Radiopaque Areas Research Articles

Dense bone islands in pediatric patients: a case series study

BackgroundDense Bone Islands (DBIs) are anatomic variants defined as radiopaque lesions consisting of hamartomatous cortical bone, often presenting as incidental radiographic findings. DBIs can also be known as idiopathic osteosclerosis, bone whorl, focal periapical osteopetrosis, bone scar and enostosis. We found a paucity of literature for management and reporting of this condition in children. For this reason, the authors describe sixteen cases of children and adolescents with dense bony islands and suggest a pathway for management.Case seriesCases presented to the RNENT and Eastman Dental Hospital or private practice, either as chance findings or for diagnosis and treatment planning of undiagnosed radiopaque areas. The individuals were aged between 10 and 17 years; 6 boys and 10 girls. All radiographic reports described DBIs. Diagnoses were confirmed by a Dental and Maxillofacial Radiology Consultant and advised no intervention. In some cases, monitoring was advised. Caution in orthodontic tooth movement was advised for five patients.ConclusionDBIs are common findings that seldom require treatment; however, caution should be exercised when undertaking orthodontic movement in the area of a DBI due to a potential risk of root resorption. Accurate identification and multidisciplinary management are of utmost importance.

Complete Edentulism of Dental Patients in Northeastern Turkey: Prevalence and Radiographic Findings on Panoramic Radiographs Prevalence and Radiographic Findings on Panoramic Radiographs

The prevalence of complete edentulism varies from country to country and from one region to another. Previous studies have reported the high prevalence of significant radiographic findings in edentulous patients. Objectives: This study aimed to determine the prevalence of complete edentulism retrospectively and to evaluate the frequency and location of significant radiographic findings on panoramic radiographs in edentulous jaws of dental patients in northeastern Turkey. Methods: The digital panoramic images of all ≥35 year-old patients admitted to our faculty from January 2014 to August 2015 were evaluated. The prevalence of complete edentulism was determined among 8314 panoramic images retrospectively. Radiographic findings identified as impacted teeth, retained roots, radiopaque, and radiolucent areas detected in panoramic radiographs of completely edentulous patients (CEP) were recorded. The obtained data were analyzed with descriptive statistics and cross-tabs. Chi-square test was employed to evaluate the statistical significance of the results at 0.05 levels. Results: A total of 8314 panoramic images were examined, and 508 (6.11%) CEP were defined. The prevalence of edentulism was higher (24.85%) among the patients older than 64 years old. A total of 206 radiographic findings were detected on panoramic images of CEP. The prevalence values of retained roots, impacted teeth, radiopacities, and radiolucencies were 18.9%, 7.09%, 2.76%, and 1.57%, respectively. Conclusions: Given the high frequency of significant radiographic findings, the radiographic examination of CEP should be performed with consideration of the cumulative effects of radiation.

Managment of the mandibular dentigerous cyst plus rigid bone fixation, Presentation of a case

The objective of this article is to present the management of a patient diagnosed with a mandibular dentigerous cyst. The present case deals with a 14-year-old male patient, without relevant antecedents who attended the SERODU dental clinic, a radiolucent shadow between the dental pieces 42, 44 and 45 was included in the computerized axial tomography with the part piece No. 43 included in the symphysis of the mandibular region, horizontal position of the dental piece, the crown towards the distal and its root towards the medial with complete formation. At the crown level, a well-defined radiolucent shadow can be observed with a radiopaque halo, compatible with a dentigerous cyst. Therefore, it was decided to carry out the endodontic treatment in the dental pieces 43,44,45, subsequently the enucleation of the lesion, elimination of the dental piece, curettage and rigid bone fixation were performed, to avoid pathological complications of adjacent structures such as fracture mandibular due to the size of the lesion. A histopathological diagnosis of dentigerous cyst was obtained. At the thirty-day control, a radiopaque area compatible with bone regeneration was observed radiographically, with a radiolucent halo separating with the original basal bone. Enucleation and rigid bone fixation is an effective treatment technique to eliminate the lesion that turned out to be benign.

Segmental Bone Reconstruction by Octacalcium Phosphate Collagen Composites with Teriparatide.

