Buccal Approach Research Articles

Palatal root endodontic microsurgery in maxillary molars using the palatal approach: a case study

BackgroundIn clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging.Case presentationWith the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022.ConclusionsComplete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection.

Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies.

The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability(O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.

Accuracy of computer-assisted dynamic navigation when performing coronectomy of the mandibular third molar: A pilot study

ObjectivesThe study represents a preliminary evaluation of the accuracy of the dynamic navigation system (DNS) in coronectomy of the mandibular third molar (M3M). MethodsThe study included participants with an impacted M3M near the inferior alveolar canal. The coronectomy planes were designed before the surgery using cone-beam computed tomography (CBCT) imaging data and then loaded into the DNS program. Intraoperatively, the navigation system was used to guide the complete removal of the target crown. Postoperative CBCT imaging was used to assess any three-dimensional deviations of the actual postoperative from the planned preoperative section planes for each patient. ResultsA total of 12 patients (13 teeth) were included. The root mean square (RMS) deviation of the preoperatively designed plane from the actual postoperative surface was 0.69 ± 0.21 mm, with a maximum of 1.45 ± 0.83/-1.87 ± 0.63 mm deviation. The areas with distance deviations < 1 mm, 1–2 mm, and 2–3 mm were 71.97 ± 5.72 %, 22.96 ± 6.57 %, and 4.52 ± 2.28 %, respectively. Most patients showed extremely high convexity of the surface area located in the mesial region adjacent to the base of the extraction socket. There was no observable evidence of scratching of the buccolingual bone plate at the base of the extraction socket by the handpiece drill. ConclusionsThese results provide preliminary support for the use of DNS-based techniques when extracting M3M using a buccal approach. This would improve the accuracy of coronectomy and reduce the potiential damage to the surrounding tissue. Clinical significanceDNS is effective for guiding coronectomy.

Palatal approach for surgical removal of mesioangularly impacted maxillary third molar - a pilot study

ObjectiveThis study aimed to investigate the application of the palatal approach for surgical removal of IMTM, and to evaluate its success rate, surgical duration, postoperative outcomes, and incidence of complications.MethodPatients with mesioangularly IMTM (Archer Classification Class B) in the none-buccal position to the adjacent second molar, which were indicated for surgical removal, were enrolled in this study. The patients were assigned into two groups according to the surgical approach: the buccal or palatal approach. The impacted tooth positions, diagnosis, past dental and medical history, and radiographic examination were recorded pre-operatively. The duration, surgery details, and surgical complications were documented during the surgery.Result40 teeth were enrolled in our study. All teeth were removed completely. The operation time was significantly shorter in the palatal approach group compared to the buccal approach group (13.3 ± 2.8 min vs. 22.3 ± 5.5 min, P<0.001). The incidence of traumatic ulcers of the lips was significantly higher in the buccal approach group than in the palatal approach group (7/20 vs. 0/20, P = 0.008).ConclusionIt is more efficient to perform surgery with a palatal approach if a Class B mesioangularly IMTM is located in the non-buccal aspect of the adjacent second molar.Clinical trial registration numberChiCTR2000040063

Incidence of lingual nerve damage following surgical extraction of mandibular third molars with lingual flap retraction: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to examine more recent data to determine the extent of lingual nerve injury (LNI) following the surgical extraction of mandibular third molars (M3M). A systematic search of three databases [PubMed, Web of Science and OVID] was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria encompassed studies on patients who underwent surgical M3M extraction using the buccal approach without lingual flap retraction (BA-), buccal approach with lingual flap retraction (BA+), and lingual split technique (LS). The outcome measures expressed in LNI count were converted to risk ratios (RR). Twenty-seven studies were included in the systematic review, nine were eligible for meta-analysis. Combined RR for LNI (BA+ versus BA-) was 4.80 [95% Confidence Interval:3.28-7.02; P<0.00001]. The prevalence of permanent LNI following BA-, BA+ and LS (mean%±SD%) was 0.18±0.38, 0.07±0.21, and 0.28±0.48 respectively. This study concluded that there was an increased risk of temporary LNI following M3M surgical extractions using BA+ and LS. There was insufficient evidence to determine whether there is a significant advantage of BA+ or LS in reducing permanent LNI risk. Operators should use lingual retraction with caution due to the increased temporary LNI risk.

