Left Molar Research Articles

Clinical, Radiological features of Calcifying Epithelial Odontogenic Tumor: Report of two rare cases

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic tumor constitutes around 1% of all odontogenic tumours involving the jaw. The intraosseous and extraosseous variant constitutes about 95% and 5% of CEOT respectively. We have reported two CEOT cases. One is associated with an impacted left third molar in the maxilla of 39-year-old female patient, and the other with a sessile soft tissue gingival mass in the left molar region of a 30-year-old female patient. It also emphasizes the importance of advanced imaging and peculiar findings of computed tomography in diagnosing this rare tumour. The visualization of the internal structure of the lesion and the involvement of the neighbouring structures were considered very helpful for diagnosis and treatment planning. Early detection and treatment planning for such rare cases is required to prevent further complications.

Anti-inflammatory effect of caffeic acid phenethyl ester supplementation on TNF-α and NF-κB expressions throughout experimental tooth movement in vivo

Context: Orthodontic tooth movement (OTM) changes the periodontal tissue and increases the incidence of root resorption (OIRR). Caffeic acid phenethyl ester (CAPE), an antioxidant and anti-inflammatory chemical generated from honey propolis, might be useful in controlling inflammation during OTM and so reducing the risk of OIRR. Aims: To evaluate if CAPE supplementation has an anti-inflammatory impact on tumor necrosis factor-α (TNF-α) and nuclear transcription factor κB (NF-κB) during experimental OTM in male Wistar rats (Rattus novergicus). Methods: Forty-eight healthy male Wistar rats were divided into positive control group (OTM 10 g/mm2 force application) and experimental group (OTM application and CAPE administration). Each groups were observed for 3, 7, 14 days. A nickel-titanium closed coil spring that was 8.0 mm long, thick was inserted between the upper left first molar and upper central incisor in order to move the molar mesially. A 20 mg/kg body weight dose of CAPE was taken orally. Using immunohistochemistry, the expression of TNF-α and NF-κB was examined on the compression side of the OTM. Both the Tukey's honest significant difference test and the one-way analysis of variance test were applied (p<0.05). Results: TNF-α and NF-κB expression in the compression side differed considerably across groups (p<0.05). Daily administration of CAPE significantly downregulates TNF-α and NF-κB expression on the compression side. Conclusions: Administration of CAPE throughout OTM can successfully reduce the number of TNF-α and NF-κB expressions in the compression side in vivo.

Healing effects of monomer and dimer resveratrol in a mouse periodontitis model

BackgroundThe antioxidant and anti-inflammatory effects of resveratrol have been reported previously. Particularly, monomeric trans-resveratrol has been demonstrated to produce positive effects in various pathological processes. We reported previously that resveratrol dimer-rich melinjo extract, among others, caused bone healing, decreased local oxidative damage, and activated antioxidants nuclear factor erythroid 2-related factor 2 (Nrf2) pathways in a mouse model of experimentally induced periodontitis (EP). This study aimed to compare the bone-healing effects of the resveratrol monomer to the resveratrol dimer (gnetin C found in melinjo seed extract) in a model of EP and investigate the involvement of Nrf2 for effects of either form of resveratrol.MethodsEP was induced experimentally in mice by placement of a 9 − 0 silk ligature around the left second molar. Mice received 10 mg/kg of either resveratrol monomer or dimer intraperitoneally on day 15 after induction of EP. The bone level around the ligated teeth was measured over time, and levels of proinflammatory cytokines and oxidative stress were measured in the periodontal tissues around the ligated teeth.ResultsResveratrol dimer induced greater periodontal bone healing as compared to that related to use of the resveratrol monomer. It appears that healing of periodontal bone in either group was likely related to master regulation of antioxidant nuclear factor erythroid 2-related factor 2 (Nrf2) significantly. Downregulation of IL-1β, a proinflammatory cytokine was also demonstrated in the resveratrol dimer group.ConclusionOur results showed that administration of resveratrol in either dimer form or the monomeric form reduced periodontal bone loss with greater inhibition of bone loss being demonstrated in the dimer group as compared to the monomer group and that these effects were related in all likelihood to decreased oxidative stress and hence reduction in local inflammation.

Prevalence of class I caries in the second mandibular primary molar in 3-6-year-old children.

