Lamina Dura Research Articles

Morphological characteristics of the unique periodontal structure in dolphins.

Although toothed whales have dentition peculiar to mammals, little attention has been paid to the periodontal tissues that support these characteristic teeth. In this study, we clarified the anatomical characteristics of the periodontal tissue in several species of Delphinidae through three-dimensional observation using micro-computed tomography, histological observations using decalcified sections, and immunohistochemical analysis. The results indicated that the teeth and the periodontal tissues of dolphins are morphologically unique among mammals. The alveolar bone was both crude and spongy. The lamina dura, a radiopaque line observed in the alveolar bone of common mammals, was thin in dolphins, and the teeth were attached to the trabeculae with the periodontal ligament (PDL). The alveolar sockets were massive for the size of the teeth. The PDL, a collagen fiber that fills the periodontal space, was well-developed and peculiarly divided into two layers. The inner layer fibers radially spread out from the cementum, similar to the PDL in common mammals. However, the outer layer fibers penetrate the spongy bone in a complicated manner. The interstitial space between the inner and outer layers contained nerve fiber bundles that were thicker than those found in the PDL of other mammals. Sensory receptor-like structures were observed at the terminal ends of the nerve fibers. These findings indicated that the dolphin PDL is more sensitive to dental stimuli than those of other mammals, suggesting that the dolphin dentition plays a functional role as a sensory receptor, similar to tactile hair.

Feasibility and Outcomes of Cell-Based Regenerative Endodontic Therapy in Post-Autogenous Transplantation of a Mature Tooth: A Case Report

Autogenous tooth transplantation (ATT) offers advantages; however, success rates depend on factors like socket formation, donor tooth manipulation, and endodontic treatment. Root canal treatment in a mature post-ATT tooth remains challenging. Cell-based regenerative endodontic therapy (RET) shows promise for regenerating the pulp-dentin complex in mature teeth. However, its application in a post-ATT tooth is unexplored. This case report demonstrates the feasibility and outcomes of cell-based RET in a post-ATT tooth. A 37-year-old male underwent ATT for a missing maxillary left first molar. The maxillary right third molar served as the donor tooth, and transplanted with surgical guides. Root canal treatment began two weeks after ATT, confirming no detectable residual bacteria and fungi after 11 weeks. Dental pulp stem cells (DPSCs) isolated from the maxillary left third molar were transplanted into the root canal 17 weeks after ATT. The ATT tooth responded positively to the electric pulp test after 1 week. Most of the periodontal ligament of the donor tooth was absent, and the ATT tooth initially showed ankylosis-like signs but regained normal mobility after 28 weeks after RET. Cone-beam computed tomography (CBCT) imaging showed successful outcomes with the presence of the periodontal ligament space and lamina dura, and without root resorption and ankylosis after 52 weeks. Magnetic resonance imaging (MRI) revealed signal intensity of the regenerated tissue comparable to normal pulp after 60 weeks. This case report suggests the effectiveness of DPSCs in regenerating dental pulp and periodontal ligament, potentially preventing root resorption and ankylosis in the post-ATT tooth.

Jaw bone changes in panoramic radiography in patients with hyperparathyroidism

Background and aims: The current investigation aimed to evaluate jaw bone changes, and compare the presence of gonial cortex bone thickness, mental index (MI), lamina dura (LD), lower dental canal, and bone density in panoramic radiography, in patients with hyperparathyroidism. Methods: The present cross-sectional descriptive-analytical study was performed on 17 healthy individuals and 17 patients who suffered from resorptive hypercalciuria in the dialysis center of Shahid Beheshti hospital in Babol in 2018. If patients had two or more decayed teeth, they were referred to a specialized maxillofacial clinic by the dentist for free panoramic imaging. Mandibular cortical index, LD, bone change, mandibular resorption (MR), and general cortical indices underwent examination. Results: The mean age of the control and case groups was 36.58±11.81 years and 40.23±14.32 years, respectively (P=0.424). In addition, the mean MI was 4.27±0.87 and 2.98±0.75 in the control and case groups, respectively (P<0.001). Based on the results, the mean gonion region’s cortical bone thickness was 0.93±0.23 and 1.09±0.24 in the case and control groups, respectively (P<0.001). Further, bone changes (P=0.036) and MR (P=0.017) were significantly different in the case and control groups. However, LD vision showed no significant difference in the hyperparathyroidism and the control groups (P=0.141). Conclusion: The results demonstrated a decrease in the thickness of the cortical bone in the guinea pig, mental region, and lack of dental canal in resorptive hypercalciuria compared to healthy individuals.