Bone Window Technique in Endodontic Microsurgery – Report of Two Cases

Endodontic microsurgery was introduced in the ‘90s and has significantly increased the success rate of apical surgical intervention the last few decades. Utilizing the dental operating microscope, ultrasonic tips for root end preparation and biocompatible root end filling materials, predictably manages the apical pathology preserving the buccal cortical plate. The bone window technique for buccal approach to the apical area involves the use of piezoelectric unit to prepare and elevate a buccal cortical bony window and the reposition of the bone after the apical root end filling is completed. Two cases are reported in this article, highlighting the importance of endodontic microsurgery and buccal bone window technique in addressing apical pathology in a minimally invasive way, preserving the hard tissues and the tooth structure. Cases were reevaluated clinically and radiographically after a period of 3 months up to 36 months.

Intra-alveolar extraction of linguoverted mandibular premolars - the Shetye technique: a technical note.

Extraction of premolars for orthodontic purposes may prove challenging when the tooth is blocked or lingualised. The standard buccal approach may prove difficult in such cases. A novel technique was used for 16 patients with healthy linguoverted mandibular premolars using maxillary extraction forceps. The ease of extraction increased and resulted in uneventful postoperative healing in all patients. The authors suggest this as a preferred technique for extracting mandibular premolars in linguoversion.

A Buccal Space Approach for Midface Free Flap Reconstruction.

This article describes a transbuccal approach to reach the facial vessels. The anatomy of this intraoral approach is predictable, minimizing the risk of facial nerve dysfunction. This technique provides the possibility of free flap midface reconstruction with short pedicles and avoids the need to use vein grafts. Moreover, it is esthetically preferable. Through cadaver dissection and anatomical drawings, we describe extensively the different surgical steps. Using the combination of the previous knowledge and recent anatomical understandings, we can provide a reliable step-by-step approach to find the facial artery and vein through a transbuccal approach for microvascular midface free flap repair.

English

The average time consumed for disimpaction of mandibular third molar using rotatory instruments was approximately 17 mins and 23 mins while using a piezotome. The authors introduce a new technique of disimpaction of mandibular third molar with the least amount of bone removal ever achieved during mandibular third molar removal. This technique can be readily included in routine clinical practice and can be performed by using routine rotary instruments. This technique was successfully accomplished in 10 individuals with the least amount of discomfort and post-operative complications reported from day 1 to day 14. The procedure was evaluated based on time of the procedure, pain score, bleeding, nerve injury, trismus, swelling &amp; dry socket. Third molar removal has been the most frequently performed oral surgical procedure in the modern world of dentistry.1 Although, mandibular third molar is the most commonly performed procedure, it demands skill, technique and experience. Several techniques have been implied for disimpaction of mandibular third molar, but every method involves either considerable amount of bone removal or splitting the bone. Bone manipulation is done by using a rotary instruments or chisel and mallet. The most popular techniques are buccal bone guttering, distal bone removal, lingual bone split technique and lingual bone guttering.2 According to the traditional classifications of impacted mandibular third molar (Pell &amp; Gregory and Winter’s classification), the minimum amount of bucco-distal bone removed during disimpaction of mesioangularly positioned class I A impacted mandibular third molar using rotary instruments and conventional techniques can be calculated as 157.5 mm2 (volume of a rectangle = L X W X H; where L = 15 mm, W = 1.5 mm [width of the bur] and H = 7 mm). The mandibular third molar requiring osteotomy and tooth section have the highest risk of complications3. Surgical time had significantly increased in cases which required osteotomy and tooth section. Post-operative swelling and pain has been recorded as significant complications after using rotary instruments via buccal approach followed by use of chisel &amp; mallet and least in lingual split approach. On the contrary, post-operative nerve injury and trismus were significantly high in lingual split technique. Dry socket was more in patients of bur technique.2

Selective Retreatment and Sinus Lift: An Alternative Approach to Surgically Manage the Palatal Roots of Maxillary Molars

Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge because of the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report presents 2 clinical cases in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective nonsurgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using cone-beam computed tomographic imaging immediately after the surgery and at multiple follow-up appointments. The cone-beam computed tomographic images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.

