Inferior Alveolar Nerve Canal Research Articles

Altered sensation following extrusion of an endodontic file treated by intentional replantation: case report and treatment recommendations.

An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal (IANC) and provide a protocol for managing nerve injuries in such incidents. A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into IANC during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was a-traumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The Root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and MTA. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. Subsequently, after completing the endodontic treatment. a stainless-steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, Periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success. Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes.

A rare case of unilateral double Stafne bone defects and literature review.

Stafne bone defect (SBD) is a rare developmental bone defect characterized by an asymptomatic focal concavity of the cortical bone, typically on the lingual aspect of the mandibular body, which generally contains salivary gland tissue. It can be detected during routine dental examinations and typically appears as an ovoid, well-defined, well-corticated, radiolucent depression in the posterior mandibular region below the inferior alveolar nerve (IAN) (in: Neville et al, Oral and maxillofacial pathology, Elsevier, Inc, St. Louis, MO, 2016).An 80-year-old male presented to our clinic for a routine dental examination. Panoramic radiography and cone-beam computed tomography (CBCT) displayed two well-defined, well-corticated, ovoid radiolucencies inferior to the IAN canal on the left mandibular molar region. The working diagnosis was SBD, and the patient was informed of the findings. Irregular margins on the superior aspect of the anterior defect were noted on CBCT imaging; therefore, follow-up with panoramic images at 6months, 1 and 5years was recommended.

Inferior Alveolar Nerve Canal Segmentation on CBCT Using U-Net with Frequency Attentions.

Accurate inferior alveolar nerve (IAN) canal segmentation has been considered a crucial task in dentistry. Failing to accurately identify the position of the IAN canal may lead to nerve injury during dental procedures. While IAN canals can be detected from dental cone beam computed tomography, they are usually difficult for dentists to precisely identify as the canals are thin, small, and span across many slices. This paper focuses on improving accuracy in segmenting the IAN canals. By integrating our proposed frequency-domain attention mechanism in UNet, the proposed frequency attention UNet (FAUNet) is able to achieve 75.55% and 81.35% in the Dice and surface Dice coefficients, respectively, which are much higher than other competitive methods, by adding only 224 parameters to the classical UNet. Compared to the classical UNet, our proposed FAUNet achieves a 2.39% and 2.82% gain in the Dice coefficient and the surface Dice coefficient, respectively. The potential advantage of developing attention in the frequency domain is also discussed, which revealed that the frequency-domain attention mechanisms can achieve better performance than their spatial-domain counterparts.

Removal of Horizontally Impacted Mandibular Third Molars Using the Three-Piece or T-Shaped Tooth Sectioning Method

BackgroundThe extraction of horizontally impacted mandibular third molars (HM3) can be a complicated surgery. Appropriate tooth sectioning methods can reduce the operation time and postoperative complications. PurposeThe current study compares operative time and postoperative pain between HM3 removed using the three-piece or T-shaped tooth sectioning techniques. Study design, setting, sampleA randomized single-blind prospective clinical trial on HM3 extraction was carried out between June and December 2022 in the Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University. Patients with local or systemic infection, poor oral hygiene and systemic disease were excluded. Predictor variableThe predictor variable was the tooth sectioning method. The subjects were randomized to three-piece or T-shaped group. Main outcome variablesThe primary outcome variables were the operative time and postoperative pain measured using a visual analogue scale (VAS). The secondary outcome variables were the rates of primary bleeding, mouth opening reduction (MOR), swelling, patient satisfaction measured using a VAS and quality of life measured using a postoperative symptom severity (PoSSe) scale. CovariatesThe covariates included age, sex, side and classification of HM3, and the relationship of HM3 to the inferior alveolar nerve (IAN) canal. AnalysesThe data were analyzed using the independent samples t-test, paired t-test, chi-square and rank sum test. A significance level set at P < 0.05. ResultsThe sample included 60 patients in the three-piece group and 66 patients in the T-shaped group. The operative time of the three-piece group (14.73 ± 3.21 min) was shorter than that of the T-shaped group (19.25 ± 4.29 min) (P < 0.05). On day 3 and 7, VAS of pain were 2.24±1.89 and 0.15±0.40 in the three-piece group , and 3.95±2.44 and 0.48±0.68 in the T-shaped group (P < 0.05). The VAS of patient satisfaction in three-piece group (6.05±1.29) was better than T-shaped group (4.90±1.05) on day 7 (P < 0.05). Conclusion and RelevanceThe three-piece tooth sectioning for HM3 removal was associated with shorter duration, slighter postoperative symptoms and higher patient satisfaction, and may be considered as a recommended practice for dentists.