A novel surgical technique to resolve mucosal fenestration of a root apex: Apical tunnel surgery: A case report.

Endodontic surgery, which includes apex resection, retro-fill and some regeneration procedures, is a traditional way to deal with apex fenestration. The endodontic surgery could bring large flap, curtate root length, non-healing mucosa and soft tissue deficiency in the apex area. Other treatment options might be considered according to different etiological factors. Mucogingival surgery provides some ideas in accumulation of soft and hard tissues, especially some unique methods such as "tunnel technique" bringing us a view of minimal invasive surgery approach. A novel surgery named "apical tunnel surgery" was reported here to resolve a root apex exposure with the tunnel-like technique. A young female complained about root exposure of upper right anterior tooth without history of trauma or orthodontic treatment. The intraoral examination revealed a buccal root apex exposure about 3mm in diameter of #12 (FDI teeth numbering system). The tooth was slightly dark with Class 1 mobility. The periodontal situation was good and the occlusion check revealed no traumatic bite on #12. The cone-beam computed tomography (CBCT) showed a bone fenestration from the buccally lower 1/2 root surface to the apex and bone absorption around the apex. It also revealed a bone contour deficiency in #12 area. Root canal treatment, root surface debridement, and soft tissue combined with hard tissue accumulation were carried out in one tunnel-like surgery. Examination of 12-month follow-up showed a healed and thickened mucosa in the buccally apical region and CBCT showed the continuous lamina dura occupied the buccal aspect of #12 root apex. This new apical tunnel surgery provided soft and hard tissue accumulation in one minimal invasive way in the apex exposure case caused by bone fenestration and thin mucosa.

Comparative evaluation of the clinical and radiographic success of regenerative endodontic procedures in immature versus mature permanent incisors with apical periodontitis: A prospective observational study

ABSTRACT Aim: The aim of the study was to know the clinical and radiographic outcomes of regenerative endodontic procedures of immature versus mature in young permanent incisors with apical periodontitis. Methods: Twenty non-vital, young permanent incisors with traumatic exposure between the age of 7 and 13 years were taken. Patients were divided into two groups: Group I – immature (number of teeth included = 10) and Group II – mature (number of teeth included = 10). The procedure was performed by the blood clot method as a scaffold. Biodentine (about 2–3 mm) was placed as a capping material at the cementoenamel junction. Evaluation was based on the clinical (pain, sinus, tender on percussion, swelling, mobility, intact restoration) and radiographical (Nolla stage, thickening of walls, lamina dura continuity, calcification of pulp chamber and canal, periapical healing, PAI score) parameters. Results: All 19 teeth were clinically asymptomatic after the 12-month follow-up. Radiographically, the percentage of continuous root development (in the immature group) was 100% at 12 months (P = 0.000**). Radiography revealed a reduction in the PAI scores at 12 months in the immature and mature groups. None of the treated teeth responded to the cold test after a 12-month follow-up. One patient did not come for intervention in the mature group. All the statistical tests (Chi-square, Mann–Whitney U-test, and Fisher’s exact test) were performed at a 5% significance level. Conclusion: Outcomes did not differ significantly between immature and mature groups.

