Semi-customized three-dimensional ultra-fine titanium meshes in guided bone regeneration for implant therapy in severe alveolar bone defect: a case report.

This case report provides a detailed description of a simple and fast bone regeneration procedure using a semi-customized three-dimensional ultra-fine titanium mesh. A 50-year-old male with a severe vertical and horizontal bone defect in the anterior mandible underwent implant treatment in a staged approach. The autologous bone was combined with a xenograft, and the mixture was grafted to augment the bone defect and covered with semi-customized ultra-fine titanium meshes, which were selected among its various types according to size and configuration of the bone defect, directly connected and immobilized on the tenting screws with minimal shaping. In a postoperative 6 months re-entry surgery, the performed titanium meshes were removed, implants were placed, and a bone core biopsy was obtained that demonstrated satisfactory new bone formation. Finally, two months later, the definitive prosthesis was installed. This semi-customized ultra-fine titanium mesh could help an implant clinician obtain more predictable results in the guided bone regeneration (GBR).

Comparison of Prophylactic Effects between Localized Biomimetic Minocycline and Systematic Amoxicillin on Implants Placed Immediately in Infected Sockets.

This study evaluated the prophylactic effect of localized biomimetic minocycline and systemic amoxicillin on immediate implant placement at infected extraction sites. Twelve mongrels with six implants each were randomly assigned to five groups: uninfected negative control (Group N); infected with oral complex bacteria (Group P); infected and treated with amoxicillin one hour before implant placement (Group A); infected and treated with minocycline during implant placement (Group B); and infected and treated with amoxicillin one hour before implant placement and with minocycline during implant placement (Group C). Radiographic bone level, gingival index (GI), probing depth (PD), papillary bleeding index (PBI), and removal torque (RT) were recorded. There was no significant difference between Groups A, B, and C for bone loss. Group A showed the highest RT, the lowest PBI, and significantly lower GI and PD values than Group P. Group B exhibited significantly higher RT value than Group N and significantly smaller PD value than Group P at 6 w postoperatively. Localized minocycline could improve implant success by reducing bone loss and increasing RT and systemic amoxicillin could maintain the stability of the peri-implant soft tissue. However, combined use of these two antibiotics did not augment the prophylactic effect.

Intra-sinus rigid fixation of a resorbable barrier membrane to repair a large perforation of the sinus membrane: a technical note.

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

A novel chimeric vaccine candidate for porcine reproductive and respiratory syndrome virus (PRRSV) I and II elicits neutralizing antibodies against both types.

Porcine reproductive and respiratory syndrome virus (PRRSV) is an economically important virus within the swine industry. The virus causes respiratory disease and reproductive failure. Two species of PRRSV-I and II are co-dominant, yet no effective vaccination strategy has been developed to protect against these two types. With an aim to develop a chimeric vaccine strain to protect against both types, in this study, a chimeric porcine reproductive and respiratory syndrome virus (PRRSV) type I and II was rescued using reverse genetics for the first time. Four chimeric infectious clones were designed based on the genomic arrangement of the structural proteins. However, only the clone carrying the transcriptional regulatory sequence (TRS) and ORF6 of a PRRSV-I and ORF6 of a PRRSV-II generated a viable recombinant virus, suggesting that concurrent expression of ORF6 from both parental viruses is essential for the recovery of type I and II chimeric PRRSV. The chimeric virus showed significantly lower replication ability than its parental strains in vitro, which was improved by serial passaging. In vivo, groups of pigs were inoculated with either the chimeric virus, one of the parental strains, or PBS. The chimeric virus replicated in pig tissue and was detected in serum 7 days post-inoculation. Serum neutralization tests indicated that pigs inoculated with the chimeric virus elicited neutralizing antibodies that inhibited infection with strains of both species and with greater coverage than the parental viruses. In conclusion, the application of this technique to construct a chimeric PRRSV holds promise for the development of a highly effective modified live vaccine candidate. This is particularly significant since there are currently no approved commercial divalent vaccines available to combat PRRSV-I and II co-infections.

Efficient reverse genetics approach involving infectious subgenomic amplicon for engineering dengue virus.

