Severe Discoloration of the Alveolar Bone Secondary to Long-Term Minocycline Therapy: A Case Report.

Minocycline, the synthetic derivative of the antibiotic tetracycline, has been used for a variety of medical treatments. One such use for minocycline is for acne vulgaris. Although widely used, minocycline has a common side effect of discoloration of tissues, including bone, skin, and mucosa. This case report presents a 19-year-old female patient with a history of long-term minocycline therapy for acne vulgaris who presented for periodontal esthetic crown lengthening. The initial exam revealed a blue-gray discoloration of the mucosa. Upon surgical exploration, it was discovered that the discoloration originated from the underlying alveolar bone with minimal gingival involvement. Surgical removal and recontouring of the bony exostoses revealed that the bone remained deeply stained. Although the discolored bone was not fully removed, the patient was able to obtain an acceptable esthetic result.

Evaluation of length and location of the maxillary sinus intraosseous artery using computerized tomography.

BACKGROUND: The intraosseous artery is a branch of the posterior superior alveolar artery that supplies the lateral wall of the maxillary sinus. The present study seeks to analyze the location of the intraosseous artery and its site of termination. METHODS: Cone beam computed tomography was used to evaluate 200 patients making up 400 maxillary sinuses. The following criteria were measured: (1) the distance of the lower border of the intraosseous artery to the floor of the sinus, (2) the average length of the artery, (3) the diameter of the artery, (4) the site at which the artery terminates at, and (5) the distance of the artery from the first premolar, second premolar, first molar, second molar, and third molar. RESULTS: The intraosseous artery was identified in 336 (84.0%) quadrants. The most common site of termination was at the mesial of the second molar (22%), regardless of dental status and right or left quadrant. Its overall mean diameter was 0.91 ± 0.56 mm, with no difference within the dental status. Its overall mean length was 7.40 ± 3.39 mm, with a statistically significant difference between dentate and edentulous quadrants (P < 0.001). Its overall mean distance from the floor was 6.95 ± 6.49 mm, with no difference within the dental status. All parameters showed no difference between right or left quadrants. CONCLUSIONS: The chances of encountering the intraosseous artery at the premolar area is <21% during a lateral window sinus floor elevation. The most common (22%) site of termination of the intraosseous artery is at the mesial of the second molar. Understanding of the course, location, and termination of the artery enhances the precision of a clinician when it comes to pre-operative treatment planning.

Prevalence and anatomical characteristics of the accessory mental foramen: a study using cone beam computed tomography.

The purpose of this study was to evaluate the prevalence of accessory mental foramina (AMFs) through the use of cone beam computed tomography (CBCT). The secondary purpose was to analyze the location of AMFs, mean distance from the nearest tooth, mean distance from the alveolar bone crest, exit angle dimensions, and whether sex, side of the mandible, or racial disparities exist. Two hundred CBCT scans were analyzed for the presence and characteristics of bifurcations of the inferior alveolar nerve. AMFs were observed in 11.5% of patients and 6.5% of all hemimandibles examined. The majority of patients with 1 or more AMFs were female (60.9%). Bilateral AMFs were found in 1.52% of patients. The location of the AMF relative to the mental foramen (MF) was evaluated, and 30.0% of AMFs were located anterosuperiorly and 23.3% posterosuperiorly to the MF. Associations between patient sex and the greatest and smallest diameters of AMFs, circumference and area of AMFs, and ratio of AMF-MF area were evaluated via statistical analysis. Additional analyses evaluated the prevalence on each side of the mandible as well as the association between race/ethnicity and occurrence of AMFs. Statistical analyses showed no association between the occurrence of AMFs and sex, side of the mandible, or race/ethnicity of the study population. This demonstrates the importance of preoperative CBCT prior to all mandibular surgery to reduce the risk of injury to the neurovascular bundles that pass through AMFs.

The Use of Computer-Guided Surgery to Avoid Severe Buccal Defect and Lingual Concavity in Mandibular Implant Placement.