Endodontic Management of Mandibular Second Molar with Middle Distal Canal

Mandibular second molar is often associated with variations in root canal morphology. Despite the intricate association, the occurrence of middle distal canal in endodontic literature is limited, with an incidence of 0.2% to 3%. Therefore, this study presents a case report describing a clinical situation in mandibular second molar that shows four canals, opening into different apical foramens. A 30-year-old male patient came to the Rumah Sakit Gigi dan Mulut of Universitas Sumatera Utara with the main complaint of intermittent pain in the lower right tooth persisting for two days. The results of clinical examination of the lower right second molar labeled as #47, showed a temporary filling, while radiography indicated widened periodontal ligament space and termination of lamina dura. After receiving informed consent, root canal therapy was carried out, and a direct resin composite onlay was selected for final restoration. To locate and treat hidden and unusual anatomy, dentists are often required to possess a comprehensive understanding of internal dental anatomy and use modern instruments, such as the dental operating microscope and ultrasonic tips. In certain clinical, direct resin composite onlay restorations can represent a valid alternative to traditional indirect restorations. In conclusion, this study shows that a comprehensive understanding of the potential variances in the internal anatomy of human teeth is essential to achieving successful outcomes in endodontic therapy.

Optimization of orofacial cleft imaging protocols using device-specific low-dose cone-beam computed tomography.

The aim of this study was to present optimized device-specific low-dose cone-beam computed tomography (CBCT) protocols with sufficient image quality for pre-surgical diagnostics and three-dimensional (3D) modelling of cleft defects. Six paediatric skulls were acquired, and an artificial bony cleft was created. A high-resolution CBCT scan acted as a reference standard (Accuitomo 170, Morita, Kyoto, Japan) for comparing eight low-dose protocols of Newtom VGi-evo (QR Verona, Cefla, Verona, Italy), which included Eco and Regular protocols with different field of views (FOVs). Delineation of lamina dura, cementoenamel junction (CEJ), trabecular bone and bony bridge were assessed. A 3D model of the defect was also evaluated. The dose area product of low-dose protocols ranged from 31 to 254 mGy*cm2. Despite the dose difference of up to eight times between applied protocols, trabecular bone and CEJ exhibited appropriate image quality in all scans. However, Regular small FOV protocols (5 × 5 and 8 × 5 cm2), for both lamina dura and bony bridge, demonstrated a significant improvement in image quality compared to Eco FOV counterparts. Based on 3D defect analysis, no significant difference existed between low-dose protocols and the reference standard. The findings highlight the possibility of achieving a considerable reduction (up to eight times) in the radiation dose using low-dose CBCT protocols while maintaining sufficient image quality for assessing anatomical structures and 3D modelling in cleft cases.

“Comparison of activated Platelet Rich Fibrin and Platelet Rich Fibrin in osseous regeneration of freshly extracted socket- A double blinded randomized clinical study”

IntroductionDental extraction is a common oral surgery procedure, but it can lead to unpredictable changes in alveolar bone structure, which can complicate future rehabilitation with prostheses. Socket preservation aims to reduce bone and soft tissue loss after extraction and involves various techniques using different materials. Autogenous bone is considered the gold standard for grafts, while autologous platelet concentrates like platelet-rich fibrin (PRF) have been used for tissue healing. This study aims to radiographically assess the bone remodeling of freshly extracted socket filled with Activated Platelet Rich Fibrin (APRF) and PRF. Materials and methodsA randomized controlled study was conducted on 60 patients undergoing tooth extraction as atraumatic as possible. Patients were divided into two groups: one receiving APRF with 10% Calcium Chloride as activating agent and the other PRF. Radiographic assessments were done using Kelley et al. scoring criteria at various time intervals, and statistical analyses were performed to evaluate the results. ResultsIn this study we found increased bone density in extracted socket filled with APRF at any given time interval compared to PRF which is statistically significant. The maxilla demonstrated better bone formation compared to the mandible. Gender, age, and site also influenced bone formation, with females showing differences in lamina dura and overall density. DiscussionPRF is rich in growth factors, promoting osteoblast formation and angiogenesis. Activation with calcium chloride accelerates clot formation and the release of growth factors. This study's radiographic data suggests that APRF may be more effective than PRF in promoting socket preservation and bone formation.