Dental caries is the disease of the oral cavity with serious oral health concern. It affects 50% of the schoolchildren worldwide. The consequences affect quality of life and may lead to socioeconomic crisis. The study was undertaken with the aim to understand the prevalence of class I caries in the second mandibular primary molar in 3-6-year-old children. The data were collected from the institutional patient records between September 2020 and February 2021. Of 6828 children, 100 children with class I caries in the mandibular second molar were included in the study. Data analysis was performed to find the association. On analyzing the correlation between age and prevalence of class I caries, all the age groups (i.e., 3-6 years) have almost equal prevalence of class I caries in both left and right second mandibular primary molars. On analyzing the correlation between gender and prevalence of class I caries, male children constitute about 56% of overall prevalence. About 43% of female children constitute class I caries. From the present study, it shows that there is high prevalence of class I caries in the second mandibular primary molar in children of 3-6 years of age. Knowledge on caries pattern on individual teeth and risk factors will help control and reduce dental caries.

Evaluation of difficulty index of impacted mandibular third molar extractions.

When compared to other teeth, third molars have a greater rate of impaction. Third molars that have been impacted are commonly encountered in dental practice, and it is the reason for complications in third molar surgery. The most commonly performed surgical procedure by dental practitioners is the third molar extraction. Despite a well-planned surgical approach, there are complications in lower third molar extractions. This study analyzes the expected difficulty during surgical removal of lower third molars that are impacted. This study analyzes the expected difficulty during the removal of impacted lower third molars by surgery. With the data from our dental institution database, the difficulty index by Pederson was used to evaluate the difficulty level of the extraction. Using SPSS, data were analyzed and results were obtained. Among impacted left mandibular third molars (38), minimal difficulty in 20.60% of the extractions, moderate difficulty in 29.58% of the extractions, and most difficulty in 2.77% of extractions were present. Among impacted right mandibular third molars (48), minimal difficulty in 18.80% of the extractions, moderate difficulty in 25.78% of the extractions, and most difficulty in 2.47% of extractions were present. According to our study, there is moderate difficulty in impacted lower third molar surgery, and it depends on factors such as systemic status and patient's age, periodontal condition, and complexity of tooth position in the dental arch.

Salivary Gene Expression of RANK, RANKL, and OPG in Type 1 Diabetes Mellitus and Periodontal Disease Patients.

The relationship between type 1 diabetes mellitus (T1DM) and periodontal disease may exhibit by the alteration of bone metabolism. However, evidence for this relationship is scarce and inconclusive. Thus, the aims of the present study were to investigate salivary receptor activator of nuclear factor kappa-β (RANK), receptor activator of nuclear factor kappa-β ligand (RANKL), osteoprotegerin (OPG) gene expression and the RANKL:OPG ratio in T1DM and non-T1DM. Secondary objective was to determine the relationships of RANK, RANKL and OPG gene expression to clinical parameters of T1DM and periodontal disease. Twenty patients with T1DM and twenty age-matched non-T1DM were recruited. Clinical periodontal parameters were measured. Total RNA was isolated from non-stimulated saliva, and the relative gene expressions of RANK, RANKL, OPG and RANKL:OPG ratio were determined by quantitative real-time polymerase chain reaction. The T1DM group had significantly higher mean periodontal parameters than the non-T1DM group, while the mean plaque scores of both groups were not significantly different. There was a trend of higher relative gene expression of RANK, RANKL, and the RANKL:OPG ratio and lower expression of OPG in T1DM group but no statistic significant different when compared to non-T1DM. In the T1DM group, RANKL:OPG correlated with the percentage of bleeding sites, whereas RANK, RANKL, and HbA1c levels correlated with pocket depth. Bone metabolisms demonstrating by decreased OPG gene expression and upregulated of RANK, RANKL, RANKL:OPG with higher pocket depth and bleeding in T1DM may play an important role in periodontal destruction in T1DM.

Prevalence of class I caries in the second maxillary primary molar in 3-6-year-old children: A retrospective study.

Class I caries is located in the occlusal surface of molars and premolars. Dental care is an international public health challenge, mainly in young group children, as they are easily affected by caries with an increased addiction to sweets and chocolates. Caries begin early in life and progress rapidly and can affect a child in the long-term quality of life. The data were collected from the institutional patient records between June 2015 and February 2021. The details of 6831 pediatric patients were collected, of which 1500 patients fulfilled the inclusion criteria. The data were collected and analyzed using SPSS software (IBM Corp, IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY). P = 0.005 was set as level of significance. Highest prevalence of caries was seen in male children with P = 0.008 (<0.05), denoting that there is a significant association between gender and number of teeth affected with caries. When age group was considered, the caries prevalence was highest at the age of 4 years and the P value was statistically significant. The prevalence of class I caries in the second maxillary primary right molars was more than the second maxillary primary left molars and within the age group of 4 years.