Octacalcium phosphate and collagen composite (OCPcol) demonstrated superior bone regeneration and has been commercialized recently in Japan. Teriparatide (TPTD) is a bioactive recombinant form of parathyroid hormone that is approved for osteoporosis treatment. Because mandibular bone reconstruction after segmental resection is a key clinical problem, it was examined whether single-dose local administration of OCPcol with TPTD can affect recovery after this procedure. OCPcol was prepared, and a commercially available hydroxyapatite and collagen composite (HAPcol) was used as a control. A 15 mm length segmental bone defect was made in the mandibular region of male beagle dogs. The experimental animals were divided in four groups. OCPcol treated with TPTD (OCPcol + TPTD), OCPcol, HAPcol treated with TPTD (HAPcol + TPTD), or HAPcol was implanted into the defect. The radiopaque areas of the implanted site were measured and statistically analyzed, and histological examination was performed after 6 months. The value of radiopaque area in total region of OCPcol + TPTD was highest (90.8 ± 7.3 mm2), followed in order by OCPcol (49.3 ± 21.8 mm2), HAPcol + TPTD (10.6 ± 2.3 mm2), and HAPcol (6.4 ± 2.3 mm2), and that of OCPcol + TPTD was significantly higher than that of HAPcol + TPTD or HAPcol. All segmented mandibles of OCPcol + TPTD and a part of those of OCPcol were bridged with newly formed bone, whereas no bone bridges were observed in HAPcol + TPTD or HAPcol. These results suggested that OCPcol treated with TPTD enabled bone reconstruction after segmental mandibular resection more than other three groups.Impact statementOctacalcium phosphate and collagen composite (OCPcol) is a bone regenerative material that has been recently commercialized in Japan. Teriparatide (TPTD) is a recombinant form of parathyroid hormone, and is used for the treatment of osteoporosis. It was investigated whether single-dose local administration of OCPcol with TPTD can repair a canine segmental bone defect, which was supposed to be an intractable bone defect. Compared with OCPcol, hydroxyapatite, and collagen composite (HAPcol) with TPTD, or HAPcol, because OCPcol with TPTD quickly enhanced bone regeneration and bridged the defect, it would be a candidate for the repair of intractable bone defect.

Osseous mass in a maxillary sinus of an adult male from the 16th–17th-century Spain: Differential diagnosis

ObjectiveTo undertake a differential diagnosis of a large mass found in the left maxillary sinus of a cranium dated to the 16th–17th-century, and to expand knowledge of the diagnosis of osseous tissue formation in osteoarchaeological studies. MaterialA cranium recovered from the cemetery of San Salvador de Palat de Rey church, León (Spain). MethodsMacroscopic analysis, CT scanning. ResultsMacroscopic analysis indicated that the individual was probably a male over 30 years old with an ossified mass in the left maxillary sinus, measuring 24 × 19 × 24 mm, occupying approximately 27 % of the maxillary antrum. Computed tomography revealed a well-demarcated radiolucent unilocular mass with some radiopaque areas, with no communication with the alveoli of the premolars or molars. No erosive lesions or signs of inflammation were found. ConclusionsNeither the macroscopic, nor the radiological characteristics are compatible with inflammatory or malignant pathology, favoring a diagnosis of ossifying fibroma. SignificanceThis case adds to the few reported cases in the osteoarchaeological literature, especially since there is limited relevant reference data to assist diagnosis. The CT scans and 3D reconstruction presented here facilitate differential diagnosis in future paleopathological studies. LimitationsDestructive methods were not authorized. Suggestions for further researchIn the future, micro-CT analysis, which was not performed in the current study, may add new and valuable information.

MUCOEPIDERMOID CARCINOMA: AN EVOLUTION OF 21 YEARS

A female patient, 37 years of age, reported volume increase in the right side of the face in 5 months with painful symptoms. An intraoral examination revealed an endophytic palatal and vestibular lesion, extending from the premolar region to the molar region. The radiographic examination showed a radiolucent lesion with radiopaque areas near the maxillary sinus. The patient presented a history of untreated lesion on the palate diagnosed as adenocarcinoma in 1997. In 2018, a new incisional biopsy was performed. The histologic examination showed the malignant neoplasm of salivary gland characterized cystic spaces lined by a single layer of mucous cells and areas with epidermoid cells. Histochemical analysis of the mucous cells and contents of the microcystic spaces were stained positive with the mucicarmine. The final diagnosis of mucoepidermoid carcinoma was issued. The patient was referred for treatment in the Liga norterriograndense contra o câncer and is followed up.