Dengue virus, which belongs to the Flaviviridae family, can induce a range of symptoms from mild to severe, including dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. While infectious cloning technology is a useful tool for understanding viral pathogenesis and symptoms, it exhibits limitations when constructing the entire Flavivirus genome. The instability and toxicity of the genome to bacteria make its full-length construction in bacterial vectors a time-consuming and laborious process. To address these challenges, we employed the modified infectious subgenomic amplicon (ISA) method in this study, which can potentially be a superior tool for reverse genetic studies on the dengue virus. Using ISA, we generated recombinant dengue viruses de novo and validated their robust replication in both human and insect cell lines, which was comparable to that of the original strains. Moreover, the efficiency of ISA in genetically modifying the dengue virus was elucidated by successfully inserting the gene for green fluorescence protein into the genome of dengue virus serotype 4. Overall, this study highlighted the effectiveness of ISA for genetically engineering the dengue virus and provided a technical basis for a convenient reverse genetics system that could expedite investigations into the dengue virus.

Application of codon pair deoptimization for ORF7-induced attenuation of type I porcine reproductive and respiratory syndrome virus without reduced immune responses.

Codon pair deoptimization (CPD) attenuated type I porcine reproductive and respiratory syndrome virus (PRRSV). Infectious clones covering the full genome of a Korean type I PRRSV (E38) were synthesized, and CPD induced nine synonymous mutants of NSP1 (n = 1) and ORF7 (n = 8). In a trial to rescue live viruses from infectious clones, only four clones with mutations at nt 177 downstream of ORF7 were rescued, which showed a substantial decrease in cellular replication ability. The rescue-failed clones had two common mutation sites with a high minimum free energy and significantly modified RNA secondary structure relative to the original virus. In infected pigs, CPD viruses demonstrated significantly lower replication ability and pathogenicity than the original virus. However, immune response level induced by the attenuated viruses and the original virus was similar. This is the first study to demonstrate that type I PRRSV virulence can be attenuated through CPD application to ORF7.

A Randomized Controlled Trial of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with Two Anorganic Bovine Bone Materials Covered by Titanium Meshes.

The aim of this study is to compare two low-temperature sintered anorganic bovine bone materials (ABBMs), Bio-Oss (Geistlich, Wolhusen, Switzerland) and A-Oss (Osstem, Seoul, Korea), for GBR in dehiscence defects. A single implant was placed simultaneously with GBR in the buccal or bucco-proximal osseous defect by double-layering of inner allograft and outer ABBM, covered by a preformed ultrafine titanium mesh and an absorbable collagen membrane. Grafted volume changes were evaluated by cone-beam computed tomography, taken preoperatively (T0), immediately after implant surgery (T1), after re-entry surgery (T2), and after delivery of the final restoration (T3). The density of the regenerated bone was assessed by measuring the probing depth on the buccal mid-center of the mesh after removing the mesh at T2. Postoperative sequelae were also recorded. Grafted volume shrinkage of 46.0% (0.78 ± 0.37 cc) and 40.8% (0.79 ± 0.33 cc) in the Bio-Oss group (8 patients) and A-Oss group (8 patients), respectively, was observed at T3 (p < 0.001). There were no significant differences in grafted volume changes according to time periods or bone density between the two groups. Despite postoperative mesh exposure (3 patients), premature removal of these exposed meshes and additional grafting was not necessary, and all implants were functional over the 1-year follow-up period. Both ABBMs with titanium meshes showed no significant difference in the quantity and density of the regenerated bone after GBR for peri-implant defects.

Evaluation of the Effects of Mouthwash on the Morphology and Cell Viability of Osteoblast-Like Cells.

This study evaluated the effects of multiple mouthwashes on the cellular viability or the morphology of preosteoblasts. Mouse calvarial osteoblast-like cells were cultured and treated with mouthwashes of (1) benzydamine hydrochloride; (2) cetylpyridinium chloride and benzalkonium chloride; (3) methyl salicylate, menthol, eucalyptol, and thymol; and (4) sodium fluoride, xylitol, and chitosan. The treatment times were 30 seconds, 90 seconds, and 270 seconds. Cell morphology was evaluated with a microscope, and the viability of the treated cells was analyzed quantitatively using a commercially available kit. The untreated control group exhibited well-stretched fibroblast-like morphology. Treatment with mouthwash resulted in morphological changes in all groups. Treatment with sodium fluoride resulted in more noticeable changes. Treatment with mouthwash for 30 seconds produced a significant decrease in cell viability. An increase in time to 90 and 270 seconds did not produce additional noticeable changes. To conclude, commercially available mouthwashes created changes in cell morphology and decreased the cell viability of osteoblast-like cells irrespective of ingredients and treatment time.