An Anatomical Study of the Foramen Ovale for Neuromodulation of Trigeminal Neuropathic Pain

Neuromodulation for trigeminal pain syndromes such as trigeminal neuropathic pain (TNP) necessitates accurate localization of foramen ovale (FO). The Härtel-type approach is very well-established and safe, ideal for temporary cannulation of the FO for ablative procedures such as balloon microcompression. A key shortcoming of the Hartel approach for placement of neuromodulation leads is the limited opportunity for secure anchoring. The aim of this study is to introduce a novel surgical approach for the treatment of TNP by investigating key osseous landmarks and their spatial relationships to the FO. Sixteen sides of cadaver heads were dissected to investigate a surgical route of the FO via transoral gingival buccal approach. Alveolar arch of the maxilla and zygomaticomaxillary suture were selected to serve as an osseous landmark for the surgical guidance to the FO. Through the intraoral route, a needle simulating electrode was traversed to aim the FO from the inferior lateral to the superior medial direction to target specific fibers of the aimed division of the nerve. Visual identification and access to the trigeminal nerve at the external opening of FO was successful in all 16 hemifacial cadavers. A needle successfully targeted different regions of the trigeminal nerve by changing the angle of the trajectory allowing the needle to reach a specific division of the trigeminal nerve. This study provides a novel means of approaching the FO via transoral gingival buccal access.

Anatomical consideration for optimal position of orthodontic miniscrews in the maxilla: a CBCT appraisal

ABSTRACTBACKGROUND: Orthodontic miniscrews are commonly used as temporary anchorage devices. Bone thickness and bone depth are important factors when placing miniscrews. There are no studies to assess the maxillary bone thickness for optimum miniscrew placement in a Saudi population.OBJECTIVE: Assess the proximity of the maxillary sinus and nasal cavity in areas where miniscrews are usually inserted using cone beam computed tomography (CBCT).DESIGN: Retrospective, cross-sectional.SETTING: Department of maxillofacial radiology in a Saudi dental school.PATIENTS AND METHODS: Using CBCT images, we measured the distance between the maxillary sinus and nasal cavity to the palatal bone, buccal intra-radicular and infrazygomatic crest areas. Mean values (SD) were compared at various locations, including by gender, and correlation with age was calculated.MAIN OUTCOME MEASURE: Mean bone thickness at commonly used sites for orthodontic miniscrew placements in the maxilla. Secondary outcome was the insertion angle in the infrazygomatic crest area.SAMPLE SIZE: CBCT images of 100 patients (50 males and 50 females).RESULTS: The mean (standard deviation) age for the sample was 25.4 (6.5) years with no significant difference between males and females. In the palate, the distance to the nasal cavity and maxillary sinus was greater anteriorly and decreased significantly posteriorly (P<.001). Buccally, the interdental bone depth was significantly greater between the second premolar and first molar (11.96 mm) compared to between the central and lateral incisors (7.53 mm, P<.001). The mean bone thickness of the infrazygomatic crest area at a 45° insertion angle was 4.94 mm compared to 3.90 at a 70° insertion angle (P<.001). No correlation was found between age and bone thickness.CONCLUSION: The distance to the nasal cavity and maxillary sinus was greater in the anterior than posterior areas. There is minimal risk of injuring the maxillary sinus or nasal cavity using the buccal approach. Caution is needed when placing miniscrews in the infrazygomatic crest area.LIMITATIONS: Cross-sectional study from one center; hence, findings cannot be generalized to other populations.CONFLICT OF INTEREST: None.