Promoting Osseointegration of Dental Implants in Dog Maxillary Sinus Floor Augmentation Using Dentin Matrix Protein 1-Transduced Bone Marrow Stem Cells.

Beta-tricalcium phosphate (β-TCP) has been employed successfully as a synthetic graft material in maxillary sinus floor augmentation (MSFA) for placing dental implants. However, the lack of osteogenic and osteoinductive properties of this substitute invariably results in bone regeneration of low quality and quantity. The purpose of this study was to determine whether loading dentin matrix protein-1 (DMP1) gene-modified bone marrow mesenchymal stem cells (BMSCs) onto β-TCP promoted bone regeneration and osteointegration of dental implants in MSFA of dogs. BMSCs were transduced with a lentiviral vector overexpressing the DMP1 gene (Lenti-DMP1) and with a lentiviral vector overexpressing enhanced green fluorescent protein (Lenti-EGFP) in vitro and were loaded into β-TCP scaffolds for autologous sinus grafting. Beagles received bilateral MSFA with four biomaterials (① Lenti-DMP1-transduced BMSCs/β-TCP, ② Lenti-EGFP-transduced BMSCs/β-TCP, ③ BMSCs/β-TCP, ④ β-TCP) and simultaneous implant placement at each sinus. Twelve weeks post operation, the maxillae were explanted, and every sinus was evaluated by radiographic observation, micro-CT and histological analysis. The osteogenic outcomes of bone regeneration and osseointegration were compared between the four groups. The sinuses grafted with Lenti-DMP1-transduced BMSCs/β-TCP constructs presented a significantly higher increase in compact radiopaque area, higher local bone mineral densities, greater bone-implant contact and greater bone density when compared to other three groups. These results demonstrated that combinations of β-TCP and DMP1 gene-modified BMSCs could be used to construct tissue-engineered bone to enhance mineralization of the regenerated bone and osseointegration of dental implants in MSFA.

Osteomielite associada à Actinomyces sp. em osso mandibular: relato de caso

A actinomicose é uma infecção rara, causada por microorganismos do gênero Actinomyces. Sua apresentação clínica pode se assemelhar ou mascarar outros processos infecciosos, o que torna complexo seu diagnóstico e compromete o êxito terapêutico. O objetivo deste trabalho é relatar um caso de osteomielite decorrente de uma infecção bacteriana, discutir as manifestações clínicas, formas de diagnóstico e tratamento. Trata-se de um estudo descritivo, retrospectivo, qualitativo feito por meio da técnica de observação direta. Paciente do sexo masculino, leucoderma, 65 anos de idade, compareceu ao serviço de cirurgia bucomaxilofacial com queixa álgica em região anterior de mandíbula e histórico de exodontia há 5 meses na região com episódios de drenagem de secreção purulenta. Ao exame físico observou-se ausência do dente 31 e tecidos íntegros, sendo solicitado exame radiográfico, onde observou-se sequestro ósseo em região de osso alveolar, com hipótese diagnóstica de osteomielite. O tratamento preconizado foi procedimento cirúrgico com exérese da área radiopaca, associado ao uso de um agente antimicrobiano. Avaliação histopatológica confirmou o processo infeccioso associado a colônias de bactérias Actinomyces sp.; o paciente evoluiu bem com completa remissão do processo infeccioso. Desta forma, a confirmação histopatológica é uma importante ferramenta para o rápido diagnóstico e estabelecimento de tratamento efetivo, tendo em vista que a actinomicose faz diagnóstico diferencial com diversas doenças e tem alto poder destrutivo local.

