Evaluation of Sagittal Root Positions and Bone Perforation in Anterior Teeth Using Cone Beam Computed Tomography: An Observational Study.

Cone beam computed tomography (CBCT) and virtual implant help clinicians assess implant positioning with nearby vital structures and plan implant surgical procedures. Thus, the current study aims to evaluate the anterior sagittal root position and assess labial bone perforations in CBCT images. This study was carried out using CBCT scans of 140 samples involving 1338 teeth. The Digital Imaging and Communications in Medicine (DICOM) files were imported into Carestream 3-dimensional imaging software for analysis. All measurements were made in the appropriate section slice of 200-µm thickness in a darkened room. A standardized orientation was established by 2 examiners. The sagittal root positions (SRPs) were assessed in maxillary and mandibular anterior teeth. Labial bone perforation (LBP) was assessed using tapered implants in the virtual implant software. Overall, Class I SRP was highest (81.48% and 38.49%, respectively) in both the sextants. The SRP for Class I was most prevalent in canine teeth in both arches (87.96% and 56.45%, respectively), followed by incisors in other types in the maxillary arch. In the mandibular arch, both incisors were in Class IV and I relationships. The overall LBP was 4.26% and was more likely in the mandibular arch (5.64%) than in the maxillary arch (2.8%). The mandibular central incisors showed the highest rate of perforation (8.5% to 11.93%). The SRP and LBP did not show a statistically significant difference between the right and left sides in both arches. The correlation coefficient between SRP and LBP showed a statistically significant result (P < .01). Class I SRP was the most prevalent in maxillary and mandibular arches. Significantly more perforations occurred with mandibular anterior teeth and in Class IV SRP types (approximately 10% to 30%), which suggests that implant placement requires careful presurgical planning and regenerative approaches or delayed implant placement may be considered.

Sinus Floor Augmentation in Presence of Mucocele Eroding Maxillary Sinus Wall: A Case Report With 3 Years Follow-Up.

INTRODUCTION: The maxillary mucocele is a slow-growing aggressive lesion and a mucous-containing sac lined with epithelium that occurs due to ductal obstruction and self-limiting injury. Rarely, it may be associated with non-specific symptoms. It is characterized by bone resorption due to its expanding behavior. Reduced height of bone and sinus pneumatization associated with pathologic lesions located in the floor of maxillary sinus may impede sinus augmentation. Therefore, careful diagnosis and management of pathology before sinus floor elevation is important in determining its recurrence and prognosis. CASE PRESENTATION: We reported a case with small mucocele on right pneumatized antrum with insufficient residual bone height for implant placement. Radiograph in the region of teeth #3 and #4 revealed a homogeneous solitary radiopaque mass. Cone-beam computed tomography revealed irregular osteolysis of the lateral wall of the sinus. It was excised through Caldwell-Luc technique and simultaneous sinus augmentation was performed. Later, delayed implant restoration was performed. No complication or recurrence was reported during 36 months of follow-up. CONCLUSIONS: The excision of mucocele on sinus floor and simultaneous sinus augmentation obviates the need for the extended treatment period. The clinician must be habituated with the anatomy and pathology of the maxillary sinus to evade any non-essential complications following lateral sinus floor augmentation procedure. A diminutive mucocele should not be regarded as a contraindication for sinus augmentation; sometimes it manifests with bone erosion. The prompt diagnosis and careful evaluation are needed to avoid future complications during implant therapy.

Effects of recombinant human bone morphogenetic protein-2 compared to other biomaterials in the treatment of intrabony defects in periodontitis patients: A systematic review.

BACKGROUND: Bone morphogenetic proteins have a powerful osteoinductive capacity and have been used as a new adjunct to graft materials for bone regeneration. The objectives of this systematic review are to assess the amount of radiographic bone fill, clinical attachment level (CAL) gain, and reduction in pocket depth (PD) in patients with intrabony defects in periodontitis patients following the use of recombinant human bone morphogenetic protein-2 (rhBMP-2). MATERIALS AND METHODS: Electronic bibliographic databases search of Medline, Science Direct, and Google Scholar was made from January 1980 to December 2017. Studies using rhBMP-2 to treat periodontal intrabony defects of the maxillary or mandibular region with follow-up period of at least 6 months were searched. Two reviewers performed the systematic review using the PRISMA Statement for reporting and the Cochrane risk-of-bias tool was used for quality assessment. RESULTS: It was found that rhBMP-2 showed statistically significant results with respect to radiographic defect resolution, CAL, and PD reduction at 9 months compared to open-flap debridement but showed statistically significant results only with respect to radiographic bone fill when compared with platelet-rich fibrin at 6 months. CONCLUSION: The rhBMP-2 may provide a promising alternative to traditional grafting procedures therapy that can enhance periodontal regeneration in patients having intrabony defects. Due to limited human studies, it can be concluded that no definitive evidence exists to ascertain the effectiveness of rhBMP-2 in the treatment of intrabony defects in periodontal diseases.