Inferior Alveolar Research Articles

Radiographic Interpretation Skills of Clinical Dental Undergraduates Studying in Karachi, Pakistan

Radiographs facilitate dentists to envision diseases of the teeth and neighboring tissues that cannot be visualize through a clinical oral examination. A competent authority, in Pakistan for approving and monitoring dental curricula – Pakistan Medical and Dental Council has set 5 hours for didactic and clinical teaching of oral radiology to undergraduate dental students. This study has been planned to confirm whether the undergraduate students acquire the obligatory knowledge and interpretation competency or not within the stipulated time for oral radiology teaching. Material and Methods: A pretested power point presentation was shown to the clinical undergraduates present on the day of the evaluation. Among the twelve slides presented, seven slides contained radiographs showing basic pathological lesions like caries, bone loss, periodontal pocket, apical radiolucency and amalgam restoration opacity & five slides showed radiographs with anatomical structures; enamel, lamina dura, PDL, mental foramen and inferior alveolar nerve. The responders were asked to answer with anonymity on provided response sheets. Results: A total of N=97 students took part in the study; n=43 were from third year of Bachelors of Dentistry tenure and n=54 were from the final year. Apical radiolucencies, PDL spaces, and mental foramina were the toughest to identify for most of the participants involved whereas it was considerably too easy for both groups to radiographically report caries, missing teeth, and amalgam restorations. Conclusion: Despite very easy interpretation skill assessment, none of the student could score 100% marks revealing some weakness in radiology teaching which could be attributed to lesser number of teaching hours allocated for oral radiology.

Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle.

Despite substantial displacements, fractures of the mandibular condyle rarely lead to necrosis. This illustrates the negligible role of the inferior alveolar artery in intraosseous supply to the condyle, and led to this systematization of its arterial vascularization. Forty-two temporomandibular joints from nonembalmed cadaveric specimens were studied following injection of latex (n = 32) or India ink (n = 10). The intraosseous branches of the inferior alveolar artery that lead to the condyle were inconstant and often rudimentary. In this study, the arteries that consistently led to the condyle were the superficial temporal artery, the deep posterior temporal artery, and arterial branches leading to the lateral pterygoid muscle emanating directly from the maxillary artery. These arteries, along with the transverse facial artery and the masseteric artery (when they participated in condoyle vascularization), formed a quadrangle around the mandibular condyle. After India ink injection, the pterygoid muscle was the most strongly colored muscle, thus indicating substantial vascularization. Although there is a lack of consensus in the literature regarding the constancy and proportions of the arteries participating in vascularization of the condyle, the superficial temporal artery, the maxillary arterial branches leading to the lateral pterygoid muscle, and the deep posterior temporal artery were constant in this study. This study shows the important role of the lateral pterygoid in the vascularization of the condyle. In case of a fracture with substantial displacement, the vascularization emanating from the superficial temporal artery and the lower alveolar artery is ruptured or compromised.

First Report of a Bifid Mandibular Canal Containing a Large Vein Draining into the Anterior Jugular Vein

The bifid mandibular canal (BMC) is an anatomical variant of the mandible that is often observed on cone-beam computed tomographic images. We identified a BMC during routine cadaveric dissection. The upper mandibular canal contained the inferior alveolar nerve and artery, and the lower mandibular canal contained a large inferior alveolar vein. This latter vein left the mandible through a lateral lingual foramen and joined the anterior jugular vein. Additionally, this vein gave rise to small tributaries to the mental foramen and anterior surface of the mandible from the second mandibular canal. To our knowledge, this is the first report illustrating the contents of a BMC and drainage of a vein into the large anterior jugular vein.