Barium Spill from Perforated Appendix After Barium Enema

Barium appendicitis is a very rare complication of barium meals or barium enema. A 39-old man presented to our hospital with right lower abdominal pain. Nine months earlier, he had previously been diagnosed with uncomplicated acute appendicitis and received antibiotic therapy. Barium enema was performed for diarrhea 3 days ago. The radiological findings showed that a radiopaque area in the right lower quadrant was similar to the image of barium enema. Computed tomography revealed high-density contents in the appendix and swelling of the appendiceal wall. Acute appendicitis was strongly suspected, and emergency laparoscopy was performed. Intraoperative findings showed acute phlegmonous appendicitis, and laparoscopic appendectomy was performed. Histopathological examination showed inflammatory cells infiltrating and perforation in the middle wall of the appendix.

Comparison of actual porcine tooth crown development stages and computer image analysis.

Tooth developmental stage evaluation is important in dental and chronological age estimation, and it is important for accurate diagnoses and appropriate treatment in dental practice. It is routinely assessed by clinical observations and radiographic techniques. This study aimed at ascertaining tooth developmental stage judgments made by examiners and Mimics software according to the Nolla method with radiographs. Meanwhile, the true tooth developmental stages would be explored with histological analysis. Twenty freshly slaughtered porcine heads were collected and hemisected, and both the left and right mandibular samples were numbered. The developmental stages of the second and third permanent molars (M2 and M3) were evaluated by examiners and Mimics software analysis. The ratio of the radiopaque calcified area to the dental follicle (RCA/DF) at different stages was calculated. Both non-decalcified and decalcified samples were processed for histologic observation. The results showed significant differences between RCA/DF ratios from different developmental stages. There was a high positive correlation between the examiners' evaluation results and Mimics analysis results. Radiograph judgments and histology observation results were consistent from Stages 2-6. However, radiograph images of Stage 1 samples showed only crypts present, while under a surgical operating microscope, a bell-shaped tooth germ was observed. This was also confirmed by normal and hard tissue histology. In conclusion, radiograph judgments made by either examiners or Mimics software were both reliable. Mimics analysis can be a useful tool in evaluating tooth developmental stages. However, judgments need to be made cautiously in early developmental stages.

Intentional Replantation to Treat Apical Periodontitis of Maxillary First Molar with Foreign Body Located Outside Apical Foramen Using CBCT: A Case Report

The recent use of cone beam computed tomography (CBCT) in the field of dentistry to obtain 3-dimensional (3D) images has enabled more effective examination and diagnosis in endodontic treatment. Such information has also been reported to be of benefit in surgical endodontic treatment such as intentional replantation. Here, we report a case of intentional replantation with the assistance of CBCT in which a good therapeutic outcome was achieved. The patient was a 30-year-old woman who visited our hospital with the chief complaint of spontaneous pain in the right maxillary first molar. Dental radiographs revealed a radiolucent area in the apical portion of the distal root, and a radiopaque area thought to be a broken shard from a small surgical instrument measuring approximately 1.5 mm in length. The shard was located outside the distal apical foramen. Based on these findings, the diagnosis was acute suppurative apical periodontitis of the right maxillary first molar. Infected root canal therapy was subsequently commenced. The patient's symptoms showed no improvement, however, and the pain persisted. Therefore, dental CBCT was performed to obtain 3D images, which confirmed a radiopaque area thought to be a broken shard from a small surgical instrument located outside the apical foramen of the distal root and facing in a direction that made it impossible to remove from the root canal. Because the patient's symptoms had shown no improvement and a foreign body was observed outside the apical foramen, intentional replantation combined with root resection was performed with informed consent. At a 1-year follow-up visit, progress was good, and there were no reported symptoms or signs. When reaching a diagnosis is difficult based on clinical findings and dental radiographs alone, the 3D images provided by CBCT offer a means of securing a more reliable diagnosis, allowing planning of treatment to be more effective.

