Actinomycosis osteomyelitis of the jaws: Report of four cases and a review of the literature.

Actinomycosis osteomyelitis of the jaw bones, particularly in the maxilla, is an extremely rare disease. This report presents two cases of maxillary and two cases of mandibular actinomycosis osteomyelitis, with the diagnosis particularly based on histological procedures. The highly diversified pathogenicity of the phenomenon and the absence of solid diagnostic criteria are discussed. Laboratory challenges are emphasized, and a comprehensive overview of the entity including treatment alternatives is given along with a review of the relevant literature.

Preemptive analgesic efficacy of dexketoprofen trometamol on impacted third molar surgery.

OBJECTIVE: The aim of this study was to compare the pre-emptive analgesic efficacy of intravenous (IV) dexketoprofen trometamol (DT) and placebo, following impacted mandibular third molar surgery. METHODS: Twenty patients over 18 year old who needed bilateral lower third molar extractions were included in this prospective, randomized and placebo-controlled clinical trial. Patients whom had taken DT 50 mg of before their one extraction, took placebo before their other extraction which had been performed on the opposite side. A total of 40 observations were made. Pain scores were evaluated with a Verbal Rating Scale (VRS) after surgery. Moreover; the time to first analgesic requirement use, additional analgesic need of patients, patient and doctor satisfaction, side effects were also determined. RESULTS: During the first 12 hours, the VRS values in DT group were significantly lower than those of placebo group patients (p<0.05). In placebo group, the time to first analgesic requirement use was significantly earlier than that of patients in DT group (p<0.05). Additional analgesic need of placebo group were significantly greater, when compared with the analgesic need of DT group patients (p<0.05). Among the DT group patients, patient and physician satisfaction was greater, which was statistically significant (p<0.05). CONCLUSION: Preemptive use of IV DT is more effective than placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent removal of an impacted mandibular third molar surgery.

Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study.

PURPOSE: To identify the quality of newly formed bone in the distraction region and to determine the percentage of mineralized bone formed in the distraction area. METHODS: Ten patients with vertically deficient mandibular alveolar ridges were treated by means of distraction osteogenesis. Four months after consolidation of distracted segments, a total of 40 dental implants were inserted in native bone and distracted bone. Bone biopsies were taken at the implant sites with trephine burrs for histological and histometric analyses. Four months after implant placement, abutments were connected, and prosthetic loading of the implants was started. RESULTS: The mean bone gain at the end of distraction was 7.2 ± 0.8 mm. The cumulative success rate of implants 3 years after the onset of prosthetic loading was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces and the percentage of mineralized bone ranged from 50.56% to 76.88%. CONCLUSIONS: Alveolar distraction osteogenesis is able to produce adequate mature bone for the correction of mandibular bone deficits before dental implant insertion.

Transpalatal distraction using bone-borne distractor: clinical observations and dental and skeletal changes.

PURPOSE: The aim of this clinical study was to analyze the outcome, complications, and long-term results of transpalatal distraction for the correction of maxillary transverse deficiency (MTD) and assess skeletal and dental changes in the sagittal, vertical, and transverse planes through cephalograms and dental casts. PATIENTS AND METHODS: Ten adult patients with MTD were treated with a Transpalatal Distractor (Surgi-Tec, Bruges, Belgium). Lateral and posteroanterior cephalometric films and dental casts were taken before surgery and at the end of the consolidation period. The statistical analysis of cephalometric film and dental cast measurements was undertaken with paired t tests. RESULTS: The intraoperative and postoperative problems encountered were damage to the central incisive teeth as a result of vertical osteotomy, wound dehiscence after the latent period, pain during the distraction period, and loosening of the distractor and buccal displacement of the left alveolar segment during the consolidation period. Model analysis showed that the greatest amount of transverse increase was in the premolar region (7.07 mm for first premolar and 7.10 mm for second premolar). Frontal cephalometric analysis indicated that transverse distances increased more at the alveolar level (7.75 mm) than in the maxillary base (5.25 mm) and nasal region (4.3 mm). The asymmetries between the left and right sides in both dental and skeletal expansions were statistically nonsignificant. The changes in the Sella-nasion-point A, Sella-nasion-point B, Sella-nasion and gonion-gnasion angles were statistically significant. CONCLUSIONS: According to the results of this study, transpalatal distraction was found to be a clinically effective technique for palatal expansion in adult patients with MTD. However, treatment planning and regular clinical follow-up visits are necessary for long-term clinical success.

Intralesional corticosteroid injection for central giant cell granuloma: a case report and review of the literature.

Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. Although benign, it may be locally aggressive, causing extensive bone destruction, tooth displacement and root resorption. The common therapy is aggressive curettage, peripheral ostectomy or resection, which may be associated with loss of teeth and, in younger patients, loss of dental germs. A number of alternative nonsurgical approaches have been advocated in recent years for the management of CGCGs. These include intralesional corticosteroid injections, calcitonin injections and subcutaneous alpha-interferon injections. In this article, an 1-year-old boy with a CGCG is successfully treated with corticosteroid injections and this treatment is discussed within a review of the literature.

Comparison of autogenous mucosal grafts and collagen-based, solvent-preserved allografts for vestibuloplasty.

This study was designed to determine whether solvent-preserved dura mater and fascia lata grafts would be as effective as palatal mucosal grafts for vestibuloplasty. All graft systems succeeded in covering the alveolar ridge with firmly attached tissue, which is needed to ensure prosthetic stability. There was no remarkable reduction in area until the stents were removed. However, after 6 months of vestibuloplasty, there was a significant reduction in gained vestibular area in the fascia lata group, whereas no significant difference between dura mater and palatal grafts was observed. These findings suggest that dura mater could serve as a biologic oral dressing for mucosal defects as effectively as palatal grafts in vestibuloplasty.

Oral mucosal ulceration: a manifestation of previously undiagnosed pulmonary tuberculosis.

BACKGROUND: Tuberculosis, or TB, is a chronic infectious disease that can affect any part of the body, including the mouth. Oral lesions may be the only finding of primary pulmonary TB, in which case proper diagnosis by dentists is vital. CASE DESCRIPTION: The authors present a case in which the patient sought treatment for a painful oral lesion. A histopathologic examination revealed characteristics of TB. Subsequently, pulmonary lesions were detected, and a diagnosis of pulmonary TB was confirmed. The patient underwent antituberculosis therapy, and his oral and systemic conditions improved rapidly. CLINICAL IMPLICATIONS: Although oral manifestations of TB are rare, clinicians should be aware of their possible occurrence in their patient populations. Such awareness can help diagnose TB at an early stage, thereby preventing complications and potential contaminations.

An unusual tonsillolith.

A case of a large tonsillolith of the left palatine is presented. The lesion was detected incidentally during radiographic examination of a patient presenting with right mandibular pericoronitis. The patient had no symptoms referable to the left tonsillar region. Superimposition of the tonsillolith on the left mandibular ramus on panoramic radiographic examination created the false impression of an intraosseous radiopaque lesion. Many radiopaque structures and lesions occur in the soft tissues close to the jaws and are often observed on panoramic radiographs produced by imaging units with broad focal troughs. Such radiopacities in the mandibular molar-ramus region include sialolith, phlebolith, cysticercosis and calcified lymph node, carotid artery arteriosclerosis, stylohyoid ligament mineralization, and dystrophic calcification in acne scars. Tonsilloliths may present on panoramic radiograph as radiopaque objects superimposed on the midportion of the ascending mandibular ramus, and may be initially misinterpreted as intraosseous lesions of the mandible, such as foreign body, odontoma, sclerosing osteitis, Garre osteomyelitis, fibrous dysplasia, idiopathic osteosclerosis, and osteoma.

Atypical presentations of pediatric actinomycosis: report of a case.

It is well recognized that cervicofacial actinomycosis is rare in children, especially at maxilla. Actinomycosis involving the maxilla usually is seen as a localized intraoral infection in contrast to classical cervicofacial actinomycosis. In this article, we describe an 8-year-old patient who had actinomycosis involving the bone at the left maxillary lateral incisor region. The diagnosis was based on histologic report because of location and development of the lesion with unusual history. The treatment of choice was removal of the soft and hard tissues with concomitant prolonged penicillin administration. In cases of persistent oral infection the diagnosis of actinomycosis should be actively attempted through microbiologic and histologic examination.

Infraclusion of primary molars: a review and report of a case.

The term infraclusion is usually used to define mandibular primary teeth in posterior region that remain below the occlusion level. The degree of infraclusion depends on some factors like deviation below the occlusal plane, and infraclusion of tooth in the alveolar bone. Deficient eruptive force, disturbed metabolism of the periodontal ligament, trauma, local inflammation, deficient local vertical bone growth, disturbance in interaction between normal resorption and hard tissue repair, ankylosis and hereditary components have been given as etiological factors. Complications of infraclused primary molars are tipping of the neighboring teeth, space loss, supraeruption of the antagonists, and dislocations of permanent teeth lying under the primary tooth. In this case report, after reviewing the literature a patient with infraclused mandibular primary second molar has been examined to observe the complications of infraclusion. With an appropriate treatment approach, a proper condition was prepared for the eruption of permanent teeth.