PALATAL VERSUS BUCCAL ANTRAL APPROACH FOR MAXILLARY SINUS LIFTING AND IMPLANT PLACEMENT

INTRODUCTION: Implant placement in the maxillary posterior alveolar ridge is often complicated by post extraction bone resorption, pneumatization of maxillary sinuses, and poor quality of alveolar bone. In these situations, the residual vertical bone height is reduced making standard implant placement difficult. Elevation of the maxillary sinus floor using the lateral antral approach is one possible solution. Palatal window osteotomy approach for maxillary sinus floor lifting is a new surgical technique used to increase vertical bone height prior to implant placement. OBJECTIVES: This study was designed for clinical evaluation of the maxillary sinus lifting technique using a palatal approach versus buccal approach. MATERIALS AND METHODS: this study was carried out as a randomized controlled clinical trial, the study sample included 14 patients. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. All patients were divided into two equal groups, had gone maxillary sinus lifting together with implant placement, group1 :( study group) seven patients had sinus lifting through the palatal approach technique simultaneously with implant insertion. In group2 (control group) seven patients had maxillary sinus lifting using buccal antral approach technique simultaneously with implant insertion. Clinical and radiographic evaluation was done through 6 months postoperatively. RESULTS: Regarding postoperative clinical evaluation, group 1 was superior to that of group 2 in tissue management, because the vestibular anatomy in this group was not altered neither postoperative swelling occurred consequently nor disharmonious soft tissue scarring. Regarding the postoperative radiographic evaluation, group 1 was significantly increased in bone density around dental implants and less marginal bone loss postoperatively, however group 2 had higher vertical amount of bone gained around implants postoperatively. CONCLUSIONS: The palatal sinus lifting approach permitted higher postoperative comfort, less postoperative edema, less marginal bone loss around implants, and higher bone density around implants postoperatively.

Use of Interarch Width Ratio to measure Transverse Relationship: A New Method to measure and assess Interarch Discrepancy

The purpose of this study was to assess the arch width, transverse discrepancy, and transverse interarch ratio for class I malocclusion sample, with and without crossbite, in permanent dentition stage. Records of class I malocclusion patients with minimal crowding and spacing with and without posterior crossbite were selected. Each group consisted of 40 pairs of dental casts (20 males and 20 females). Arch widths were measured for the canine, first, and second premolars, and first permanent molars using the buccal approach. Means and standard deviations (SDs) of dental arch widths were measured for the maxillary and mandibular arches, and the interarch width ratio was calculated. There was a highly significant difference between the noncrossbite and crossbite groups regarding the maxillary width, p < 0.001. However, no differences were found between groups for the mandibular widths, p > 0.01. There were also significant differences between both groups for the intercanine, first and second premolars, and first molar ratios, p < 0.001. This new simple method showed that a transverse maxillary-mandibular ratio of 1:1.1 is ideal. A ratio less than 1:0.9 will indicate the presence of crossbite. The interarch ratio significantly aids in orthodontic treatment planning in patients requiring maxillary expansion and/or surgical cases.

The Buccal Lid Approach for Removal of Impacted Mandibular Molars—When, How and Why?

Background: The surgical removal of impacted mandibular molars represents one of the most prevalent procedures carried out by the oral and maxillofacial surgeon. Despite its prevalence, unusual impaction location of mandibular molars necessitates alternative extraction approaches. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. The aim of this study was to evaluate the outcome of the bony lid approach in extracting mandibular molars. In addition, critical clinical key points, new aspects while performing this procedure, indications and contraindications are discussed. Materials and Methods: 9 patients were treated with the bony lid technique. A retrospective analysis of medical charts was conducted to evaluate the results of surgery. Results: The operative technique described in the article was successfully carried out in 12 cases of impacted mandibular molars. No incidence of permanent sensory deficit was recorded. In one patient, an infection mandated the removal of the bony lids. In all other cases the healing process was uneventful. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve.

Comparison of three different crown-lengthening procedures in the maxillary anterior esthetic regions.