PERAWATAN OBSTRUKSI SALURAN AKAR MENGGUNAKAN EDTA PADA GIGI PASKA RESTORASI AMALGAM

Root canal calsification can occur due to prolonged trauma, aging, or restorations with pressure on the teeth for a long time, and causes root canal obstructed. The purpose of this case report to evaluate the results of root canal treatment with obstructed root canal post amalgam restoration, continue with unimetrix post and PFM crown. Thirty three years old female patient has come to dental clinic to treat her left mandibular molar tooth that have big amalgam restoration in the occlusal and tooth fracture at lingual side, but there was no pain when he came. Clinical examination on tooth 36 is necrosis pulpa. Radiographs showed radiopaque area from occlusal until pulp chamber floor and no periapical lesions were found. Rewalling lingual wall was done before the procedure of multivisit root canal treatment with EDTA, that consists of three obstructed root canal. Preparation and insertion of tapered self threading dowel (unimetrix, Dentsply) and build up core with cement resin at once. Core preparation were done for PFM jacket crown, and then mold with irreversible hydrocolloid for maxilla and double impression material for the mandible. PFM jacket crown was cemented using resin cement. The evaluation after six months, there were no complaints of pain and good marginal adaptation of restoration has performed. Selection cases and the right diagnosis with treatment procedures and adequate restoration, root canal treatment can be effective and durable.

JUVENILE OSSIFYING FIBROMA: A RARE CASE REPORT EMPHASIZING CLINICAL, RADIOGRAPHIC, AND HISTOPATHOLOGIC ASPECTS

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion, which most often arises in children, adolescents, and young adults; however, a broad age range has been reported for the psammomatoid and trabecular variants. A 29-year-old male patient presented with a 5-year history of painless swelling in the mandible. Intraoral examination revealed a mass of approximately 3 cm in the molar region of the left mandible. Radiographic examination showed a well-circumscribed radiolucent lesion containing radiopaque areas. An incisional biopsy was performed, and histopathologic evaluation revealed a lesion characterized by deposition of trabecular immature bone within fibrous connective tissue, associated with proliferation of large mesenchymal cells presenting with varied morphology, and multinucleated giant cells. The final diagnosis was JOF (trabecular variant) and the patient was referred to a surgical service for excision of the lesion. This case reinforces the importance of knowledge of clinicopathologic features for the correct diagnosis of JOF. Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion, which most often arises in children, adolescents, and young adults; however, a broad age range has been reported for the psammomatoid and trabecular variants. A 29-year-old male patient presented with a 5-year history of painless swelling in the mandible. Intraoral examination revealed a mass of approximately 3 cm in the molar region of the left mandible. Radiographic examination showed a well-circumscribed radiolucent lesion containing radiopaque areas. An incisional biopsy was performed, and histopathologic evaluation revealed a lesion characterized by deposition of trabecular immature bone within fibrous connective tissue, associated with proliferation of large mesenchymal cells presenting with varied morphology, and multinucleated giant cells. The final diagnosis was JOF (trabecular variant) and the patient was referred to a surgical service for excision of the lesion. This case reinforces the importance of knowledge of clinicopathologic features for the correct diagnosis of JOF.

MULTIPLE HEMANGIOMAS WITH FORMATION OF PHLEBOLITH: CASE REPORT

Lesions of vascular nature often suffer dystrophic calcification inside, called phleboliths, and are represented by radiopaque areas sometimes forming concentric circles. A white 30-year-old male patient complained of purple growths in mouth and face for several years. Medical records were not contributory. During physical examination, we found purplish growths with discoloration in the labial mucosa and cutaneous region. During intraoral examination, we observed lesions on the lip mucosa, purplish in the commissures, and purplish nodules on the floor of the mouth and lingual side. Purplish stains are observed in retromolar trigone and lingual dorsum regions. With a diagnosis of hemangiomas, occlusal x-ray was performed, which revealed radiopacities (phleboliths) in the mouth floor corresponding to the vascular lesions of the region. We referred him for a systemic evaluation by a vascular surgeon. Phleboliths can be easily confused with sialoliths, therefore requiring careful consideration by the clinician.