Children and carer`s experience and satisfaction of two local anaesthetic techniques; for treatment of carious mandibular primary molars in children

Background: Local anaesthesia (LA) forms the backbone of pain control techniques in dentistry and has a major role in dentistry for children. Inferior Dental Nerve Block (IDNB) has been the LA technique of choice for treatment of carious mandibular primary molars in children. However, several disadvantages have been associated with the IDNB. Buccal Infiltration (BI) with 4% Articaine have been proposed as more comfortable and pleasant alternative LA techniques to IDNB which became widely used in paediatric dentistry especially for the treatment of carious mandibular primary molars in children above the age of 4 years. Aim: To explore children and carer`s experience and satisfaction of their child’s dental treatment under LA and compare their acceptance of two LA techniques; BI with 4% Articaine and IDNB with 2% lidocaine for the treatment of mandibular carious primary molars in children under ten years of age. Method: A prospective study design was used to explore patient and carer`s acceptance of the two local anaesthetic techniques. 96 patients aged 5-9 years and their carer`s completed two questionnaires on treatment acceptance. Result: A total of 49 (50%) participants received BI with 4% Articaine and 49 (50%) had IDNB with 2% lidocaine. Two patients had IDNB but no dental treatment was performed as patients could not cope with dental treatment, thus these participants did not complete the questionnaires. The majority of the children (84.7%) and their carers (91%) were happy with their experience at the dentist including the administration of the LA (61.5% for BI and 64% for IDNB), delivery of the dental treatment (87.8% for BI and 81.6% for IDNB) and dentist management including dental teamwork (over 90%). Conclusion: Both local anaesthetic techniques; BI with 4% articaine and IDNB with 2% lignocaine were accepted among patients and carers. Dental team attitude can significantly impact the treatment outcome in children. Establishing a clear communication between the dentist, the child patient and his/her carer as well as implementing good behaviour management techniques contribute significantly to treatment acceptance among children and carers.

The course of double mandibular canal - confront to dentist

The mandibular canal is usually a single canal that begins with mandibular foramen on the medial surface of the ascending mandibular ramus. It transmits the inferior alveolar artery, vein, and the inferior alveolar nerve. The identification of the mandibular canal and its anatomic variations is of great importance in many branches of dentistry, especially in implant dentistry. Sometimes, there may be variations in the normal anatomic structures; one of the rarest among them is double mandibular canal. The clinician should be aware of such variations to avoid complications during the treatment. In the present case report, we have discussed about a case with double mandibular canal and the complications that can arise during the treatment.

IMPORTANCE OF BIFID MANDIBULAR CANAL IN IMPLANTOLOGY AND IN ORAL SURGERY: REVIEW OF THE LITERATURE AND REPORT OF THREE CASES

The mandibular canal or the inferior alveolar canal typically extends from the mandibular foramen to the mental foramen and includes the inferior alveolar artery, vein and the inferior alveolar nerve. During embryonic development three canals fuse to form a single canal. Failure of these canals to fuse can explain presence of multiple canals in some individuals. It is important to localize the course of the mandibular canal at the site of implant placement as altered sensation of the inferior lip due to inferior alveolar nerve injury. It is one of the most serious complication of mandibular implant surgery. Also the difficulty in performing mandibular anesthesia is the other problematic issue for patients and the clinicians. The purpose of this study is to call attention to a rare anatomical variation. This case report reveals an unusual variant of the bifid mandibular canals. Three new cases, two of which are in the same family, have been presented.

Anatomia comparativa da artéria facial de Sus scrofa scrofa Linnaeus, 1758 (Mammalia, Suidae)

O javali encontra-se amplamente distribuído pelo homem em diversas partes do mundo, com exceção da Antártica. É sabido que a artéria facial e seus ramos são responsáveis por manter o suprimento sanguíneo das estruturas relacionadas com a mastigação, deglutição e produção de saliva. Diante do exposto, objetivou-se descrever as origens e distribuições das artérias faciais direita e esquerda do javali. As artérias faciais deste suídeo originaram-se da artéria carótida externa em todos os espécimes e distribuíram-se em ramos faríngeo, glandulares, musculares e ramos para linfonodos mandibulares. Ramos anastomóticos da artéria facial com a bucal e com o ramo milo-hioideo da artéria alveolar inferior foram identificados. Essa característica demonstra que a região de alocação da artéria facial nesses animais necessita de um expressivo contingente para irrigação, colaborando muito com sua eficácia funcional, bem como com o modus viventis deste animal.