Five-Year Prospective Study on Implant Failure and Marginal Bone Remodeling Expected Using Bone Level Implants with Sandblasted/Acid-Etched Surface and Conical Connection.

OBJECTIVE: The purpose of the present prospective, case-series study was to report implant survival rate and marginal bone remodeling expected 5 years after loading using dental implants placed in daily practice. MATERIALS AND METHODS: This research was designed as an open-cohort, prospective, case-series evaluation. Any partially or completely edentulous patient, scheduled to receive at least one bone level implant, was considered eligible for this study. Primary outcome measurements were: implant and prosthetic cumulative survival rate and any complications experienced up to the 5-year follow-up. Secondary outcome measures were: thickness of gingival biotype, implant insertion torque, implant stability quotient, and marginal bone loss (MBL). RESULTS: Ninety consecutive patients (34 males and 56 females, aged between 24 and 81 years old [mean: 53.2 ± 15.4]) with 243 inserted implants were followed for at least 5 years after loading (mean: 65.4 ± 3.1 months; range from 60 to 72). At the 1-year follow-up, no drop-outs were recorded, but 17 patients (18.9%) with 18 restorations (12.6%) delivered on 34 implants (14%) were lost at the 5-year examination. At the 5-year follow-up examination, six implants lost osseointegration (97.5%). In the same period, four prostheses failed (97.2%). Five complications were reported in five different patients (prosthetic success rate was 96.5%, at patient level). Five years after loading, the mean MBL was 0.41 ± 0.30 mm. The difference from the 1-year data was 0.04 ± 0.19 mm. A statistically significant higher MBL was found for smokers, and patients with thin gingival biotype. The mean implant insertion torque was 42.9 ± 4.8 Ncm (range from 15 to 45 Ncm). Two-hundred and three implants (83.5%) were inserted with an insertion torque ≥35 and ≤45 Ncm. CONCLUSIONS: High implant survival and success rate could be expected with stable marginal bone remodeling up to 5 years after loading. Smoking and thin tissue biotype were the most important variabilities associated with higher MBL. Further research studies are needed to confirm these results.

Accuracy of surgical templates with and without metallic sleeves in case of partial arch restorations: A systematic review.

INTRODUCTION: The aim of the present systematic review was to evaluate whether there were any differences in the three-dimensional accuracy and the implant survival rate of implants placed using computer-assisted planning and surgical templates with or without metallic sleeves. SOURCES: This systematic review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered to the PROSPERO (International prospective register of systematic reviews) database. STUDY SELECTION: PICOS (population, intervention, control, outcomes, and studies) question was assessed, too. Search strategy encompassed the online (MedLine) literature from 1990 up to December 2020 published in English, and evaluating the accuracy of surgical templates with and without metallic sleeves in partial or complete patients. Only in vivo, randomized controlled trial and observational studies were included. Quality assessment of selected full text articles was performed according to the CONSORT (CONsolidated Standards of Reporting Trials) and STROBE (Strengthening the Reporting of Observational studies in Epidemiology) statement guidelines, respectively. For data analysis, the three-dimensional accuracy and the overall implant survival rate was calculated and compared between implants placed using surgical templates with or without metallic sleeves. DATA: A total of 12 articles fulfilled the inclusion/exclusion criteria. Data from 264 patients with 614 implants were subjected to quality assessment (templates with metallic sleeves: 279 implants and 136 patients; templates without metallic sleeves: 335 implants and 128 patients). In all the three deviation parameters (angular, vertical, and horizontal), the differences in average accuracy were noticed (angular 2.33° ± 2.01° versus 3.09° ± 1.65°, vertical: 0.62 ± 0.36 [mm] versus 0.95 ± 0.42 [mm]; and horizontal: 0.62 ± 0.41 [mm] and 1.11 ± 0.57 [mm]. No differences was found regarding overall implant survival rate (0.4891). CONCLUSIONS: With the limitations of the present study, the surgical templates without metallic sleeves demonstrated high level of accuracy in all the three-dimensional measurements, when used to rehabilitate partially edentulous patients. Further randomized controlled trials, reporting according to the CONSORT guidelines are needed to confirm that the differences in accuracy depended on the type of used templates.

The dual-port endoscope-assisted cyst enucleation on the maxillofacial region.