ANATOMICAL VARIABILITY OF THE SEGMENTS OF THE INFERIOR ALVEOLAR NERVE IN THE PEOPLE OF SECOND PERIOD OF MATURE AND OLDER AGE

To avoid complications of bicortical implantation, great importance is attached to the study of individual morphological features of the mandible and its structures, in particular, the anatomical variability of the inferior alveolar nerve (IAN) and mandibular canal. The purpose of the study was to fi nd out the peculiarities of the structure, topography and individual anatomical variability of the IAN in persons of the second period of maturity and older age. Cone-beam computer tomography of 54 people of both sexes aged 45-65 years with three- dimensional reconstruction, morphometry and statistical analysis was studied. On the basis of our own research on the topographical and anatomical features of the IAN and its syntopy with the mandible, in particular, with the mandibular canal, we propose to distinguish 4 of its divisions: extra- canal – from the place of formation to the entrance to the mandibular canal; intracanal – from the mandibular foramen to the mental foramen; mental – after exiting the mandibular canal; incisive – after the departure of the mental branch. The topographical and anatomical features and anatomical variability of the IAN were studied. In people of the second period of mature and elderly age, anatomical variability of the macroscopic structure and topography of the IAN was established, which manifested itself in high (4.0-11.0 mm) and low (22.0-33.0 mm) levels, relative to the foramen ovale its beginning and form (one or two trunks) of departure from the mandibular nerve. The largest number of nerve connections with other branches of the mandibular nerve is formed by the extracanal section of the IAN: with the auriculo-t emporal nerve (29 cases – 53.7 %), with the lingual nerve (5 cases – 9.26 %), with the nerve of the medial pterygoid muscle (3 observations – 5.56 %) and with the nerve of the lateral pterygoid muscle (2 specimens – 3.7 %). A diff erent level of departure of the nerve to mylohyoid from the extracanal section of the IAN was established: high (5.0-7.0 mm) and low (27.0-31.0 mm). Anatomical variability of the intracanal part of the IAN was manifested by structural variants: a single trunk (43 cases, 79.6 %), rarely – two trunks (11 observations, 20.4 %) and very rarely – the lower dental plexus (6 specimens, 11,11 %). The proximity of the roots of the 7th and 8th teeth to the IAN can be the cause of severe pain in the pathology of these teeth and cause nerve damage during their removal. Nerve connections occur between the right and left incisive nerves, the knowledge of which is an important practical value for performing anesthesia of the front row of teeth. The number of branches to the teeth, interalveolar septa and gingiva from the IAN signifi cantly decreases with age and with a violation of the integrity of the dentition.

Morphological and quantitative study of the inferior alveolar nerve canal in hemifacial microsomia.

This study aimed to probe into the anatomic course of inferior alveolar nerve canal (IANC) in hemifacial microsomia (HFM) on a large scale, morphological observations and further quantitative study were performed. Patients were classified by Pruzansky-Kaban classification. The anatomic course of IANC was analyzed morphologically with three-dimensional (3D) imaging software among 248 patients. Seven distances between fixed landmarks on both sides were measured for 236 patients. The differences between affected and unaffected sides were compared. Significant differences were found in the entrance (P < 0.001), route (P < 0.001), and exit (P < 0.05) of IANC in type IIb and III HFM. The higher the degree of mandibular deformity was, the higher the incidence of IANC variation was (P < 0.05). The distances in the horizontal aspect of IANC including from mandibular foramen to mental foramen (P < 0.05) and from mental foramen to gonion (P < 0.05) were significantly shorter on the affected side. Abnormalities of the anatomical course of IANC exist in patients with Pruzansky-Kaban type IIb and type III HFM. The reduction of IANC on the affected side in the horizontal distance is more obvious. Three-dimensional imaging assessment is recommended before surgery.