Key insights into antiresorptive drug use and osteonecrosis in osteoporotic patients undergoing tooth extractions: A clinical and CBCT assessment

SummaryThis study investigates the effects of antiresorptive drugs and risk factors for medication-related osteonecrosis of the jaws in osteoporotic patients undergoing tooth extraction. Among the findings, antiresorptive-treated patients had thicker lamina dura and longer healing times. Additionally, corticosteroid intake and multi-rooted teeth carried a higher osteonecrosis risk. Bone sequestrum indicated osteonecrosis.PurposeTo describe the effects of antiresorptive drugs (ARD) in the maxilla and mandible and risk factors for medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients undergoing tooth extractions using clinical data and cone beam computed tomography (CBCT).MethodsThis retrospective cohort study collected clinical and CBCT data from 176 patients. The study group (n = 78; 224 extractions) received ARD treatment, underwent tooth extraction, and had a pre-operative CBCT. Additionally, age-, sex-, and tooth-matched controls were selected (n = 98; 227 extractions). Radiographic examinations were performed independently by three calibrated examiners. Statistical analysis included Chi-square, Fisher’s exact, Mann–Whitney U, and t-tests to contrast clinical and radiographic data between study and control, MRONJ + and MRONJ − , and bisphosphonate and denosumab patients/sites. Significance was set at p ≤ 0.05.ResultsFrom the study group, 4 patients (5%) and 5 sites (2%) developed MRONJ after tooth extraction. ARD-treated patients exhibited significantly more thickening of the lamina dura and a longer average mucosal healing time (4.4 weeks) than controls (2.6 weeks). In the study group, MRONJ risk significantly increased with corticosteroid intake and in multi-rooted teeth. No significant differences between bisphosphonates and denosumab use were seen in the tomographic features (p > 0.05). Lastly, bone sequestrum was exclusively observed in osteoporotic patients, who exhibited post-operative exposed bone or histological evidence of osteonecrosis.ConclusionOsteoporotic patients under ARD may exhibit thickening of the lamina dura and prolonged post-operative healing. Among these patients, multi-rooted teeth are at higher risk for MRONJ than single-rooted teeth. Sequester formation is a radiographic indicator of osteonecrosis.

Evaluation of Root Canal Treatment in Chronic Periapical Abscess of Central Incisor

Introduction: trauma to the maxillary anterior teeth is often encountered, especially in teenagers. Severe trauma can result in pulp death and even periapical lesions if left untreated. This case report aims to evaluate periapical lesions in root canal treatment with anterior tooth fractures. Case report: A 21-year-old man came to RSGM UMY with complaints of a broken left front tooth. Teeth have been broken since early high school, around 16 years old. Clinical examination showed tooth 21 an Ellis class II fracture with caries in the fracture area in the mid and distal teeth. Apart from that, there was a vesicular lesion on the mucosa parallel to tooth 21 at 5 mm above the gingival margin, which was painless. Based on radiograph examination, a fracture of 1/3 of the crown is visible, there is a periapical lesion with a lesion size of approximately 5 mm, the lamina dura and periodontal ligament are broken in the apical 1/3. Case management: Root canal treatment was performed on tooth 21 to eliminate or reduce bacteria in the root canal. The sealer for treatment uses eugenol based. Results: The results showed that there was a significant change in the apical lesion at the beginning of the visit until the second control was carried out. Conclusion: Adequate root canal treatment can cure periapical lesions and bone regeneration in cases of chronic periapical abscess

Radiographic Detection Rate of Distal Surface Caries in the Mandibular Second Molar in Populations with Different Third Molar Management Strategies: A Multicenter Study.

