant expansion of bone cortices. Incisional biopsy was performed, and microscopic analysis revealed multinucleated giant cells in a hemorrhagic cellular stroma, intermingled with areas of benign fibro-osseous lesion. The diagnosis was CGCG-COF. Laboratory blood tests ruled out secondary hyperparathyroidism. The treatment consisted of marginal mandibular resection and the patient has been under strict follow-up over the last 4 months. We report an unusual case of CGCG-COF exhibiting clinical-radiographic features of aggressiveness, and long-term follow-up is required.

SURGICAL TREATMENT OF MANDIBLE AMELOBLASTOMA: CLINICAL CASE REPORT

Ameloblastoma is a benign tumor of the odontogenic epithelium commonly found in the oral cavity and that has the capacity to present large dimensions. We report a clinical case of a patient in the third decade of life with a lesion in the anterior mandible with cortical expansion and facial asymmetry who sought care at the Maranhão Cancer Hospital Tarquínio Lopes Filho in São Luís, MA, because his condition caused him pain and aesthetic, functional, and social discomfort. Thus, after physical, imaging, and preoperative examinations, the treatment was performed, which consisted of enucleation of the lesion. The prognosis was positive. The patient is under constant postoperative evaluation and has a good recovery.

AMELOBLASTIC FIBROSARCOMA OF THE MANDIBLE: REPORT OF TWO NEW CASES

The aim of the present study is to report the clinicopathologic features of 2 new cases of ameloblastic fibrosarcoma (AFS). Case 1 was a 9-year-old boy presenting with a painful ulcerated swelling in the posterior mandible causing facial asymmetry. Case 2 presented as an asymptomatic swelling in the anterior mandible of a 14-year-old female patient. Imaging exams revealed destructive multilocular radiolucencies with irregular margins, associated with impacted teeth, causing exuberant cortical expansion and tooth displacement. Microscopically, both cases showed mesenchymal cells with marked hypercellularity and nuclear pleomorphism containing small islands of odontogenic epithelium with peripheral palisading. Both patients were treated by surgical excision; case 1 showed recurrence after 2 years of follow-up. AFS usually affects the posterior mandible of young adults with previous history of ameloblastic fibroma; nevertheless, clinicians should also consider this rare odontogenic sarcoma when evaluating aggressive ill-defined radiolucent lesions in the mandible of pediatric patients.

Lingual foramina of the anterior mandible in edentulous patients: CBCT analysis and surgical risk assessment

ObjectiveThe mandible has various unnamed accessory foramina, and surgery is often performed in the symphyseal area. The aim of this study was to analyze the anatomical characteristics of mandibular lingual foramina with the objective of preventing clinical complications during implant surgery on an edentulous mandible. Study designA total of 100 cone beam computed tomography scans of completely edentulous patients were included in this study. For each canal, nine measurements were recorded in millimeters: seven length or height measurements and two diameter measurements. The placement of a standard implant was simulated and whether the implant passed through the canal was noted. The results were analyzed by t-test and chi-squared at a significance level of 0.05. Pearson correlation analysis was used to assess the relationship between variables. ResultsWe identified 309 foramina: 236 medial lingual foramina and 73 lateral lingual foramina. We found no significant relationship between the number of foramina and the age of the individuals, or between diameter and the age or gender of the individuals. The mandibular canal was injured in 32.7 % of implant placement simulations. ConclusionThe risk of injury to neurovascular bundles is increased in edentulous patients due to vertical bone resorption.

Prevalence and Anatomic Variations of Lingual Foramina and Lingual Canal in Anterior Mandible Using Cone Beam Computed Tomography – A Cross-Sectional Study

Introduction: Rich neurovascular supply in the anterior mandible necessitates a preoperative radiological assessment of the lingual foramina/canal where cone beam computed tomography (CBCT) could produce promising results. Aim: To assess the prevalence of lingual foramina and canal in mandible and variations in their anatomy in a hospital-based population in Chennai. Methodology: Sagittal sections of the anterior mandible from CBCT images of 140 patients were evaluated for number, location of the lingual foramen, length of the lingual canal, a distance of lingual foramen from the alveolar crest and inferior border of the mandible, and thickness of the lingual cortex. Results: A total of 166 lingual foramina-canals were identified in 140 individuals; 82.1% presented with one, 15.1% with two, and 2.1% with three lingual foramina canals. The majority of foramina (79.51%) were located above the genial tubercles. The mean lengths of the superior, middle, and inferior canals were 5.45 ± 1.34, 5.00 ± 1.73, and 3.92 ± 1.10 mm, respectively. The mean thickness of the lingual cortex was 2.35 ± 0.55 mm. The distance from the inferior lingual foramina to the alveolar crest was significantly greater in males (P = 0.001). Conclusion: Anatomical characteristics of lingual foramen-canal varied significantly across the total sample.