Immediate implant placement in the posterior mandibular region was assisted by dynamic real-time navigation: a retrospective study

BackgroundEfficient utilization of residual bone volume and the prevention of inferior alveolar nerve injury are critical considerations in immediate implant placement (IIP) within the posterior mandibular region. Addressing these challenges, this study focuses on the clinical efficacy and implant accuracy of dynamic real-time navigation, an emerging technology designed to enhance precision in implantation procedures.MethodsThis study included 84 patients with 130 implants undergoing immediate placement in the posterior mandibular region. Stratified into dynamic navigation, static guide plate, and freehand implant groups, clinical indicators, including initial stability, distance to the inferior alveolar nerve canal, depth of implant placement, and various deviations, were systematically recorded. Statistical analysis, employing 1- or 2-way ANOVA and Student’s t-test, allowed for a comprehensive evaluation of the efficacy of each technique.ResultsAll 130 implants were successfully placed with an average torque of 22.53 ± 5.93 N.cm. In the navigation group, the distance to the inferior alveolar nerve and the depth of implant placement were significantly greater compared to the guide plate and freehand groups (P < 0.05). Implant deviation was significantly smaller in both the navigation and guide plate groups compared to the freehand group(P < 0.05). Additionally, the navigation group exhibited significantly reduced root and angle deviations compared to the guide plate group(P < 0.05), highlighting the superior precision of navigation-assisted immediate implant placement.ConclusionsIt is more advantageous to use dynamic navigation rather than a static guide plate and free-hand implant insertion for immediate posterior mandibular implant implantation.

ISSN Print 0719-2460 - ISSN Online 0719-2479. Attribution 4.0 International (CC BY 4.0). https://www.joralres.com/index.php/JOralRes/issue/archive© 2023Evaluación basada en tomografía computarizada de haz cónico de la relación entre el canal alveolar inferior y las placas corticales y las raíces de los molares mandibulares en la subpoblación saudita

Aim: To assess the distance between the inferior alveolar canal and the roots of the mandibular second molar and the mandibula and cortex in a Saudi Arabian subpopulation through existing CBCT images. Materials and Methods: This retrospective study was performed based on 120 patients CBCT images in five age groups.The distances (D1 and D2) between the buccal cortex (BC), lingual cortex (LC), and mandibular molars and the distances (D3) between the root apices and inferior alveolar nerve canal (IANC) were measured for each dental root on the right and left of the mandible with the help of Vision iCAT software. A radiology specialist with a gap of 15 days twice carried out the measurements. Statistical analysis was carried out with the help of SPSS 24. to analyse variability Chi-square analysis was done, and the p value was fixed at &gt; 0.05. To check inter-person variability, Cohen’s variability was fixed at 0.8. Results: The distance between the outer surface of the buccal cortical plate and the buccal root surface ranged between 3.8 and 5.7 mm, whereas the distance between the root apices of the mandibular molars and the IANC ranged between 4.8 and 3.5 mm. The distance from the outer surface of the lingual cortical plate to the lingual root surface varied between 1.2 and 2.8 mm. The mean distance between the root apices and IANC increased with age, more so in males than females. Conclusions: Even though this study was conducted on a small sample size, it will help the dental practitioners in planning endodontic procedures, surgical extractions, and implant placements, and it should be repeated with a higher number of images. Keywords: Radiology; Cone-beam computed tomography; Inferior alveolar nerve; Molars; Mandible; Saudi Arabia

Radiological evaluation of inferior alveolar nerve displacement after removal of impacted mandibular third molars prior to sagittal split osteotomy