A papilla preservation crown-lengthening procedure (PPCL) was proposed for treatment of the maxillary anterior teeth (canine to canine) and compared to two traditional techniques. Thirty patients were assigned to three treatment groups: PPCL, the apically positioned flap with buccal approach (APF-B), and the apically positioned flap with buccal and palatal approach (APF-BP). Several clinical parameters were recorded at baseline and 6 months after surgery. Although no statistically significant differences were reported in many of the clinical parameters examined, APF-B and APF-BP showed a significantly higher interproximal clinical attachment loss when compared to PPCL. In the PPCL group, there was a significant increase in esthetic appraisal by the patients. Crown lengthening using a papilla-preservation flap approach and osseous recontouring is a viable alternative approach and could be useful in esthetic regions.

Modified Flap Design for Lower Third Molar Surgery: A Short Patient-based Outcome Comparative Study

Objectives: to compare the influence of a newly suggest modified flap design on pain and swelling with the traditional two sided flap.&#x0D; Materials and Methods: Patients were divided into two groups: conventional approach (control) group (n=42) and modified approach (experimental) group (n=41). Pain and swelling were evaluated for the first three postoperative days using 10 cm visual analogue scales. Presence of dry socket was documented in the 7th postoperative day.&#x0D; Results: There was statistically significant difference on the third postoperative day (p &lt;0.05) in the mean pain score between the two surgical groups. The mean score of swelling in conventional group&#x0D; was slightly higher than the modified approach (p&lt;0.05) in the first and the third post operative days. The incidence of dry socket in the modified approach was significantly less than conventional approach group (p &lt;0.001).&#x0D; Conclusions: The modified flap design has a relative advantage over the conventional two sided buccal approach in terms of postoperative pain, swelling and dry socket incidence.

Eventuality of Dexamethasone Injected Intra-massetrically on Post Operative Sequel Following the Surgical Extraction of Impacted Mandibular Third Molars: A Prospective Study.

The objective of the study was to compare the efficacy of dexamethasone given intra-massetrically via intra buccal approach on postoperative sequele after surgical extraction of impacted mandibular third molars. Twenty patients, each of who required surgical extraction of a single impacted mandibular third molar under local anesthesia, were randomly set apart to one of the two groups of ten each. The experimental group received dexamethasone 8mg injected to the masseter muscle intra buccally and the control group did not receive any steroid. Facial swelling and maximal inter-incisal distance were measured by an independent examiner preoperatively, and at 4th h, on the day of surgery, 2 and 7 postoperative days. Pain was measured from the patient's response to a visual analogue scale. Patients were of the age range 18-40years. Dexamethasone group showed significant reduction in swelling and pain compared with the control group at all intervals. Dexamethasone injected into the masseter muscle via intra buccal approach resulted in significantly less trismus than control on day one postoperatively. Dexamethasone 8mg given intra-massetrically through intra buccal approach is an effective way of minimizing swelling, trismus, and pain following surgical extraction of impacted mandibular third molars. It offers a simple, safe, painless, non-invasive and cost-effective treatment.

One stage combined endoscopic and per-oral buccal fat pad approach for large oro-antral-fistula closure with secondary chronic maxillary sinusitis.

There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF ≤ 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral BFP regional flap for OAF closure. Total OAF closure, complications and need for revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent rhinorrhea (n = 22, 48.9 %), foreign body in sinus (n = 10, 22.2 %) nasal congestion (n = 7, 15.5 %), halitosis (n = 6, 13.3 %) and pain (n = 5, 12.2 %). Surgical complications included local pain (n = 2, 4.4 %), persistent rhinitis (n = 2, 4.4 %) and synechia (n = 1, 2.2 %). One patient required revision surgery due to an unresolved OAF. The OAF of all the other 44 patients (97.8 %) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported. Combined, one step, endoscopic Maxillary sinus drainage together with per-oral BFP flap approach is an efficacious surgical approach for safe closure of OAFs that are complicated with secondary chronic maxillary sinusitis.

Bur Technique and Chisel Mallet Technique in Impacted 3rd Molar

Surgical removal of impacted third molar is one of the common surgical procedures carried out in Oral and Maxillofacial Surgery set up. This study aimed at clinically assessing the three different surgical techniques (lingual split, using chisel and mallet, buccal approach techniques, using rotary instruments used in the removal of impacted mandibular third molars