A retrospective audit to review success rates of coronectomies in the management of lower third molars at Mid Yorkshire Hospital Trust

Introduction: Coronectomies are used in the management of third molars requiring extraction which appear closely associated with the inferior dental (ID) nerve and lingual nerve. The aim of the procedure is to decoronate the tooth and therefore reduce the risk of damage to the ID nerve and lingual nerve. Within the Mid Yorkshire Hospitals NHS Trust Oral and Maxillofacial surgery department the number of coronectomies performed is relatively low in comparison to the routine removal of third molars. Currently there is no data in our department that demonstrates the success of coronectomies.

Bifid mandibular canal: an aberrant anatomic variation

Objective: To review the literature and to present the report of a case with bifid mandibular canal.Methods: A cone-beam computed tomography scan with incidental finding of bifid mandibular canal was studied and presented in different sections.Results: The MC is a bilateral channel in the mandible that gives the passage to the inferior alveolar nerve, artery, and vein. It usually presents as a single canal where a variation in anatomy has been reported. The bifid mandibular canal is such an anatomic variant where it splits into two canals.Conclusion: The role of CBCT scans can be emphasized while performing procedures on posterior mandibular region, as it can provide the vital information regarding anatomical variation to avoid iatrogenic complication.

Arterial Patterns of the Face in Perissodactyla.

Considerable consistency in the arterial pattern of the head has been observed in species of Artiodactyla, but few studies have examined the order Perissodactyla. Here, we describe arteries supplying the intermandibular, mental, masseteric, buccal, labial, and nasal regions in eight perissodactylans, including representing of all families comprising this order. Observations were made on a total of 45 preparations of head arteries, obtained by injection of arteries with acetone-dissolved stained vinyl superchloride or stained latex LBS3060. In the Equidae species alone it was found that the facial artery descends from the linguofacial trunk. In tapirs and rhinos the facial artery branches off directly from the main arteries of the head. In tapirs alone it was found that the inferior alveolar artery gives off the buccal and sublingual arteries, and then extends into the mental artery. In the rhino a specific feature of the arterial pattern of the head was the exit of the occipital artery from the superficial temporal artery. In all equines studied, the transverse facial artery gave off a larger blood vessel to the masseter muscle and ran along the facial crest, while in tapirs and rhinos the transverse facial artery fanned out branches in the masseteric fossa. The variations observed can be considered in future studies on the origin of Perissodactyla. In this context, we note that the most similar patterns of exit and course of the facial, mental, transverse facial and infraorbital arteries exist in tapirs and rhinos (Ceratomorpha suborder), at least among the perissodactylans studied here. Anat Rec, 300:1529-1534, 2017. © 2017 Wiley Periodicals, Inc.

Effect of Low-intensity Pulsed Ultrasound on the Mandibular Remodeling Following Inferior Alveolar Nerve Transection.

Objective To investigate the effects of low-intensity pulsed ultrasound (LIPUS) on the mandibular remodeling following inferior alveolar nerve transection (IANX) and to optimize the parameters of LIPUS in the treatment of nerve injury. Methods IANX was performed in male Sprague-Dawley rats. Four weeks after IANX,the effect of daily LIPUS (from day 1) on the transected inferior alveolar nerve was examined in terms of sensitivity to mechanical stimulation. Moreover,histopathologic changes of mandibles were analyzed by micro-CT,HE staining,Masson trichrome staining,and immunohistochemical staining. Results LIPUS promoted the recovery of inferior alveolar nerve injury after transection. HE staining displayed the improvement of trabecular thickness and continuity. LIPUS with higher duty ratios had more obvious effect on bone remodeling. Conclusion LIPUS promotes the mandibular remodeling following IANX.