Effect of Anatomical Location of Dental Implants in the Mandible on Generation of Metal Artifacts on Cone-Beam Computed Tomography Scans

Background: Metal artifacts are the major weak points of cone-beam computed tomography (CBCT) scans. This study aimed to quantify the amount of metal artifacts generated by dental implants placed in different anatomical locations in the mandible on CBCT scans. Methods: In this study, 98 CBCT scans of mandibular dental implants with prosthetic crowns were randomly selected irrespective of the age and gender of the patients. Of all 98 implants, 42 were placed in the anterior mandible and 56 were placed in the posterior mandible. The samples were divided into two groups of single and multiple implants. The CBCT scans of each implant were evaluated in apical and cervical cross-sections. The amount of metal artifacts generated around the implants was calculated. Data were analyzed using the Mann-Whitney U test at 0.05 level of significance. Results: Higher amounts of artifacts were noted in the anterior mandible compared to the posterior mandible. Additionally, the amount of artifacts was higher in the cervical cross-section than in the apical cross-section. The difference in the amount of artifacts generated in the cervical cross-section was significant between single and multiple implants (P<0.05). However, this difference was not significant in the apical cross-section (P>0.05). Conclusions: Dental implants always generate metal artifacts on CBCT scans, and the amount of generated artifacts is influenced by the anatomical location of implants in the mandibular arch.

Doppler ultrasound assessment results at stages of orthodontic treatment

Relevance. A modern diagnostic complex when planning orthodontic treatment is impossible without assessing the condition of periodontal tissues.Purpose. To evaluate the changes in periodontal tissues during orthodontic treatment.Material and methods. Blood velocity and flow rate in the anterior mandible were compared before and after the orthodontic treatment.Results. Blood velocity and volumetric blood flow rate significantly increased 6 ± 2 months after the beginning of orthodontic treatment.Conclusion. Orthodontic movement of crowded teeth using aligners proceeds without excessive pressure, which allows for a smooth and gradual change in the blood velocity and volumetric blood flow rate, pulsation index and peripheral resistance index.

Evaluation of neurovascular anatomical variation in the anterior mandible in North Indian population: A CBCT assessment

IntroductionThe purpose of this retrospective study was to determine the visibility, location and other morphometric features of lingual foramina on CBCT along with its age wise and gender wise correlation. Material and methodsA total of 250 patients were included in the study. Cross-sectional CBCT images of the mandible in the midline were used to locate and define each detected lingual foramen and canal. Descriptive statistics including tables and graphs were used. Genderwise and Age wise correlations were analyzed using Chi-square tests. ResultsThe number, direction, length, diameter, distance from alveolar crest and inferior borders of mandible were evaluated. Genderwise Lingual foramen was most frequently located in the mandibular midline, above genial tubercle (81.7%). Agewise it was found to be significant (p = 0.019). Genderwise length of canal was found to be significant (p = 0.022). Genderwise diameter of canal at midpoint was found to be very highly significant (p < 0.001) and at innermost point was found to significant. (p = 0.037) Genderwise and Agewise distance between orifice of canal and alveolar crest was found to be very highly significant. (p < 0.001) Genderwise and Agewise distance between innermost point of canal and alveolar crest was found to be highly significant (p = 0.001) and very highly significant (p < 0.001) respectively. ConclusionClinicians may consider CBCT for procedures with a risk of hemorrhagic and neurosensory complications such as dental implant placement in the anterior mandible.

Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial.

The gingival thickness (GT) and keratinized tissue (KT) height are defined as the gingival phenotype. Both the modified coronally advanced tunnel technique (MCAT) and free gingival grafts (FGG) are used in modifying the gingival phenotype. This study aims to compare MCAT and FGG in gingival phenotype modification. One hundred and forty recessions in 50 patients with thin and insufficient keratinized tissue at the anterior mandible were treated with either MCAT or FGG. GT, KT height, recession depth, recession width, probing depth, and clinical attachment level were evaluated at baseline and 6weeks, 6months, and 12months. GT change, KT change, root coverage (RC), clinical attachment gain, and complete root coverage (CRC) were calculated. The wound healing index, tissue appearance, patient expectations, aesthetic, and dentin hypersensitivity were assessed at baseline and 6months. All periodontal variables showed significant change from baseline to 12months in both groups (p < 0.05). While FGG resulted in more KT change (p < 0.001), all MCAT sites showed at least 2mm KT change in 12months. MCAT resulted in greater GT change (p < 0.05) and RC (p < 0.003). In contrast, there was no significant inter-group CRC difference (p = 0.523). All patient-based variables were favorable to MCAT (p < 0.05), except dentin hypersensitivity (p = 0.225). Both techniques were successful in terms of gingival phenotype modification in the anterior mandible. Additional GT increase, RC, and patient-based outcomes favored MCAT, though KT change proved greater with FGG. Clinicians may choose MCAT for higher GT increase whereas FGG for more KTC. NCT04690140 and date: 12/26/2020.