Background: Distal surface caries (DSC) has been associated with partially erupted impacted third molars. The purpose of this study was to compare the rates of DSC between populations that had undergone different third molar management strategies. Methods: Radiographs that had been taken during routine examinations of 1012, 251 and 250 patients in Manchester, Bucharest and Amsterdam, respectively, were evaluated. The following parameters were assessed: the state of the distal surface in the second mandibular molar, loss of periodontal support, impaction type of the third molar, contact point localization, and patients' genders, ages and their cumulative history of dental health. Results: The rate of DSC in the second mandibular molar was 63.9%, 19.9% and 26.0% in the Manchester, Bucharest and Amsterdam populations, respectively. A loss of lamina dura of ≥2 mm, increased percentages of decayed, missing or filled teeth and male gender were risk factors in all three populations. All assessed parameters apart from the site of the mandible reached statistical significance in the Manchester sample (p < 0.001). The DSC rate was cumulative with increasing age in the Manchester population, in which third molars were strategically retained. Conclusions: The UK population, treated according to strict guidelines that limit the removal of third molars, had a statistically significant higher DSC prevalence rate (p < 0.001) than the Romanian or Dutch populations. The active surgical management of mandibular third molars seems to have the potential to reduce the DSC rate in the adjacent second molar.

Mandibular changes in a patient suspected with Thalassemia trait: A case report by radiograph finding

Thalassemia is an inherited hemolytic anemia characterized by abnormal synthesis the hemoglobin globin component. A forty-year-old woman presented to a private dentist complaining of a left-sided facial pain and headache that occurred out of the blue. Panoramic radiograph showed severe caries on several teeth, generalized reduction in the alveolar crest, thin lamina dura and changes in trabecular pattern of mandible and the inferior alveolar canal on each side was partially absent. Unmanaged anemia caused ineffective erythropoiesis resulting extensive bone marrow with sparse coarse trabecular. As the mean hemoglobin falls, enhanced osteoclastic bone resorption thus thinning lamina dura, reducing alveolar crest and lacking radiopaque line of inferior alveolar canal. Panoramic is widely used in dentistry, this case report presents a case of patient discovered thalassemia through radiological findings.

A skeleton in a huff: insights in etiologies of osteosclerosis.

A 30-yr-old man developed right lower leg pain and a palpable solid mass. Radiographic imaging revealed a periosteal reaction with an exostotic mass arising from the right distal fibula. Generalized skeletal osteosclerosis with periosteal reaction was discovered on a radiographic skeletal survey. A biopsy of the right fibular mass revealed reactive woven bone. The patient was referred to a metabolic bone disease clinic, where laboratory values were consistent with secondary hyperparathyroidism and increased bone turnover. A DXA bone density scan revealed high bone density, with an L1-4 spine Z-score of +9.3, a left femoral neck Z-score of +8.5, and a total hip Z-score of +6.5. A dental exam revealed generalized gingival inflammation, teeth mobility, generalized horizontal alveolar bone loss and widening of the periodontal ligament space, increased bone density around the teeth, and thickening of the radicular lamina dura. An extensive evaluation was performed, with the result of a single test revealing the diagnosis. The differential diagnoses of osteosclerosis affecting the skeleton, teeth, and oral cavity are discussed.

Solitary Radiopacity Associated with Root of Unerupted Supernumerary Tooth - A Case Report and Differential Diagnosis

Radiopaque lesions of jaws are innumerable and variable in appearance. There are several radiopaque lesions seen in the periapical region of tooth root which are indistinguishable from other lesions. The diagnosis and management of these lesions from clinical and radiographic features could be challenging to the dentist. Alterations in the bone could be inflammatory cystic odontogenic and non-odontogenic neoplastic reactive vascular traumatic dysplastic or metabolic in origin. As intraoral periapical radiographs IOPA provide the best image resolution they can aid in identifying the subtle changes in the bone architecture periodontal ligament Pdl space and lamina dura. Radiographic analysis of the involvement of adjacent structures using panoramic imaging is not sufficient for diagnosis as it provides 2D imaging of a 3D object. Cone Beam Computed Tomography CBCT provides an accurate 3D image of the involvement of bone and adjacent structures. Systematic radiologic analysis of lesions based on their location size shape borders internal structure effect on surrounding structures and consideration of clinical signs and symptoms enable clinicians to arrive at a reliable diagnosis. Here we present a case report of an asymptomatic radiopaque lesion associated with the root of an unerupted supernumerary tooth which was accidentally detected on an IOPA taken for treating the adjacent tooth.