IntroductionWe hypothesize that the removal of mandibular third molars (M3) 6 months prior to a bilateral sagittal split osteotomy (BSSO) could allow the displacement of the inferior alveolar nerve (IAN) in a favorable lingual position. This study aimed to radiographically compare the position of IAN before and after M3 removal in patients with Class II malocclusion. Materials and methodThe CBCT images of 30 randomly selected patients (mean age 15.5 years, 19 females and 11 males) were segmented regarding the mandibular bone and the IAN canal. Mandibles were then superimposed and compared using 3D slicer (www.slicer.org). An orthonormal system was constructed, and the coordinates of IAN were assessed in the x- (horizontal axis), y- (depth axis), and z- (vertical axis) directions. ResultsThe mean changes in x- and z-values were 0.37 %, -0.09 % for the right IAN, 0.07 %, and -0.10 % for the left IAN, respectively. Y-axis was the dimension the most impacted by the M3 removal with a mean variation of -11.96 % for the right IAN, and 0.45 % for the left nerve (p1=0.74 and p2=0.04, respectively). Three patients presented a change in the IAN position superior to 1 mm on at least one coordinate axis. We observed a more important change in x-values of the right IAN in male than in female (p = 0.04), and no significant modifications regarding the other dimensions. Finally, there was no correlation between the age of the patients and the changes in IAN position. ConclusionThis study confirms the absence of influence of mandibular third molar removal on the inferior alveolar nerve route prior to BSSO.

Analysis of the Relation between Inferior Alveolar Nerve Canal and the Roots of Impacted Mandibular Third Molars in the Local Population of Punjab

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; It is important to understand the proximity of the inferior alveolar nerve canal (IANC) and lower third molar before performing any surgical procedure. The aim of the study was to determine the proximity of the IANC to the lower third molar and the pattern of impaction among the population of Punjab, Pakistan.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional observational study was conducted from December, 2021 to November, 2022 in the Maxillofacial Surgery departments of four private dental institutes in Punjab. A total of 134 patients were recruited. The IANC proximity and impaction pattern of the lower third molars of both sides were assessed using cone beam computed tomography images. Statistical Package for Social Sciences was used for analysis and a p-value less than or equal to 0.05 was set as significant.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 76 (56.7%) males and 58 (43.3%) females, with the majority belonging to the age range from 40 to 59 years. The mean proximity of IANC to the impacted third molar was 1.87 + 2.33 mm. Sixty-seven participants had IANC in close proximity (less than 1 mm) to the impacted third molar. IANC was positioned apically with the least proximity to the impacted third molar in 56% of the participants. Moreover, 20 (4.9%) impacted third molars, affecting mostly females, were in direct contact with the canal. Most of the impacted third molars were in vertical position [89 (66.4%)] followed by mesioangular [22 (16.4%)] and horizontal [21(15.7%)] positions, respectively.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Most of the patients with impacted third molars had IANC in close proximity (less than 1 mm) to the impacted tooth with a possible risk for nerve injury during surgical extraction making it imperative to assess the position of the IANC before performing dental procedures.&lt;/p&gt;

Intraosseous schwannoma of the mandible: new case series, literature update, and proposal of a classification

Intraosseous schwannoma of the mandible is rare, with diagnostic and therapeutic challenges. The aims of this study were to report new cases of intraosseous schwannoma of the mandible and to propose a clinical classification, providing suggestions for treatment methods. The cases of 13 patients treated at the authors’ hospital and 86 cases reported previously in the literature were reviewed. The most common clinical feature was facial swelling (60/93). The rate of cortical thinning or expansion was 44.8% (43/96); widening of the inferior alveolar nerve canal on radiographs was observed in 15 patients.

Comparative Evaluation of a Lower-Dose CBCT Acquisition Protocol for Preoperative Implant Site Assessment in Dry Human Skulls: A Proof-of-Concept Study.

Restoration of edentulous sites with dental implants is increasingly becoming a popular choice. Cross-sectional 3-dimensional imaging using cone-beam computed tomography (CBCT) provides a better depiction of the implant site to help the clinician plan the procedure better. In spite of the advantages, radiation dose will always remain a concern. The evolution of lower-dose protocols is ongoing, but whether those acquisition protocols yield comparable diagnostic information is still not well established. The objective of this study was to evaluate the diagnostic efficacy of a low-dose, 180° rotational CBCT acquisition protocol for evaluating a potential implant site in comparison with a conventional 360° rotational acquisition. Ten dentate and partially edentulous dry human skulls providing 82 randomized implant sites-40 in the maxilla and 42 in the mandible-were chosen for this study. Each skull was imaged using a 360° and a 180° rotational acquisition on a J. Morita Accuitomo CBCT scanner. Evaluation of cortical and trabecular bone, height, width, and proximity to critical structures, such as the inferior alveolar nerve canal and the maxillary sinus, were measured. An oral surgeon and an oral radiologist rated the diagnostic efficacy of the scans by evaluating the above characteristics. Statistical evaluation of the data with linear regression showed significant agreement between both protocol measurements. Kappa analyses yielded a good interobserver agreement. In this proof-of-concept study, CBCT imaging using the lower-dose, modified arc, and 180° acquisition protocol shows comparable results to the conventional 360° protocol for preoperative implant assessment.