BACKGROUND: Endoscope-assisted surgery is a surgical method that has been used in oral and maxillofacial surgical fields. It provides good illumination, clear, and magnified visualization of the operative field. The purpose of this article is to describe the early clinical experiences to conduct minimally invasive surgery with endoscope-assisted enucleation of cysts on the jaw. It appears that this approach may be a superior alternative to the conventional approach. METHODS: In this study, 24 patients (9 females, 15 males, average age 41.5) underwent endoscope-assisted cyst enucleation under general anesthesia. All operations were done by one surgeon. The cases were classified depending on whether bone penetration occurred at the cyst site. The cystic lesions were enucleated using an endoscope with a 0°, 1.9 mm diameter, or a 30°, 2.7 mm diameter. Two bony windows were used for the insertion of a syringe for irrigation, curettes, suction tips, sinus blades, surgical drills, and an endoscope. An additional small channel was made for the insertion of endoscopic instruments. RESULTS: The 24 patients who underwent cyst enucleation were regularly observed for 3 to 12 months to evaluate for complications. Although some patients experienced swelling and numbness, these symptoms did not persist, and the patients soon returned to normal and there was no sign of recurrence. CONCLUSIONS: The results of this study have suggested the possibility of minimally invasive surgery with endoscopes when it comes to cyst removal in the oral and maxillofacial region. Nevertheless, this study has limitations designed as a preliminary report focusing on the feasibility of endoscope-assisted cyst enucleation in the oral and maxillofacial regions.

Clinical factors affecting the longevity of fixed retainers and the influence of fixed retainers on periodontal health in periodontitis patients: a retrospective study.

PURPOSE: The aim of this study was to evaluate clinical factors affecting the longevity of fixed retainers and the influence of fixed retainers on periodontal health in periodontitis patients. METHODS: In total, 52 patients with at least 2 years of follow-up after periodontal and orthodontic treatment were included in this study. After scaling and root planing, orthodontic treatment with fixed appliances or clear aligners was performed. Fixed retainers with twist-flex stainless steel wires were bonded to the palatal or lingual sides of anterior teeth. Changes in clinical parameters, including the plaque index, gingival index, calculus index (CI), probing pocket depth, and radiographic bone levels, were evaluated before bonding of fixed retainers and at a 12-month follow-up. Cumulative survival rates (CSRs) for retainer failure were evaluated according to sex, site, CI, stage of periodontitis, and the severity of the irregularity with the log-rank test and hazard ratios (HRs). RESULTS: Twelve months after bonding of fixed retainers, improvements were observed in all clinical parameters except CI and radiographic bone gain. The overall CSR of the retainers with a CI <1 at the 12-month follow-up after bonding of fixed retainers was significantly higher than that of the retainers with a CI ≥1 at the 12-month follow-up (log-rank test; P<0.001). Patients with stage III (grade B or C) periodontitis had a higher multivariate HR for retainer failure (5.4; 95% confidence interval, 1.22-23.91; P=0.026) than patients with stage I (grade A or B) periodontitis. CONCLUSIONS: Although fixed retainers were bonded in periodontitis patients, periodontal health was well maintained if supportive periodontal treatment with repeated oral hygiene education was provided. Nonetheless, fixed retainer failure occurred more frequently in patients who had stage III (grade B or C) periodontitis or a CI ≥1 at 12-month follow-up after bonding of fixed retainers.

Biosilicated collagen/ß-tricalcium phosphate composites as a BMP-2-delivering bone-graft substitute for accelerated craniofacial bone regeneration.

BACKGROUND: Bioceramic ß-tricalcium phosphate (ß-TCP) is used as a bone-grafting material and a therapeutic drug carrier for treatment of bone defects in the oral and maxillofacial regions due to the osteoconductivity and biocompatibility. However, the low mechanical strength and limited osteoinductivity of ß-TCP agglomerate restrict bone regenerating performance in clinical settings. METHODS: Herein, a biomimetic composite is proposed as a bone morphogenetic protein-2 (BMP-2)-delivering bone graft substitute to achieve a robust bone grafting and augmented bone regeneration. RESULTS: The sequential processes of brown algae-inspired biosilicification and collagen coating on the surface of ß-TCP enable the effective incorporation of BMP-2 into the coating layer without losing its bioactivity. The sustained delivery of BMP-2 from the biosilicated collagen and ß-TCP composites promoted in vitro osteogenic behaviors of pre-osteoblasts and remarkedly accelerated in vivo bone regeneration within a rat calvarial bone defect. CONCLUSIONS: Our multicomposite bone substitutes can be practically applied to improve bone tissue growth in bone grafting applications with further expansion to general bone tissue engineering.