Analysis of the fluid contents of simple bone cyst in the mandible

Description of simple bone cyst (SBC) content has been controversial. This study aimed to assess and give a clearer picture of the SBC cavity contents. Between 2014 and 2016, 19 patients with SBC verified by histopathological examination were included in this study. SBC cavity content was investigated using clinical, radiographic, surgical, and laboratory findings. The difference in components among cavity fluid, blood, and serum was evaluated using a paired sample t-test for statistical analysis. All 19 SBC cases radiographically and surgically revealed a fluid-filled cavity. The patients’ average age was 21.3 ± 13.2 years, with no sex predominance found. SBCs were found mostly in the anterior mandible (n = 12, 63.2%). All lesions were filled with clear straw-colored or blood-colored floods with low concentration. Although the fluid components were similar to those in the blood and serum in the laboratory analysis, the statistical analysis revealed that the fluid components were not significantly different only for eosinophil (p = 0.43) and basophil (p = 0.06) counts as blood components and sodium (p = 0.76), potassium (p = 0.08), and chloride (p = 0.13) concentration as serum components. The results show that SBC is a fluid-filled cavity, with the cavity fluid being more likely similar to serum rather than blood regarding internal components.

Tissue Surface Adaptation and Clinical Performance of CAD-CAM Milled versus Conventional Implant-Assisted Mandibular Overdenture.

Purpose To evaluate the surface adaptation and maximal biting force of CAD-CAM milled mandibular overdenture (CAD-CAM MOD) compared to conventional compression mold mandibular overdenture (CC MOD). Materials and Methods Ten completely edentulous subjects with persistent complaints of their complete mandibular dentures were received four dental implants in the anterior mandible. Three months after osseointegration, subjects were randomly received either conventional compression mold or CAD-CAM MOD in a crossover design. To assess tissue surface adaptation, the fitting surfaces of each denture base were scanned and placed on the reference master cast. Three and six months after each overdenture was inserted, clinical performance in the form of maximum biting force was evaluated. Results The results of this study indicated that the tissue surface adaptation of the CAD-CAM MOD bases was significantly better than the conventional (compression mold technique) processed bases where (P=0.0001). Regarding clinical performance (maximum biting force), the CAD-CAM MOD exhibited better clinical performance (P=0.0001). Conclusions In denture processing methods, the CAD-CAM overdenture delivered more precise adaption and clinical performance than the compression mold technique.

Evaluation of the Hyaluronic Acid Versus the Injectable Platelet-Rich Fibrin in the Management of the Thin Gingival Phenotype: A Split-Mouth Randomized Controlled Clinical Trial.

BackgroundSeveral procedures have been used to enhance thin gingival phenotype and the majority of these procedures have been surgical. A new minimally invasive approach that involved multiple injections of platelet-rich fibrin (i-PRF) to enhance the thin gingival phenotype has been proposed. As the hyaluronic acid (HA) and the i-PRF share similar properties in terms of promoting periodontal regeneration, the present trial aimed to evaluate the effectiveness of multiple injections of the i-PRF in patients with thin gingival phenotypes in comparison with those of the HA in increasing the gingival thickness (GT) and the keratinized tissue width (KTW).Materials and methodsEighty-four sites from 14 systematically healthy patients who had thin gingival phenotypes (GT ≤1 mm) were included in this split-mouth randomized controlled trial. For each patient, each side of the anterior mandible was randomly allocated to one of the two materials (HA or i-PRF). In the HA group, the selected sites of the gingiva were injected with cross-linked HA using a 30-gauge microneedle. In the i-PRF group, the i-PRF was injected in the same manner. This procedure was repeated in both groups three times with intervals of 7 days. The GT, KTW, and periodontal indices: gingival index (GI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline, 1 month, and 3 months following the initial injection.ResultsThe GT increased significantly in both groups at the three assessment times (p<0.001). The KTW also showed a statistically significant increase in the intragroup comparisons in both groups (p<0.05). No statistically significant difference was observed between the two groups at the three assessment times for the GT and the KTW (p>0.05).The GI significantly decreased after 1 month and 3 months compared to the baseline values in both groups (p<0.05). The intergroup comparisons for the GI revealed no statistically significant differences at the three assessment times (p>0.05). As for the BOP and the PD, no statistically significant differences were found between the three assessment times (p>0.05) and between the two groups at each assessment time (p>0.05).ConclusionMultiple injections of the i-PRF and the HA in the thin gingival phenotype resulted in an increased GT and increased KTW, with no statistically significant differences between the two methods. Both minimally invasive techniques were more effective in improving the GT rather than the KTW.