Dental implant treatment planning has traditionally been accomplished using 2-dimensional radiographs and stone models. Although historically this method has been used with success, there are limitations. Two-dimensional radiographs and stone models may not allow for accurate diagnosis of ridge defects or the presence of a mandibular lingual concavity. The use of cone-beam computed tomography (CBCT) can help the dental practitioner identify such structures. Computer-generated surgical guides allow the dental surgeon to safely place implants in a minimally invasive manner. This case report describes the utilization of CBCT and computer-generated surgical guides to help facilitate mandibular dental implant placement in the presence of a buccal ridge defect and lingual concavity.

Utilization of cone beam computed tomography to determine the prevalence and anatomical characteristics of bifurcated inferior alveolar nerves.

The primary purpose of this study was to evaluate the prevalence of inferior alveolar nerve (IAN) bifurcations through the utilization of cone beam computed tomography (CBCT). The secondary purposes of this study were to analyze the average distance from the main trunk to its branch at the greatest point, to calculate the average distance of the bifid IAN from the apices of the teeth, and to determine the appropriate classification for each IAN bifid nerve according to the types described by Nortjé et al: type 1, 2 canals originating from a single foramen with a narrower inferior canal; type 2, 2 canals originating from a single foramen with a superior canal extending to the second or third molar; type 3, 2 canals of equal size that arise from 2 mental foramina that may link into a single canal near the molars. Examination of 194 CBCT scans revealed that IAN bifurcations were present in 13.4% (n = 26) of the study population. Bifurcation was bilateral in 4 individuals. For left bifurcated IANs, the average distance between the superior border of the main branch and inferior border of the bifurcated IAN (GDN) was 3.41 mm. The average distance from the superior border of the bifurcated IAN to the apex of the closest root (NAP) was 3.45 mm. For right bifurcated IANs, the average GDN was 4.01 mm, and the average NAP was 4.85 mm. Fourteen bifid nerves were type 1, and 16 were type 2. Preoperative CBCT studies can determine the presence of a bifurcated IAN, thereby reducing the chances of neurologic damage.

Investigation of Dental Implant Referral Patterns Among General Dentists and Dental Specialists: A Survey Approach.

A historical area of referral involves the placement of dental implants. Because there is a high demand for dental implant therapy and relatively few general dentists participating in the surgical aspect, it is important to investigate referral characteristics to specialists. The authors conducted a study in which 6,769 general dentists and specialists were emailed an anonymous online survey. Study participants were given a series of eight questions and asked to rank the importance levels of each when dealing with dental implant referrals. General dentists found that office location and insurance were important factors when making a dental implant referral. Specialists did not find any particular attribute to be significantly important. When the two groups were evaluated, communication, quality of work, and, to a lesser extent, accepted insurance were found to be important attributes to both general dentists and specialists. The results of this research suggest there is a positive correlation among general dentists and specialists in regard to communication, quality of work, and, to a lesser extent, accepted insurance.

Cone Beam Computerized Tomography Analysis of the Posterior and Anterior Mandibular Lingual Concavity for Dental Implant Patients.

This study was conducted to evaluate variations in and the prevalence of the lingual concavity. Images were taken between January 1, 2011, and August 31, 2015, from a total of 104 patient charts randomly selected from a private practice. These images were acquired from a single cone beam computerized tomography (CBCT) machine. The CBCTs were reviewed in cross-sectional images in both the left and right anterior incisor and posterior molar regions. These scans were classified into 1 of 3 categories-parallel, concave, or convex-based on the measurements of the level of concavity degree as well as the mandibular morphology observed. Lingual concavity characteristics including depth, angulation, and vertical location were also measured. Most of the posterior mandibular CBCT scans were classified as concave. Although there was no significant difference detected for race or gender, statistical significance was noted with regard to age, with an increase in prevalence observed at age 63 years and older. Of the 3 different morphological classifications used, the vast majority were identified as concave in the posterior mandibular regions and parallel in the anterior mandibular region. There was a significant decrease in concavity VL/height (bone loss) associated with age, which was most commonly seen in edentulous areas.