In vitro evaluation of bioburden, three-dimensional stability, and accuracy of surgical templates without metallic sleeves after routinely infection control activities.

BACKGROUND: Surgical templates are classified as noncritical devices, and they do not need to be sterile. AIM: Primary aim of this study was to assess the microbiological burden present on the surgical templates without metallic sleeves after disinfection. Furthermore, to evaluate trueness after disinfection and steam sterilization at 121°C/15 min, and over a 8-week storage period. Finally, to assess their accuracy after in vitro implant placement simulation. MATERIALS AND METHODS: Forty surgical templates were printed and divided in five groups of eight templates each. Groups A to C were disinfected with 0.5% Chlorhexidine Gluconate and 70% ethyl alcohol base solution for 15 min. Templates in the group D were steam sterilized at 121°C for 15 min, while, the templates in the group E were used as control. Implant simulation was performed in the group A. Outcome measures were determination of bioburden, trueness assessment using GOM Inspect Professional software, and accuracy evaluated thought the mean angular deviation of simulated implants. RESULTS: Total microbic charge measured as colony forming units (CFU) for sample, was 24.40 in the control group (group E; n = 8), and <4.40 in the test group (group C; n = 8), with a reduction of 84%. Colored representation from GOM inspection showed no differences after disinfection and implant simulation, disinfection alone, and steam sterilization, compared to the control group. A very small difference in the surface and volume dimensions was reported 1 month after templates fabrication. The mean roundness tolerances of the tested templates improved of 0.96 ± 0.56° (95% CI 0.57-1.35). CONCLUSION: Surgical templates without metallic sleeves can be safely used after disinfection, demonstrating high level of accuracy, even when the surgical procedures should be postponed within a couple of weeks. Further in vivo study are needed to confirm these preliminary results.

Customized 3D-Printed Titanium Mesh Developed to Regenerate a Complex Bone Defect in the Aesthetic Zone: A Case Report Approached with a Fully Digital Workflow.

Alveolar-ridge augmentation, anterior aesthetics, and digital technologies are probably the most popular topics in the dental-implant field. The aim of this report is to present a clinical case of severe atrophy of the anterior maxilla in a younger female patient, treated with a titanium membrane customized with computer-aided design/computer-aided manufacturing (CAD/CAM), simultaneous guided implant placement, and a fully digital workflow. A young female patient with a history of maxillary trauma was treated and followed-up for 1 year after implant placement. A narrow implant was inserted in a prosthetically driven position with the aid of computer-guided surgery. In the same surgical section, a customized implantable titanium mesh was applied. The scaffold was designed according to the contralateral maxillary outline in order to recreate a favorable maxillary bone volume. Finally, highly aesthetic, CAD/CAM, metal-free restorations were delivered using novel digital technologies.

Radiologic comparative analysis between saline and platelet-rich fibrin filling after hydraulic transcrestal sinus lifting without adjunctive bone graft: A randomized controlled trial.

OBJECTIVES: To evaluate implant survival rate, any complications, and changes in residual alveolar bone height (RABH) using saline or platelet-rich fibrin (PRF) filling after hydraulic transcrestal sinus lifting. METHODS: Dental implants were placed after hydraulic transcrestal sinus lifting and the filling of saline (20 patients) or PRF (20 patients). Outcome measurements were implant survival, any complications, and RABH changes. Cone-beam computed tomography (CBCT) scans were taken and compared preoperatively (T0), immediately postoperatively (T1), at 3 months (T2), 6 months (T3), and 12 months postoperatively (T4), respectively. RESULTS: In a total of 40 patients, 45 implants with a mean length of 10.4 ± 0.8 mm were placed in posterior maxilla of a mean RABH of 6.8 ± 1.1 mm. The increase in RABH peaked at T1, and continuous drooping of the sinus membrane was observed but stabilized at T3. Meanwhile, the gradual increase in the radiopacities was found below the lifted sinus membrane. The PRF filling induced the radiographic intrasinus bone gain of 2.6 ± 1.1 mm, which was significantly more than 1.7 ± 1.0 mm of saline filling at T4 (p < .05). All the implants were in function with no significant complications over the one-year follow-up period. CONCLUSIONS: In this randomized case-control study, the feasibility of hydraulic transcrestal sinus lifting without bone graft was confirmed and PRF might be a better filler to support the elevated sinus membrane. However, adjunctive bone grafting should still be indicated for cases requiring more than 2-3 mm of intrasinus bone gain.