An Insight Into the Effect of Odontogenic Keratocysts on Surrounding Structures: Cone-Beam Computed Tomography-Based Analysis of Cases.

Introduction An odontogenic keratocyst (OKC) is a benign intraosseous lesion with potential to demonstrate aggressive and invasive behavior. The aim of this retrospective study was to analyze the imaging features of the OKCusing cone-beam computed tomography (CBCT) and to evaluate the association between the internal structure of the lesion and the effect of the lesion on surrounding structures. Methods Overall, 32 CBCT scans of histopathologically diagnosed cases of OKC were analyzed retrospectively. The following variables were analyzed: anatomic location of the lesions (mandible body (right/left), ramus (right/left), mandible body+ramus (right/left), maxilla (right/left), and both jaws), the internal structure of the lesion (unilocular/multilocular), and the effect ofthe lesion on the surrounding anatomical structures (involvement of the inferior alveolar nerve canal (IANC), displacement of the IANC, cortical expansion, displacement of the tooth, resorption of the root, associated impacted tooth, associated missing tooth). We also looked for the association between the internal structure and the effect of the lesion on anatomic structures. Results Out of 32 cases, 29 (90.6%) cases involved the mandible alone. Statistically significant association (p-value 0.005) was present between the internal structure and mean age of presentation as well as between the internal structure and impacted tooth (p-value 0.027). The association between the internal structure and other variables was statistically not significant. Conclusions The radiographic features of OKCs can be variable, and these lesions have a considerable effect on the tooth, IANC, and cortical bone. Significant association was found between the internal structure, age, and impacted tooth. Since OKCs have a high recurrence rate, CBCT is advised for evaluating the extent and location of any cortical perforations.

Comparative evaluation of a lower dose CBCT acquisition protocol for preoperative implant site assessment in dry human skulls.

Restoration of edentulous sites with dental implants is increasingly becoming a popular choice. Cross-sectional 3D imaging using CBCT provides a superior view of the implant site to help the clinician plan the procedure better. In spite of the advantages, radiation dose remains a concern. The evolution of lower dose protocols is ongoing but whether those acquisition protocols yield comparable diagnostic information is still not well established. The objective of this study was to evaluate the diagnostic efficacy of a low dose, 180˚ rotational CBCT acquisition protocol for evaluating a potential implant site in comparison with a conventional 360˚ rotational acquisition. Ten dentate and partially edentulous dry human skulls were chosen for this study. Each skull was imaged using a 360˚ and a 180˚ rotational acquisition on a J. Morita's Accuitomo CBCT scanner. 82 randomized implant sites, 40 in the maxilla and 42 in the mandible were analyzed. Evaluation of cortical and trabecular bone, proximity to crucial structures such as the inferior alveolar nerve canal and the maxillary sinus, and width of the potential placement site were measured. An oral surgeon and an oral radiologist rated the diagnostic efficacy of the scans by evaluating the above characteristics. Statistical evaluation of the data with linear regression showed significant agreement between both protocol measurements. Kappa analyses yielded a good inter-observer agreement. In this ex-vivo study, there was no significant difference in both the qualitative and quantitate evaluation between the conventional 36 0˚ acquisition protocol and the modified lower dose 180˚ rotational protocol.