High-resolution magnetic resonance imaging of teeth and periodontal tissues using a microscopy coil.

This study aimed to assess the performance of 2-dimensional (2D) imaging with microscopy coils in delineating teeth and periodontal tissues compared with conventional 3-dimensional (3D) imaging on a 3 T magnetic resonance imaging (MRI) unit. Twelve healthy participants (4 men and 8 women; mean age: 25.6 years; range: 20-52 years) with no dental symptoms were included. The left mandibular first molars and surrounding periodontal tissues were examined using the following 2 sequences: 2D proton density-weighted (PDw) images and 3D enhanced T1 high-resolution isotropic volume excitation (eTHRIVE) images. Two-dimensional MRI images were taken using a 3 T MRI unit and a 47 mm microscopy coil, while 3D MRI imaging used a 3 T MRI unit and head-neck coil. Oral radiologists assessed dental and periodontal structures using a 4-point Likert scale. Inter- and intra-observer agreement was determined using the weighted kappa coefficient. The Wilcoxon signed-rank test was used to compare 2D-PDw and 3D-eTHRIVE images. Qualitative analysis showed significantly better visualization scores for 2D-PDw imaging than for 3D-eTHRIVE imaging (Wilcoxon signed-rank test). 2D-PDw images provided improved visibility of the tooth, root dental pulp, periodontal ligament, lamina dura, coronal dental pulp, gingiva, and nutrient tract. Inter-observer reliability ranged from moderate agreement to almost perfect agreement, and intra-observer agreement was in a similar range. Two-dimensional-PDw images acquired using a 3 T MRI unit and microscopy coil effectively visualized nearly all aspects of teeth and periodontal tissues.

The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology.

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.

Measurement of the apical anatomy of immature maxillary central incisors using cone-beam computed tomography

ObjectiveTo investigate the CBCT findings of the apical anatomy of immature maxillary central incisors.MethodsCBCT images of 100 immature maxillary central incisors in Nolla 8 and 100 immature maxillary central incisors in Nolla 9 were collected. The mesiodistal and carniocaudal diameters of the apical foramen of immature maxillary central incisors were measured by software included with CBCT, as well as the mesiodistal, carniocaudal and facioligual diameters of the apical shadow. The apical shadow and apical foramen diameters were compared between Nolla 8 and Nolla 9. Data were analyzed using the MedCalc software package.ResultsFor immature maxillary central incisors, the mesiodistal and facioligual diameters of the apical foramen were 2.75±0.68 mm and 3.28±0.74 mm in Nolla 8 and 1.50±0.51 mm and 1.92±0.79 mm in Nolla 9. The mesiodistal, facioligual and carniocaudal diameters of the apical shadow were 3.84±0.73 mm, 4.49±0.68 mm and 3.41±1.27 mm in Nolla 8 and 2.76±0.60 mm, 3.41±0.80 mm and 2.06±0.65 mm in Nolla 9, respectively.ConclusionsThe immature maxillary central incisors in Nolla 8 have a larger apical shadow and apical foramen than those in Nolla 9. The apical region of the maxillary central incisors in Nolla 8 was more likely to have a broad, blurred lamina dura. With the development of the apical foramen, the lamina dura in the apical region tended to be clear and sharp.Clinical significanceTo our knowledge, this is the first study to radiologically analyse the in vivo anatomy of the apical foramen and apical shadow of immature maxillary central incisors. The results of this study provide a more detailed understanding of the apical anatomy of the immature maxillary central incisor for the diagnosis and treatment of apical lesions.

Three-dimensional clinical assessment for MRONJ risk in oncologic patients following tooth extractions.