The preliminary study for three-dimensional alveolar bone morphologic characteristics for alveolar bone restoration.

BACKGROUND: The concept of the ideal morphology for the alveolar bone form is an important element to reconstruct or restore the in maximizing esthetic profile and functional alveolar bone restoration. The purpose of this preliminary study is to evaluate the normal alveolar bone structure to provide the standard reference and guide template for use in diagnosing for implant placement, determining the correct amount of bone augmentation in actual clinical practice and producing prostheses based on three-dimensional imaging assessment of alveolar bone. METHODS: This study was included 11 men and 11 women (average age, 22.6 and 24.5 years, respectively) selected from among 127 patients. The horizontal widths of alveolar bone of maxilla and mandible were measured at the crestal, mid-root, and root apex level on MDCT (multi-detector computed tomography) images reconstructed by medical imaging software. In addition, tooth dimensions of the central incisors, canines, second premolars, and first molars of maxilla and mandible, including the horizontal width of the interdental alveolar bone crest, were also measured and statistically analyzed. RESULTS: The horizontal alveolar bone width of the palatal side of maxilla showed a distinct increment from the alveolar bone crest to the apical region in both anterior and posterior areas. The average widths of the maxillary alveolar ridge were as follows: central incisor, 7.43 mm; canine, 8.91 mm; second premolar, 9.57 mm; and first molar, 12.38 mm. The average widths of the mandibular alveolar ridge were as follows: central incisor, 6.21 mm; canine, 8.55 mm; second premolar, 8.45 mm; and first molar, 10.02 mm. In the buccal side, the alveolar bone width was not increased from the crest to the apical region. The horizontal alveolar bone width of an apical and mandibular border region was thinner than at the mid-root level. CONCLUSIONS: The results of the preliminary study are useful as a clinical guideline when determining dental implant diameter and position. And also, these measurements can also be useful during the production of prefabricated membranes and customized alveolar bone scaffolds.

Correction to: Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection.

[This corrects the article DOI: 10.1186/s40902-019-0208-2.].

Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection.

BACKGROUND: Brain abscess is a life-threatening condition that occurs due to complications during a neurosurgical procedure, direct cranial trauma, or the presence of local or distal infection. Infection in the oral cavity can also be considered a source of brain abscess. CASE PRESENTATION: A 45-year-old male patient was transported with brain abscess in the subcortical white matter. Navigation-guided abscess aspiration and drainage was performed in the right mid-frontal lobe, but the symptoms continued to worsen after the procedure. A panoramic radiograph showed alveolar bone resorption around the maxillary molars. The compromised maxillary molars were extracted under local anesthesia, and antibiotics were applied based on findings from bacterial culture. A brain MRI confirmed that the three brain abscesses in the frontal lobe were reduced in size, and the patient's symptoms began to improve after the extractions. CONCLUSION: This is a rare case report about multiple uncontrolled brain abscesses treated by removal of infection through the extraction of maxillary molars with odontogenic infection. Untreated odontogenic infection can also be considered a cause of brain abscess. Therefore, it is necessary to recognize the possibility that untreated odontogenic infection can lead to serious systemic inflammatory diseases such as brain abscess. Through a multidisciplinary approach to diagnosis and treatment, physicians should be encouraged to consider odontogenic infections as a potential cause of brain abscesses.

Local anesthesia for mandibular third molar extraction.

Mandibular third molar extraction is commonly performed in dental clinics. However, the optimal method of anesthesia has not been established for this procedure. The conventional inferior alveolar nerve block is the most widely used method. However, its success rate is not high and it may lead to complications, such as aspiration and nerve injury. Therefore, various anesthesia methods are being investigated. Articaine has been proven to be efficacious in a number of studies and is being used with increasing frequency in clinical practice. In this review article, we will briefly review various local anesthesia techniques, anesthetics, and a computer-controlled local anesthetic delivery (CCLAD) system, which reduces pain by controlling the speed of drug injection, for mandibular third molar extraction.