FREQUENCY OF PARESTHESIA DUE TO INFERIOR ALVEOLAR NERVE DAMAGE AFTER EXTRACTION OF MANDIBULAR THIRD MOLAR AMONG PATIENTS SHOWING DARKENING OF ROOT IN ORTHOPANTOMOGRAM

Background: Paresthesia is an abnormal dermal sensation with no apparent physical cause. One of the everyday practices in any oral surgery setup is the extraction of the impacted mandibular third molars surgically. Precise measurement of the bone present for support of the implant coronal to the inferior alveolar nerve (IAN) canal is the pertinent way to prevent IAN injuries.&#x0D; Objective: To assess the frequency of paresthesia due to IAN damage after mandibular third molar’s surgical extraction in patients with darkening of root on orthopantomogram.&#x0D; Material &amp; Methods: It was a descriptive case series study which took place in the department of Oral and Maxillofacial Surgery at Sharif Medical and Dental College, Lahore in a time frame of 6 months i.e. from December 2020 till May 2021. After meeting the inclusion/exclusion criteria, 200 patients were made part of the study program. Informed consent and demographic information was recorded. Surgical procedure of all these patients was done. Assessment was done post-operatively first after one week when patient came for suture removal by inquiring about the subjective perception of abnormal feeling or sensation on lower lip and chin area. Patients were then reappointed for a follow-up visit after 1 month as well.&#x0D; Results: Patients’ mean age was 28.05±3.94 years. There were 104 (52%) males and 96 (48%) females in the study population. There were 38 (19%) patients of distoangular impaction, 39 (19.5%) had horizontal impaction, 55 (27.5%) had mesioangular impaction while 68 (34%) had vertical impaction. The IAN paresthesia after 1st month of surgery was found in 13 (6.5%) patients.&#x0D; Conclusion: According to this study, the frequency of paresthesia after 1st month of surgery was 6.5% due to IAN injury after mandibular third molar surgery in patients with darkening of root as observed on orthopantomogram.&#x0D; Keywords: Inferior Alveolar Nerve, Orthopantomogram, Paresthesia, Third Molar Surgery.

Management of Temporomandibular Joint Reankylosis: A Case Series.

Background Temporomandibular joint ankylosis is a severe debilitating clinical condition where there is fusion of the mandible with the temporal bone. It is often a challenge to the maxillofacial surgeon as the surgical treatment protocol must be tailored individually according to the time of presentation of the ankylosis, and proper postoperative aggressive physiotherapy must be advocated, which is essential for a successful outcome. This is a case series of six recurrent temporomandibular joint ankylosis, in which the historical Esmarch surgery was done, and the pterygomassetric sling was interposed between the osteotomized segments. Postoperative mouth opening and surgical outcome were satisfactory. In our cases, we created a pseudojoint, which was very successful using the Esmarch procedure. Aim We aim to improve mouth opening in patients presenting with temporomandibular joint reankylosis using the Esmarch procedure and evaluate the efficacy of the conventional and modified Esmarch procedure. Materials and methods We have included six cases of recurrent temporomandibular joint reankylosis. Five cases were operated on using the conventional Esmarch procedure in which the osteotomy was done at the angle region, below the inferior alveolar nerve canal, and one case using the modified Esmarch procedure, wherein the osteotomy was done above the inferior alveolar nerve canal. The patients included in the case series presented withtemporomandibular joint reankylosis and had undergone multiple surgeries for the release of ankylosis. Results Satisfactory postoperative mouth opening was achieved in all six patients. It wasobserved that in the modified Esmarch osteotomy, where the cuts were placed above the inferior alveolar nerve canal, there was a massive hemorrhage intraoperatively. This was primarily attributed to the altered anatomy of the maxillary artery, which was very close to the ankylotic mass. When the osteotomy was done below the inferior alveolar nerve canal, it was found that by this technique, the intraoperative hemorrhage was minimal, but it carries a risk of postoperative inferior alveolar nerve paresthesia, which was managed conservatively. Conclusion With the abovementioned results, we proceeded with the conventional Esmarch procedure for five cases and the modified Esmarch procedure for one case. It was found that in temporomandibular joint reankylosis cases, where there is extensive ankylotic mass extending from the glenoid fossa to the coronoid process of the mandible, this Esmarch procedure provides promising results when the osteotomy cuts are placed below the nerve canal.

The efficacy of supervised learning and semi-supervised learning in diagnosis of impacted third molar on panoramic radiographs through artificial intelligence model.