To identify clinical and local radiographic predictors for medication-related osteonecrosis of the jaws (MRONJ) by the assessment of pre-operative CBCT images of oncologic patients treated with anti-resorptive drugs (ARDs) undergoing tooth extractions. This retrospective, longitudinal, case-control study included clinical and imaging data of 97 patients, divided into study and control group. Patients in the study group (n = 47; 87 tooth extractions) had received at least one dose of ARD, undergone tooth extraction(s), and had a pre-operative CBCT. An age-, gender-, and tooth extraction-matched control group (n = 50; 106 tooth extractions) was selected. Three calibrated, blinded, and independent examiners evaluated each tooth extraction site. Statistical analysis used χ2/Fisher's exact/Mann-Whitney U test to contrast control and study group, ARD type used, and sites with or without MRONJ development. p-value ≤ 0.05 was considered significant. From the study group, 15 patients (32%) and 33 sites (38%) developed MRONJ after tooth extraction. When controls were compared to study sites, the latter showed significantly more thickening of the lamina dura, widened periodontal ligament space, osteosclerosis, osteolysis, and sequestrum formation. In the study group, MRONJ risk significantly increased in patients who had multiple tooth extractions, were smokers, and had shorter drug holidays. Periosteal reaction and sequestrum formation may indicate latent MRONJ lesions. Additionally, patients given bisphosphonates showed considerably more osteosclerosis than those given denosumab. Periosteal reaction and sequestrum formation are suspected to be pre-clinical MRONJ lesions. Furthermore, ARD induced bony changes and radiographic variations between ARD types were seen.

Association between clinical manifestations of occlusal trauma and magnetic resonance imaging findings of periodontal ligament space.

The purpose of this study was to evaluate the association between clinical manifestations of occlusal trauma of the teeth and maximum signal intensity of periodontal ligament space on MRI. 20 subjects (males: 9, females: 11, mean age: 35.9 ± 14.0 years, range: 22-65 years) participated in this study. Subjective symptoms of bruxism, tooth mobility, fremitus, occlusal contact area, occlusal force, widening of the periodontal ligament space, and thickening of the lamina dura were defined as clinical manifestations of occlusal trauma. The total number of clinical manifestations was used to evaluate the degree of clinical occlusal trauma, with a score of 7 indicating the highest degree of occlusal trauma. The maximum signal intensity in the periodontal ligament space was evaluated by a specific T2 weighted MRI sequence: IDEAL image. Spearman's rank correlation between the total clinical occlusal trauma score and maximum signal intensity in the periodontal ligament space was 0.529 for all teeth, 0.517 for anterior teeth, and 0.396 for molar teeth (p < 0.001 for all). A significant correlation between the degree of occlusal trauma and the signal intensity of the periodontal ligament space suggests a new potential MRI-based method for objectively determining occlusal trauma.

Daha Önce Tanı Almamış İnsan İmmünyetmezlik Virüsü Pozitif Hastada Plazmablastik Lenfoma: Bir Olgu Sunumu

Plasmablastic lymphoma (PBL) is a rare and aggressive non-Hodgkin lymphoma subtype associated with human immunodeficiency virus (HIV) infection. PBL is extremely aggressive and has a poor response to treatment. Clinically PBL resembles a periodontal disease, Kaposi sarcoma, or melanoma. Delayed diagnosis adversely affects the treatment and life expectancy. A 52-year-old male presented with a firm intraoral mass causing a slight elevation noticeable extraorally. Radiologically, loss of lamina dura around the first premolar and loss of both vertical and horizontal bone height around the dental implant replacing the second premolar were present. The biopsy confirmed a diagnosis of PBL. Further evaluation revealed that the patient was positive for HIV. The chemotherapy regimen included etoposide, vincristine, hydroxydaunorubicin, cyclophosphamide, and prednisolone, followed by an autologous hematopoietic stem cell bone marrow transplant. This article attempts to describe the clinical presentation and histopathological evaluation of PBL, and emphasize the paramount role of biopsy, early clinical suspicion, and correct diagnosis.