Application of odontometric dimensions of molars in sex assessment in Bulgarians.

Sex estimation is an important step in developing a biological profile. Teeth are one of the most durable physical elements in the human body and thus can be used very successfully for this purpose. The aim of the present study was to determine sex differences in odontometric dimensions of maxillary and mandibular molars in Bulgarians.

Effects of aging on the evolution of Apical Periodontitis lesions in rats

This study aimed to evaluate the effects of aging on the evolution of Apical Periodontitis (AP) lesions in rats. Elderly males (study group, n = 12) and young males (control group, n = 12) Wistar rats were used. When the study group were 24 months old and the control group were 3 months old, AP lesions were induced by creating pulp exposure of the mandibular left first molars. After 21 and 40 days, the animals were euthanized and the mandibles were removed. The left hemi- mandibles were radiographed and the AP lesions of the mesial roots of the first molars were measured using ImageJ software (National Institute of Mental Health, Bethesda, USA). The AP lesions were significantly larger in the Elderly (E) group (p = 0.0006) compared to the Control (C) group (E 21: 218.8 ± 72.96, C 21: 94.77 ± 9.44, E 40: 237.8 ± 57.20, C 40: 85.23 ± 6.63). The lesions of the animals in the elderly groups were significantly larger than the lesions in the younger animals. These findings suggest that the bone and immunological changes caused by aging can influence the progression of AP lesions.

Correlation of Dental and Skeletal Maturity Using Dimirgian and Cervical Vertebral Maturation Indices in Orthodontic Patients

OBJECTIVES To determine the correlation between skeletal and dental maturity using the cervical vertebral maturation (CVM) index (CVMI) and Demirjian index (DI) in orthodontic patients. METHODOLOGY Panoramic and lateral cephalogram radiographs of 105 patients pretreatment records were retrieved. Tooth calcification stages for mandibular left molar were recorded using Demirjian Index on the panoramic radiograph. The skeletal maturation stages were evaluated on a lateral cephalogram through CVMI staging. Fisher’s exact test and Cramer’s V values were estimated to determine the correlation between DI and CVMI. Weighted kappa statistics were used to determine the reproducibility of inter-observer assessment of DI and CVMI. A p-value of ≤ 0.05 was taken to be statistically significant. RESULTS A statistically significant correlation is present among the various stages of DI and CVMI for the males (Fisher exact = 25.006, Cramer’s V = 0.848, p = &lt; 0.001) and females (Fisher exact = 41.006, Cramer’s V = 0.623, p = &lt;0.001). A comparison of DI with respect to CVMI shows a more advanced skeletal stage in males than for female subjects. CONCLUSION The correlation between CVMI and DI stages was found to be highly significant. Stage D and F of DI were significantly correlated with stage 3 and stage 4 of CVMI in females and males respectively.

Dental Caries Prevalence, Severity, and Pattern Among Male Adolescents in Kano, Nigeria.

Dental caries is the most common oral disease of mankind; however, there are limited data on the oral status of adolescents in northern Nigeria. Recently, the World Health Organization set the global caries goal as significant caries (SiC) index score of <3. This study was designed to appraise the magnitude of the disease among adolescents in northern Nigeria. The objective of the study was to determine the prevalence, pattern, and severity of caries among 10-12-year-old adolescents in Kano, Nigeria. Six hundred and ninety-four school-aged children were selected through a multi-stage sampling of 10-12-year-old children in Kano and examined for dental caries using the WHO protocols. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS version 20 Inc. Chicago IL, USA). The prevalence of caries was 22.9% with mean DMFT and SiC scores of 0.5 (±1.2) and 3.7 respectively. DMFT >0 ranged from 1 to 8. Tooth 85 (the right mandibular second primary molar) and tooth 36 (left mandibular permanent first molar) had the highest caries count for primary and permanent teeth respectively. More lesions occurred on the left mandible in primary and permanent teeth. The second primary molars and the first permanent molars were most affected by the disease. The prevalence of dental caries was low among male adolescents in Kano as evidenced by the low mean DMFT/dmft scores; however, the condition exceeded the recommended WHO thresholds. Caries occurred more frequently on teeth 85 and 36.