The aim of the study was to evaluate the efficacy of traditional supervised learning (SL) and semi-supervised learning (SSL) in the classification of mandibular third molars (Mn3s) on panoramic images. The simplicity of preprocessing step and the outcome of the performance of SL and SSL were analyzed. Total 1625 Mn3s cropped images from 1000 panoramic images were labeled for classifications of the depth of impaction (D class), spatial relation with adjacent second molar (S class), and relationship with inferior alveolar nerve canal (N class). For the SL model, WideResNet (WRN) was applicated and for the SSL model, LaplaceNet (LN) was utilized. In the WRN model, 300 labeled images for D and S classes, and 360 labeled images for N class were used for training and validation. In the LN model, only 40 labeled images for D, S, and N classes were used for learning. The F1 score were 0.87, 0.87, and 0.83 in WRN model, 0.84, 0.94, and 0.80 for D class, S class, and N class in the LN model, respectively. These results confirmed that the LN model applied as SSL, even utilizing a small number of labeled images, demonstrated the satisfactory of the prediction accuracy similar to that of the WRN model as SL.

The inferior alveolar nerve and its relationship to the mandibular canal.

Previous work on the mandibular canal, mental foramen, and mandibular foramen has focused on humans and some other non-primate mammals (with small sample sizes), but little work has investigated the mandibular canal and inferior alveolar nerve (IAN) across primates. However, it is important to understand the relationship between the IAN and mandibular canal due to the IAN's close relationship to the teeth and mastication, and thus dietary adaptations. While it is assumed that most bony canals within the skull grow around and form to pre-existing nervous structures, this relationship has never been validated for the IAN and mandibular canal. MicroCT scans of 273 individuals (131 females, 134 males, and 8 unknown sex) from 68 primate species and three mammalian outgroups, and diceCT scans of 66 individuals (35 females, 23 males, and 8 unknown sex) from 33 primate species and the same mammalian outgroups were used to create 3D models of the IAN and mandibular canal from which cross-sectional areas were taken at various points on the structures. Using qualitative descriptions, phylogenetic generalized least squares analysis, and phylogenetic ANOVAs, we were able to establish three main conclusions: (1) the mandibular canal is most often not a defined canal within the mandible of primates, (2) when the canal can be identified, the IAN does not comprise most of the space within, and (3) there are significant relationships between the IAN and the corresponding canals, with most showing isometry and the mental foramen/nerve showing negative allometry.

Optimized IANSegNet: Deep Segmentation for the Detection of Inferior Alveolar Nerve Canal

Imaging studies in dentistry and maxillofacial pathology have recently concentrated on detecting the inferior alveolar nerve (IAN) canal. In spite of the minor dimensions of 3D maxillofacial datasets, deep learning-based algorithms have shown encouraging consequences in this study area. This study describes a mandibular cone-beam CT (CBCT) dataset with 2D and 3D hand comments. It is huge and freely available. It was possible to utilise this dataset by applying the residual neural network (IANSegNet), which consumed less GPU memory and computational complexity. As an encoder, IANSegNet uses the computationally efficient 3D ShuffleNetV2 network to reduce graphics processing unit (GPU) memory usage and improve efficiency. After that, a decoder with leftover blocks is added to keep the quality high. To address network convergence and data inequity, Dice’s loss and cross-entropy loss were created. Optimized postprocessing techniques are also recommended for fine-tuning the coarse segmentation findings that are generated by IANSegNet. The results of the validation show that IANSegNet outperformed other deep learning models in a variety of criteria.

Surgical Removal of Dental Implants Dislocated Into the Mandibular Body

With the recent advances in dental implantology, the number of implant surgeries is rapidly increasing. Unfortunately, along with considerable success, several complications have been reported. Regarding inferior alveolar nerve damage, the severity of damage is the most critical factor affecting the prognosis. Patients with poor-quality bone are at risk for nerve damage even if the distance from the alveolar crest to the inferior alveolar nerve canal is sufficient to prevent nerve damage. Herein, we report two cases of accidental insertion of a dental implant into the inferior alveolar canal. In both cases, the displaced implant was removed using a piezosurgery device without causing excessive bone defects. Therefore, good bone healing was achieved without plate fixation. Inferior alveolar nerve damage recovered in both patients.