Failure of Dental Implants and Associated Risk Factors in a University Setting.

To assess the cumulative failure rate of 4,842 implants comprising six commercial implant brands in a university setting, and to evaluate the influence of different risk factors on the implant failure rate. A retrospective chart review was conducted in patients receiving dental implants at the School of Dentistry of the International University of Catalonia (Barcelona, Spain) from 2011 to 2018. The inclusion criterion was patients presenting at least one failed implant. The cohort study included 1,510 patients who received a total of 4,842 implants. The cumulative failure rate was 4.9% and 10.8% at the implant and patient levels, respectively. The multiple regression analysis showed that for the same number of implants per patient, variables such as age and sex were not associated with higher implant failure rates. Furthermore, in considering the combination of arch-sector, a statistically significant reduction in failure rate was observed in the posterior maxilla (OR = 0.66, P = .038) and in the posterior mandible (OR = 0.64, P = .037). The results showed all implant brands offering high implant survival rates (> 91%). Nobel Biocare and Straumann implants significantly reduced the risk of implant failure (OR = 0.37, P = .021 and OR = 0.53, P = .024, respectively), while no significant differences were recorded among Klockner (2.8%), MIS (5.4%), Biomet 3i (7.1%), and Astra Tech (8.4%; P ≥ .05). No association was found between implant loss and bone augmentation, time of implant placement, smoking, and history of periodontal disease. The implant failure rates obtained in a university setting resulted in overall cumulative rates of 4.9% and 10.8% at the implant and patient levels, respectively, over a 7-year period. Male sex and implants placed in the anterior mandible may be associated with a higher risk of implant failure. Nobel Biocare and Straumann implants seem to positively affect implant survival rate.

THREE CASES OF AMELOBLASTIC CARCINOMA WITH REVIEW OF CLINICAL, RADIOGRAPHIC AND HISTOPATHOLOGIC FEATURES

<h3>Introduction</h3> Ameloblastic carcinoma (AC) is a rare malignant primary epithelial odontogenic tumor demonstrat- ing histologic features of ameloblastoma with signs of overt malignancy. In this case series, we describe the clinical, radiographic and histologic features of 3 cases of AC. <h3>Methods</h3> Three cases of AC were identified from the University of Florida Oral Pathology Biopsy archives. Clinical data and original slides were retrospectively analyzed. Immuno- histochemical (IHC) stains for cytokeratin 19 (CK19) was performed on all cases to demonstrate odontogenic epithe- lial origin. <h3>Results</h3> All cases of AC in this series occurred in elderly males, with two presenting in the mandible and one in maxilla. Radiographically, all presented as ill-defined radiolucencies and demonstrated cortical expansion, consistent with features of malignancy. The first case involved a 60-year-old male with an erosive soft tissue mass along the anterior mandible between teeth #27 and #28 and corresponding radiolucent lesion on films. The second case occurred in a 75-year-old male presenting with gingival swelling and an expansile radiolucent lesion in the right maxilla, extending from tooth #3 to #7. The third case was seen in a 75-year-old male displaying a large oste- olytic lesion of the mandibular ramus surrounded by a bulky soft tissue mass extending deep into the right lateral and medial pterygoid muscles. Histologically, all cases revealed large sheets of interconnecting islands and strands of malignant cells displaying peripheral palisading, reverse nuclear polarity and apical vacuolization. In addition, the malignant islands exhibited central necrosis and neoplastic cells showed significant hyperchromatism with nu- clear pleomorphism. IHC staining with CK19 were strongly positive in two cases and focally positive in one case. <h3>Conclusion</h3> This case series documents 3 cases of a rare odontogenic malignancy and highlights the importance of including this entity in a differential diagnosis of aggressive lesions of the jaws, especially in older patients.