DIFFUSE SCLEROSING OSTEOMYELITIS TREATED WITH METHOTREXATE: CASE REPORT

Diffuse sclerosing osteomyelitis (DSO) affects adults, exhibits no gender predilection, and often occurs in the jawbone. A 20-year-old male patient presented to our service with "facial pain" and mandibular asymmetry caused by a bone enlargement in the right side. Computerized tomography (CT) scanning showed large, mixed radiolucent and radiopaque areas associated with bone erosions from mandibular condyle to ipsilateral body. Culture and antibiogram analysis were negative. Histopathologic examination demonstrated unspecified bone inflammation signs. After review of the literature, the patient was referred to a rheumatologist and methotrexate in combination with folic acid was initiated on a weekly basis. The patient reports progressive reduction of pain although facial asymmetry still persists. Diagnosis of DSO may be challenging due to nonspecific findings and rarity of the disease. Fibrous dysplasia should be ruled out. Diffuse sclerosing osteomyelitis (DSO) affects adults, exhibits no gender predilection, and often occurs in the jawbone. A 20-year-old male patient presented to our service with "facial pain" and mandibular asymmetry caused by a bone enlargement in the right side. Computerized tomography (CT) scanning showed large, mixed radiolucent and radiopaque areas associated with bone erosions from mandibular condyle to ipsilateral body. Culture and antibiogram analysis were negative. Histopathologic examination demonstrated unspecified bone inflammation signs. After review of the literature, the patient was referred to a rheumatologist and methotrexate in combination with folic acid was initiated on a weekly basis. The patient reports progressive reduction of pain although facial asymmetry still persists. Diagnosis of DSO may be challenging due to nonspecific findings and rarity of the disease. Fibrous dysplasia should be ruled out.

FINAL DIAGNOSIS OF GARDNER SYNDROME DUE TO STOMATOLOGIC SUPPORT

Gardner syndrome (GS) is an autosomal dominant disease characterized by adenomatous intestinal polyps, and if not treated, shows a great chance of becoming malignant. Multiple osteomas in the skull, maxilla, and mandible, along with multiple cutaneous and subcutaneous masses are also characteristics of GS. A 30-year-old woman reported an epidermoid cyst on the frontal bone and a scar on the left shoulder due to osteoma removal. Tooth absence, malocclusion, and osteoma in the palatal region were observed in the intraoral exam. A panoramic radiography analysis revealed permanent teeth retention, supernumerary teeth, and radiopaque areas suggestive of osteomas. Although there were Gardner syndrome manifestations, only after our evaluation, a colonoscopy examination was ordered and intestinal polyps were removed with a diagnosis of tubular adenoma with low grade dysplasia. Today, the patient is under follow-up with a gastroenterologist and oral and maxillofacial surgeons, orthodontists, and stomatology experts with a common goal of function, esthetic, and quality of life improvements. Gardner syndrome (GS) is an autosomal dominant disease characterized by adenomatous intestinal polyps, and if not treated, shows a great chance of becoming malignant. Multiple osteomas in the skull, maxilla, and mandible, along with multiple cutaneous and subcutaneous masses are also characteristics of GS. A 30-year-old woman reported an epidermoid cyst on the frontal bone and a scar on the left shoulder due to osteoma removal. Tooth absence, malocclusion, and osteoma in the palatal region were observed in the intraoral exam. A panoramic radiography analysis revealed permanent teeth retention, supernumerary teeth, and radiopaque areas suggestive of osteomas. Although there were Gardner syndrome manifestations, only after our evaluation, a colonoscopy examination was ordered and intestinal polyps were removed with a diagnosis of tubular adenoma with low grade dysplasia. Today, the patient is under follow-up with a gastroenterologist and oral and maxillofacial surgeons, orthodontists, and stomatology experts with a common goal of function, esthetic, and quality of life improvements.

METASTATIC CALCINOSIS OF THE TONGUE: A CASE REPORT

Metastatic calcinosis (MC) is a pathologic process that results from the deposition of calcified product in normal tissues as result of hyperphosphatemia with or without concomitant hypercalcemia. A 52-year-old man with history of renal transplant was evaluated for an asymptomatic nodule on the dorsal surface of the tongue. On intraoral examination, an undefined, firm, sessile, irregular, and yellowish surface nodule, measuring 10 × 8 × 4 mm was observed. Panoramic radiograph showed radiopaque areas adjacent to the hyoid bone and paired linear areas of calcification next to the mandibular angle. The medical history revealed a previous diagnosis of chronic renal disease with slightly increased levels of serum phosphorus (5.5 mg/dL). An excisional biopsy was performed. Histopathologic and scanning electron microscopy analysis revealed the presence of amorphous material and basophilic irregularly shaped acellular deposits with a lamellar-like aspect. A final diagnosis of MC was made and the patient was referred for medical evaluation. Financial support: FAPEMIG.