Complex root anatomy of upper molar with presence of three mesiobuccal canals

The mesiobuccal root of the upper molars usually presents anatomical complexities that limit the correct cleaning and shaping. This results in treatments with a high incidence of failure, which is why knowledge of the internal anatomy is essential. The presence of three main canals in the mesiobuccal root of maxillary molars is infrequent, which can make root canal treatment difficult. A clinical case of a maxillary left first molar with three mesiobuccal canals is presented here.

Hypertrophic Scars in Molar Tooth Extraction Socket: A Case Report

Among the various problems that can occur in the extraction socket, hypertrophic scars are rare. A hypertrophic scar with a pattern similar to that of a keloid should be treated by accurately identifying its clinical characteristics. This report describes the clinical differential diagnosis and treatment of hypertrophic scars after extraction of the maxillary left first and second molars. The treatment of hypertrophic scars with excisional biopsy was successful, and there was uneventful healing in the subsequent sinus floor elevation and implant placement. In addition, there were no recurrences or other problems during a follow-up period of approximately 16 months after completion of the prosthesis. Under a clear diagnosis, hypertrophic scars can be treated through excision, and primary wound closure after excision is important for successful results.

Inclination of Mandibular Molars and Alveolar Bone in Untreated Adults and Its Relationship with Facial Type

To date, there is no solid agreement on the relationship between mandibular molars, mandibular alveolar bone, and vertical facial types. Therefore, we aim to assess the buccolingual inclination of mandibular first molars and respective alveolar bones and their relationship with different vertical skeletal patterns. The CBCT data from fifty-four untreated Caucasian adult patients (12 males and 42 females, 18–65 years old) were obtained from a private orthodontic practice. We measured the inclination of the tooth and alveolar bone of the right and left mandibular first molars using CBCT. From the two-dimensional lateral cephalometric radiographic images extracted from CBCT, we assessed FMA, SN-GoGn, and PFH:AFH. All subjects showed lingual inclinations of the mandibular molars and alveolar bones which were significantly correlated with each other. However, there was no significant correlation between the inclination of alveolar bone and vertical facial types. Our study supports the conclusion that a proper curve of Wilson is physiological and should be maintained during orthodontic treatment.

AN UNUSUAL OCULAR COMPLICATION FOLLOWING INTRAORAL LOCAL ANASTHESIA – A CASE REPORT AND REVIEW OF LITERATURE

Intraoral administration of local anesthetics is one of the most common dental procedures. Although this procedure is well known for its safety, complications can still occur. Ocular complications due to intraoral local anesthesia are rare but most distressing to the surgeon and patient. Ocular complications after local anesthetic injections are rarely reported in the literature and these complications include strabismus, ptosis, diplopia, blindness, ophthalmoplegia, loss of accommodation. A 50 year-old male patient developed transient diplopia and ipsilateral lateral rectus muscle paralysis following administration of local anesthesia for left maxillary third molar extraction. The patient was informed and proper instructions were given regarding the complications. Most of ocular complications are temporary; They can revert back to normalcy after anesthetic affect wears off. Complete resolution occurred within 2 h. Oral surgeons should be well aware of the ocular complications and its prevention and immediate management.

Hypertrophic pachymeningitis: An odontogenic origin?

This article discusses a rare case of Hypertrophic Pachymeningitis (HP). The patient was referred to the Oral and maxillofacial department presenting with atypical facial pain in conjunction with atypical visual symptoms. The atypical facial pain was concurrent to a long-standing history of a dental abscess associated with the upper left first molar. The special investigations confirmed the diagnosis of HP. HP may be either idiopathic or associated with infective or autoimmune conditions.

Correction of Extruded Upper First Molars and Bimaxillary Protrusion by Temporary Anchorage Device

Early loss of the lower first molar may cause extrusion of the upper first molar and mesial tipping of the lower second molar. It could be locked by the mesial contour of the upper second molar, causing the door-wedge effect which impedes the intrusion of the upper first molar. Skeletal Class II malocclusion, canting, and the need for anterior retraction on the upper arch was adding space requirement and anchorage problem to the case. Treatment by using absolute anchorage would be the most efficient way to treat this case. This case report aims to show how to manage molar extrusion, bimaxillary protrusion, and occlusal plane canting using temporary anchorage devices (TADs). A 30-year-old Portuguese-Ambonese female complained about her protruded front teeth. The patient had mild skeletal Class II malocclusion, bimaxillary protrusion, occlusal plane canting, skeletal asymmetry, extruded upper first molars, missing lower first molars and upper left second premolar, crowding on the upper arch, and multiple diastemas on the lower arch. The patient had deviation when opening the mouth. The treatment was initiated by very light intrusion forces by using a power chain that crosses the occlusal side from buccal TAD to palatal TAD. Leveling the upper and lower arch was done simultaneously without including the upper first molar. The upper right first premolar was then extracted to balance the missing upper left second premolar and the anterior retraction was done using TAD as anchorage. The active orthodontic period was 23 months. The intrusion of 2.5 mm and 3.5 mm of left and right upper first molar was achieved. The facial profile and occlusal plane canting were corrected. The patient was satisfied with the result.