Bilateral sagittal split mandibular osteotomies for enhanced exposure of the anterior cervical spine in children: technical note.

The bilateral sagittal split mandibular osteotomy (BSSMO), a common maxillofacial technique for expanding the oropharynx during treatment of micrognathia, is a rarely employed but useful adjunct to improve surgical access to the ventral cervical spine in children. Specifically, it provides enhanced exposure of the craniocervical junction in the context of midface hypoplasia, and of the subaxial cervical spine in children with severe kyphosis. The authors describe their technique for BSSMO and evaluate long-term outcomes in patients. The pediatric neurosurgical database at a single center was queried to identify children who underwent BSSMO as an adjunct to cervical spine surgery over a 22-year study period (1993-2015). The authors retrospectively reviewed clinical and radiographic data in all patients. The authors identified 5 children (mean age 5.3 ± 3.1 years, range 2.1-10.0 years) who underwent BSSMO during cervical spine surgery. The mean clinical follow-up was 3.0 ± 1.9 years. In 4 children, BSSMO was used to increase the size of the oropharynx and facilitate transoral resection of the odontoid and anterior decompression of the craniocervical junction. In 1 patient with subaxial kyphosis and chin-on-chest deformity, BSSMO was used to elevate the chin, improve anterior exposure of the subaxial cervical spine, and facilitate cervical corpectomy. Careful attention to neurovascular structures, including the inferior alveolar nerve, lingual nerve, and mental branch of the inferior alveolar artery, as well as minimizing tongue manipulation and compression, are critical to complication avoidance. The BSSMO is a rarely used but extremely versatile technique that significantly enhances anterior exposure of the craniocervical junction and subaxial cervical spine in children in whom adequate visualization of critical structures is not otherwise possible.

The histological and histomorphometric changes in the mandible after radiotherapy: An animal model

PurposeApproximately 5% of irradiated head and neck cancer patients develop osteoradionecrosis of the mandible. The current non-surgical treatment options for osteoradionecrosis have limited effects and are based on a small number of studies. Therefore, we aimed to enhance the understanding of the pathophysiology of osteoradionecrosis by investigating changes induced by external irradiation in mini-pigs. MethodsSixteen Göttingen mini-pigs were divided into four groups for the application in two fractions with total equivalent radiation dosages of 25, 50, 70 Gray, and one group served as control. Thirteen weeks after irradiation, the left lateral teeth the mandible were removed and implants were placed. The pigs were sacrificed twenty-six weeks after irradiation, and the bone samples were stained with Masson's trichrome. ResultsThe amount of fibrosis, resorption lacunae, necrosis, and the woven/lamellar bone ratios were increased after higher radiation dosages. The diameter of the lumen of the inferior alveolar artery was reduced depending on the irradiation dosages. The rate of bone remodeling decreased after irradiation. ConclusionBoth surgery and increasing irradiation dosages cause architectural bone changes and damage the vascularization. This might result in a chronic hypoxic state of the mandibular bone. In general, the bone formation rate was markedly decreased after radiotherapy.

CBCT evaluation of the tridimensional relationship between impacted lower third molar and the inferior alveolar nerve position.

The aim of this study is to evaluate if the statistical significant relations between the measures taken exists or not and to show how the 3D reconstruction could be help the oral surgeon in all those instances in which it may have a direct impact on the planning of the surgical steps. Thanks to use of NobelClinician™ Software it was possible to analyze 200 mandibular tomography computerized, random selected, and create a 3D reconstruction of mandibular bone, point out dental structure of wisdom tooth and the way of IAN. Statistical analysis was performed using the Statistical Package for Social Sciences. One way ANOVA test was used to measure the association between each independent variable and the outcome variable, followed by the post-hoc least significant difference (LSD) test for intergroup differences. Two independent variables were significant predictors for risk to have the distance 0 mm from IAN to apex: "Ramus relationship/space available" and "depth". The 3D reconstruction software provide surgeons with an additional planning tool, offering: immediate and neat visualization of the noble structures that have to be respected and their localization in the three spatial planes; the exact morphology of the relevant root apex; a 360° view of the relationship between the IAN and the third molar and the exact point in which the root is in relationship with the canal.