Cemento-Ossifying Fibroma in Maxillofacial Region: A Series of 16 Cases.

Cemento-ossifying fibroma is considered as a benign osseous tumour, closely related to other lesions such as fibrous dysplasia and cementifying periapical dysplasia. These lesions occur in the second to the fourth decade of life. It is a bony tumour of maxilla and mandible of possibly odontogenic origin with aggressive behaviour and high tendency for recurrence. Radiologically, the lesion appearances varied ranging from radiolucent cyst-like appearance to mixed and/or radiopaque areas. The article attempts to highlight the importance of clinical, imaging aspects and histopathology in diagnosis of cemento-ossifying fibroma along with management and long-term follow-up. This retrospective study was done on histologically diagnosed 16 fibro-osseous lesions. These patients were treated under general anaesthesia at our institute. The demographic data, radiographic features, and histopathologic findings were analysed and compared. The treatment and follow-up data were also recorded. Cemento-ossifying fibroma showed higher predilection for female than for male patients and with an equal number of cases reported in maxilla and mandible with no signs of recurrence in long-term follow-up of 15years. Complete surgical excision of cemento-ossifying fibroma comes out to be only effective treatment that gave satisfactory results and can be considered as a definitive treatment modality.

The impact of graft remodeling on peri‐implant bone support at implants placed concomitantly with transcrestal sinus floor elevation: A multicenter, retrospective case series

To evaluate the impact on peri-implant bone support (as assessed on periapical radiographs) of the remodeling dynamics of varying graft biomaterials used for transcrestal sinus floor elevation (tSFE). The study is a multicenter, retrospective series of cases undergone tSFE (performed according to the Smart Lift technique) and concomitant implant placement. At operator's discretion, tSFE was performed with bone core (BC) alone or supplemented by deproteinized bovine or porcine bone mineral (DBBM and DPBM, respectively), synthetic hydroxyapatite in a collagen matrix (S-HA), or ß-tricalcium phosphate (ß-TCP). Immediately after surgery, at 6-12months post-surgery, and at later (≥24months) follow-up intervals, the percentage proportion of the implant surface in direct contact with the radiopaque area was calculated for the entire implant surface (totCON%). Also, the height of the graft apical to the implant apex (aGH) was assessed. At 6-12months following tSFE, median totCON% was 100%, with a median aGH of 1.4mm. A tendency of aGH to decrease in height was observed at later follow-up intervals for sites treated with all grafting procedures. In all treatment groups, the majority of the implant surface was still surrounded by the radiopaque area at the longest follow-up visits. Although the height of the peri-implant radiopaque area apical to the implant apex tends to reduce overtime at sites which have received tSFE, the peri-implant bone support seems to be maintained long term irrespective of the graft material used.

Radiographic outcomes of transcrestal and lateral sinus floor elevation: One-year results of a bi-center, parallel-arm randomized trial.

To comparatively evaluate the radiographic outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) when applied concomitantly with implant placement. Patients with at least 1 edentulous site with residual bone height (RBH) of 3-6mm were enrolled in a bi-center, parallel-arm, randomized trial. Both tSFE and lSFE were associated with a bovine-derived xenograft, and implants were inserted concomitantly. In lSFE group, the antrostomy was covered with a resorbable collagen membrane. Marginal bone loss and the maturation of the grafted area were evaluated on periapical radiographs at 6 and 12months. Twelve-month CT/CBCT was used to assess the effect of grafting procedures circumferentially around the implant. A per-protocol analysis was performed. The per-protocol study population consisted of 26 patients in the tSFE group and 28 patients in the lSFE group. At 12months, the median proportion of the implant surface in contact with the peri-implant radiopaque area was 100% in both groups, with no significant inter-group difference. Suboptimal bone-to-implant contact was observed in 13% and 3.6% of tSFE and lSFE cases, respectively. In both groups, marginal bone loss was minimal (≤1mm) and infrequent, and the radiographic aspect was suggestive of an advanced stage of maturation. At sites with RBH of 3-6mm where implants are placed concomitantly with sinus floor elevation, tSFE and lSFE are both highly predictable in obtaining an implant surface completely embedded in a radiopaque area at 12months post-surgery. (ClinicalTrials.gov ID: NCT02415946).