Expression of the receptor of advanced glycation end products in the gingival tissue of smokers with generalized periodontal disease and after nornicotine induction in primary gingival epithelial cells.

BACKGROUND: The association between smoking and periodontal disease is well established; however, the mechanism by which smoking augments the destruction of periodontal tissue is not clear. We hypothesize that smoking is related to an increased expression of receptor of advanced glycation end products (RAGE) in gingival tissues of smokers. METHODS: Gingival biopsies from five smokers and five age- and gender-matched non-smokers were examined. In addition, gingival epithelial cells (GECs) were reacted with 1 muM nornicotine for 4, 16, 24, and 48 hours for mRNA for RAGE and an additional 72 hours for protein expression. RAGE mRNA was amplified by reverse transcriptase-polymerase chain reaction (RT-PCR), and expression of RAGE at the protein level in GECs was studied with Western blots. RESULTS: In the gingival biopsies from all 10 subjects, RT-PCR with RAGE-specific primers produced a band of the predicted size. For all pairs, the smoker biopsies expressed a greater level of RAGE compared to the matched non-smokers. When viewed as groups, analysis of the band intensity indicated that RAGE mRNA in smokers was approximately 1.4-fold of the expression in non-smokers (Wilcoxon test; P = 0.031). In GECs treated with nornicotine, there was a time-dependent increase in RAGE expression up to two-fold at 48 hours. RAGE protein levels initially were reduced but increased to 1.4-fold after 48 hours. CONCLUSION: The ability of nornicotine to elevate RAGE expression in GECs, along with increased RAGE expression in inflamed gingival tissue from smokers, indicates that RAGE may be associated with periodontal disease linked to smoking.

Squamous cell carcinoma of the gingiva presenting as localized periodontal disease.

Gingival squamous cell carcinoma represents less than 10% of diagnosed intraoral carcinoma. Many unique features of gingival squamous cell carcinoma clearly delineate it from oral squamous cell carcinoma arising in other sites. This article presents the clinicopathologic findings of a case. An 81-year-old woman presented for evaluation of multiple oral lesions primarily limited to the maxillary gingiva; the lesions had been present for about 2 years. Differential diagnosis included epithelial dysplasia, benign mucous membrane pemphigoid, inflammatory lesion of endodontic/periodontic origin, lichen planus, and squamous cell carcinoma. Clinical examination revealed extensive erythematous and ulcerative lesions of maxillary buccal and palatal gingiva extending into the maxillary buccal vestibule; the lesions did not respond to antibiotic therapy. Radiographic evaluation demonstrated advanced alveolar bone loss as well as displacement of the maxillary right first molar. Subsequent histology confirmed diagnosis of moderately differentiated squamous cell carcinoma. Gingival squamous cell carcinoma can mimic a multitude of oral lesions, especially those of inflammatory origin. In addition, predisposing and presenting factors are different from those of other oral squamous cell carcinomas. Careful examinations as well as routine biopsy are crucial for accurate diagnosis.

Lip hypertrophy secondary to cyclosporine treatment: a rare adverse effect and treatment considerations.

Gingival hypertrophy is a well-known and extensively documented undesirable side effect of cyclosporine in posttransplant patients. However, severe lip enlargement associated with cyclosporine is less recognized and has seldom been reported in the literature. Lip enlargement may lead to social, physical, and psychological stress, especially in the older childhood and adolescent age groups. We present a case of marked lip hypertrophy and concomitant gingival hypertrophy secondary to cyclosporine (Neoral) treatment in a pediatric bilateral lung transplant recipient. We also discuss the various side effects and treatment considerations available including more recent substitution therapy. Cyclosporine has most effectively and conclusively enabled transplantation of solid organs by reducing transplant-associated morbidity. We believe clinicians should be knowledgeable and aware of lip hypertrophy associated with cyclosporine use. This rare and less understood adverse effect should be recognized during the clinical evaluation of the posttransplant patient.