Sagittal split ramus osteotomy combined with intraoral distraction osteogenesis for hemifacial microsomia

To investigate the effect of sagittal split ramus osteotomy(SSRO) combined with distraction osteogenesis(DO) for hemifacial microsomia (HFM). From January 2013 to September 2015,7 cases of unilateral HFM were included in the study. The 3-dimensional reconstruction images were used for the operation design. The location of the germs and inferior alveolar nerve was marked to avoid injury. The distractor was fixed after SSRO. The distractor was distracted 2-4 mm intraoperatively and began enlongation 3-5 days after operation,1-2 mm every day until the pre-designed length attained. The patients were followed up for 3-D CT and measurement of the height of bilateral ramus. The enlongation length was 7 mm to 20 mm(mean,14.6 mm).The facial symmetry and occlusion plane was improved a lot. No complication occurred. The mean follow-up period was 22 months (range 17-32 months) with almost symmetrical appearance and occlusion function. SSRO combined with DO has a good therapeutic effect and low complication for patients with HFM. The distraction rate is relatively high with a short treatment period. The ramus width, even thickness, are not decreased, or even can be increased after DO.

PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. Perforation of inferior alveolar nerve by maxillary artery

La fosa infratemporal es un área anatómica clínicamente importante para la administración de agentes anestésicos locales en odontología y cirugía maxilofacial. Fueron estudiadas variaciones en la anatomía del nervio alveolar inferior y la arteria maxilar en la disección infratemporal. Durante la disección rutinaria de la cabeza en el cadáver de un varón adulto, fue observada una variación excepcional en el origen del nervio alveolar inferior y su relación con las estructuras circundantes. El nervio alveolar inferior se originaba en el nervio mandibular por dos raíces y la primera parte de la arteria maxilar estaba incorporada entre ambas. El origen embriológico de esta variación y sus implicaciones clínicas es debatido. Dado que la arteria maxilar transcurría entre las dos raíces del nervio alveolar inferior, y el nervio estaba fijado entre el foramen oval y el foramen mandibular, el atrapamiento vásculo-nervioso pudo causar entume-cimiento o dolor de cabeza e interferir con la inyección de anestésicos locales en la fosa infratemporal. Variaciones anatómicas en esta región deben ser tenidas en cuenta, especialmente en casos de tratamiento fallido de neuralgia del trigémino. Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originated from the mandibular nerve by two roots and the first part of the maxillary artery was incorporated between them. An embryologic origin of this variation and its clinical implications is discussed. Because the maxillary artery runs between the two roots of the inferior alveolar nerve, and the nerve was fixed between the foramen ovale and mandibular foramen, neurovascular entrapment may cause pain numbness or headache and may interfere with the injection of local anesthetics into the infratemporal fossa. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.

Comparison of Anaesthetic Efficacy of 4% Articaine Primary Buccal Infiltration Versus 2% Lidocaine Inferior Alveolar Nerve Block in Symptomatic Mandibular First Molar Teeth.

To evaluate success of pulpal anaesthesia of mandibular 1st molar by using 4% articaine in buccal infiltration versus 2% lidocaine in inferior alveolar nerve block. Randomized control trial. Department of Operative Dentistry, Sardar Begum Dental College, Gandhara University, Peshawar, from March to August 2014. One hundred and fifty-six emergency patients, who had 1st molar diagnosed with irreversible pulpitis, participated in the study. Subjects were divided into two groups by random allocation. One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 2% lidocaine. Subjects’self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation. Mean age of subjects was 31.46 ±10.994 years. The success rate of 4% buccal infiltration was 76.9%; whereas the success rate of 2% lidocaine inferior alveolar nerve block was 62.8%. There was no statistically significant difference between the two groups. 4% articaine buccal infiltration can be considered a viable alternative to 2% lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy.