Case Report: Interstitial-intralesional laser therapy and laser-assisted new attachment procedure for the treatment of alveolar bone loss provoked by an aggressive pyogenic granuloma

A pyogenic granuloma (PG) is a common benign vascular lesion found in the oral cavity. The gold standard treatment of this lesion, comprising surgical excision and the elimination of etiological factors, cannot avoid tooth loss in the case of an aggressive pyogenic granuloma. Because of the prominent properties of 980 nm and 635 nm diode lasers in photocoagulation and photobiomodulation, we applied these wavelengths in the treatment of a large pyogenic granuloma with alveolar bone loss. Our objective was to use a combination of interstitial-intralesional laser therapy, photocoagulation and laser-assisted new attachment procedure (LANAP) to preserve the teeth and periodontal tissue in a case of an aggressive pyogenic granuloma. The patient was a 13-year-old Thai male with a pyogenic granuloma involving the interdental papilla and lingual gingiva of the lower left first and second molars. The teeth were also displaced by the lesion. After treatment with three sessions of photocoagulation, three sessions of interstitial-intralesional laser therapy and two sessions of LANAP, the lesion was completely resolved. The periodontal status of the teeth was improved at the six-month follow-up. The combination of interstitial-intralesional laser therapy, photocoagulation and LANAP was able to treat an aggressive pyogenic granuloma with tooth preservation.

Dilacerated distolingual root of mandibular first molar mimicking cementoblastoma: case report by radiographic findings

Objectives: This case report aimed to report an extra root number of mandibular first molars that are mimicking benign cementoblastoma in the periapical radiograph and clarified using cone beam computed tomography (CBCT) examination.&#x0D; Case Report: A 22-year-old female patient was referred from private clinic to Radiology Department of Universitas Padjadjaran Dental Hospital for a CBCT examination of the left mandibular first molar with benign cementoblastoma as the provisional diagnosis.&#x0D; Conclusion: It is necessary to consider CBCT examination in order to obtain accurate diagnosis of the presence of distolingual root.

Evaluation of Root Canal Configuration of Maxillary and Mandibular First Molar by CBCT: A Retrospective Cross-Sectional Study.

Adequate knowledge of root canal morphology along with its probable variations is imperative to acquire successful endodontic treatment. This retrospective cross-sectional study aimed to investigate the root canal configuration of maxillary and mandibular first molar using Cone-Beam Computed Tomography (CBCT) among patients in Al-Ahsa region, Saudi Arabia. A total of 377 samples were included, out of which 123 CBCT (I-CAT Vision QTM) scans with intact all first permanent molars were selected in this study and scanned in sagittal, axial, and coronal views by using BlueSkyPlan software. The number of canals in each root and their configuration according to the Vertucci classification system was evaluated. Statistical analysis was analyzed using SPSS version 21 (IBM). Chi-square test was applied to evaluate the association of root canal morphology and mandibular and maxillary first molars with respect to gender. Out of 123 CBCT scans, 59 (48.0%) were males and 64 (52.0%) were females; the mean age was 26.95 ± 10.65 years. The mesiobuccal root of bilateral maxillary first molar had Type-I (87.0%) of Vertucci classification followed by Type-IV (9.8%). Additionally, all mesiobuccal roots (100%) of the left mandibular first molar had Type-I of Vertucci’s classification. A significant association has been observed between gender and a number of canals in bilateral maxillary first molars. Females showed a significantly higher prevalence of three-root canal configuration in maxillary first molars of both sides compared four canals found most commonly in males (p = 0.004). This study concluded that the majority of maxillary and mandibular permanent first molars had three roots and three canals with Type-I Vertucci’s classification in patients belonging to the Al-Ahsa region of the Saudi Arabia. It was also proved that gender is significantly associated with the number of canals in a bilateral maxillary molar.