Radiographic Evaluation of the Status of Third Molars in Sriganganagar Population - A Digital Panoramic Study.

Third molar (M3) agenesis and impaction are associated with evolution, changed dietary habits, and human jaw growth. The aim of the study was to radiographically evaluate the prevalence of M3s agenesis, impacted M3s with different impaction patterns, and the approximation of Inferior Dental Canal (IDC) with impacted mandibular M3s roots among the Sriganganagar population. The study included 700 randomly selected subjects from OPD with an age range of 25-45 years. Digital OPGs were taken for all subjects using Kodak 8000C digital OPG machine. The M3 impaction patterns were evaluated using Winter's classification. The prevalence of subjects with at least one M3 agenesis was found to be 34.1% and with 95% confidence interval was 30.6% to 37.6%. The overall M3s agenesis was 16.8% with more prevalence in the males. The patients with agenesis of one M3, two M3s, three M3s, and four M3s were 14.4%, 11.3%, 3.7% and 4.7%, respectively. M3 agenesis was more in the upper jaw and on the left side. The total impacted M3s were 21.11% with more prevalence in mixed diet subjects. Mesioangular was most common impaction pattern, and notching was most prevalent IDC relationship with impacted mandibular M3s roots. This study highlighted the evolutionary increasing M3 agenesis and the importance of diagnostic OPG for seeing the status of M3s in jaws.

Histologic features and fascicular arrangement of the inferior alveolar nerve

ObjectivesKnowledge of the various possible morphologies and courses of the inferior alveolar nerve and artery is important for successful and safe surgical procedures in the mandibular region. The purpose of this study was to verify the histologic features and fascicular arrangement of the inferior alveolar nerve and artery relative to tooth region. Materials and methodsTwenty embalmed dentulous hemimandibles were examined (eight males and two females; mean age, 58.2 years). The hemimandibles were prepared for routine histology and stained with hematoxylin–eosin and Masson’s trichrome. The histologic features, fascicular arrangement, courses, and areas of the inferior alveolar nerve and artery were investigated with the aid of a light microscope. ResultsThe inferior alveolar neurovascular bundle comprised the inferior alveolar nerve, which appeared as a large trunk comprising two major nerves (the mental and dental nerves), and the inferior alveolar artery, which occupied a relatively small portion of the bundle. The mental nerve was located inferolingually in the third molar region and turned to the buccal side in the first molar region, separating from the dental nerve before reaching the mental foramen. The mandibular incisive canal with a bony wall was not found in the lateral incisor region; instead, small dental nerve fascicles and arteries presented consistently in the intertrabecular spaces. The inferior alveolar artery traveled above the inferior alveolar nerve over the entire mandibular canal. ConclusionsThese results provide data that are relevant to treatment planning for operative procedures such as implant placement, endodontic treatment, and osteotomy in the mandibular region.

Evaluation of the Course of the Inferior Dental Canal Using Digital Dental Panoramic Imaging

Background The position and appearance of the inferior dental canal (IDC)areimportant consideration during a surgical treatment of the mandible. Objective To study the appearance of the IDC radiographically with the aid of histogram equalization of digital imaging to improve the vision of the IDC outline on the digital dental panoramic images in the posterior area of the lower jaw. Method 150 digital panoramic images ofthe right side of the mandible were evaluated according to a particular inclusive criteria.The percentage of the IDCwas calculated to assist the histogram equalization usefulness in the vision of the canal. Result The results showed that there was a difference in the appearance of IDC on the panoramic images of the mandible. The evaluation of the histogram equalization of the digital imageshowed that the canal visualization improved in twenty-seven images,representing 52%,and twelve images,representing 23%, did not show any improvement. The researcher was no sure of thirteen images, representing 25%. Conclusion Since the radiographic appearance of IDC is not universal, and the evaluation of the histogram equalization of the digital image found to be useful in some cases, but not in all; therefore, there is a need for further investigation using advanced modalities such as cone beam CT.