Determination of Palatal Soft Tissue Thickness and Safe Zone for Palatal Soft Tissue Harvest Using CBCT: A Retrospective Study.

Aim: Our decision to conduct this study was motivated by the dearth of knowledge on geographical variations in the thickness of the palatal masticatory mucosa. The aim of the present study is to comprehensively analyze the palatal mucosal thickness and indicate the safety zone for palatal soft tissue harvesting using cone beam computed tomography (CBCT). Material and Methods. As this was a retrospective analysis of cases previously reported to the hospital, written consent was not acquired. The analysis was carried out on 30 CBCT images. Two examiners evaluated the images separately to avoid bias. Measurements were done from the midportion of the cementoenamel junction (CEJ) to the midpalatal suture in a horizontal line. Measurements were recorded from the maxillary canine, first premolar, second premolar, first molar, and second molar and were marked in axial and coronal sections at distances of 3, 6, and 9 mm from the CEJ. The relationship between palate soft tissue thickness in relation to each tooth, palatal vault angle, teeth, and the greater palatine grove was evaluated. Differences in the palatal mucosal thickness according to age, gender, and tooth site were evaluated. Categorical data were presented as frequencies and percentages. Numerical data are presented as mean and standard deviation values. They are explored for normality using Shapiro-Wilk's test. Data are normally distributed and are analyzed using one-way ANOVA followed by Tukey's post hoc test for independent variables and paired t-test for repeated measures. The significance level is set at p ≤ 0.05 for all tests. Statistical analysis is performed with R statistical analysis software version 4.1.3 for Windows. Results: For sex and nationality, there was no significant association (p > 0.05), while for age, cases 35 years and older had significantly higher mucosal thickness than cases younger than 35 years old (p < 0.001). For all teeth, the association was statistically significant (p < 0.001). For the canine and first premolar, cases with deep angles had significantly higher mean values than those with moderate angles (p < 0.001). For other teeth, cases with deep angles had significantly higher mean values than other angles (p < 0.001). Conclusion: Palatal mucosal thickness varied significantly from the canine to the second molar; the most appropriate site for graft harvesting is the canine to second premolar area which is 9-12 mm from the midpalatal suture aspect and is considered a safe zone for harvesting palatal graft.

Bilateral Inverted and Impacted Mandibular Third Molars: A Rare Case Report.

Even while certain forms of mandibular impactions (such as inverted molars) might be considered unusual findings, mandibular impacted teeth are really one of the most regularly seen dental abnormalities. Two female patients' mandibular third molars were discovered to be inverted during a regular inspection, and two such examples are reported here in this article. Both patients underwent routine radiographic examination. Cone beam computed tomography and orthopantomogram were requested to evaluate the state of the bone and to check for any abnormalities, and inverted impacted teeth were discovered. A tooth is said to be inversed when it is placed reversed and seated upside down. Ascending ramus is the most common site for third molars in the mandible. It is also possible for a maxillary tooth to get impacted and for the tooth to be pushed all the way to the orbit's floor, though mandibular impacted teeth are more common. Only a few cases of inverted and impacted mandibular third molars have been reported in the literature. No definitive treatment protocols exist for the removal of inverted teeth. The safest protocol is conservative treatment in which the teeth are not extracted until they produce pathological signs.

Oral Hygiene Practices and Awareness of Pregnant Women about the Effects of Periodontal Disease on Pregnancy Outcomes.

Objectives: Adverse pregnancy outcomes, such as preterm low birth weight (PTLBW), is a severe public health issue that needs to be dealt with by educating the general female population, dental practitioners, and gynecologist. One of the major contributing factors is periodontal disease, which accounts for about 18.2% of all PTLBW cases worldwide, and prevention of the same could reduce the occurrence of PTLBW babies. This study aimed to assess the oral hygiene practices and awareness of pregnant women about the effect of periodontal disease on pregnancy outcomes. Methods: A descriptive cross-sectional study was conducted where 400 pregnant women after consent were requested to complete an anonymous, self-administered, structured questionnaire with twenty-one close-ended questions. Results: Only 5% of participants in this study reported that gum diseases during pregnancy lead to preterm labor or low birth weight babies. About 70.7% of pregnant women mentioned that they did not use any interdental cleaning aids, and 54.5% did not use mouthwashes. Conclusion: Tooth brushing practices among pregnant women were good; however, there was an overall lack in the use of adjunctive aids. The study highlighted a deficiency in the awareness of pregnant women regarding the association between periodontal disease and adverse pregnancy outcomes.

A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography.

BACKGROUND: Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. METHODS: CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. RESULTS: Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18-65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. CONCLUSIONS: The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.

Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study.

BACKGROUND: In individuals with nasal septal deviation (NSD), compensatory hypertrophy of the nasal turbinates occurs as a protective mechanism of the nasal passage from dry and cold air. NSD associated nasal turbinate hypertrophy is usually recurrent, requiring repetitive imaging. Therefore, a multiplanar imaging modality with a low radiation dose is best suited for long-term follow-up of this condition. This study aimed to evaluate the association of width of inferior turbinates and presence of concha bullosa with the degree of NSD using Cone beam computed tomography (CT). METHODS: The CBCT scans of 100 patients with NSD were selected as per convenience sampling and were evaluated by two maxillofacial radiologists. The width of the non-hypertrophied inferior turbinate (NHT) on the convex side of the NSD, and hypertrophic inferior turbinates (HT) on the concave side of the NSD were measured at three locations. The septal deviation angle (SDA) and the presence of concha bullosa (CB) were determined. RESULTS: A significant difference was observed in the anterior, middle, posterior, and mean widths between HT and NHT (p < 0.001). There was a significant difference in the widths of the HT and NHT among different types of NSD. A strong positive correlation (r = 0.71, p < 0.001) was found between SDA and the mean width of the HT. Age (P = 0.71) and gender (P = 0.65) had no significant difference among different types of NSD. Regression analysis revealed that the presence of CB (p = 0.01) and middle width of the HT (p < 0.001) are significant predictors of SDA and type of NSD. CONCLUSION: The results of the present study reveal that the middle width of the HT and the presence of CB influence the degree of NSD. The present study results recommend the use of CBCT as a substitutive low radiation dose imaging modality for evaluation of NSD, CB, and associated inferior turbinate hypertrophy.

Cone-beam computed tomography characterization of the intraosseous vascular canal in the lateral wall of the maxillary antrum.

OBJECTIVES: : The purpose of the study was to assess the occurrence, location, and dimensions of the intraosseous vascular canal in the lateral wall of the maxillary antrum using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: In this retrospective study, we examined 400 CBCT scans from our archive of patients who had earlier reported to a dental teaching hospital in the United Arab Emirates. The prevalence, location, and dimensions of the lateral antral intraosseous canal (LAIC) in the maxillary antrum were evaluated by 2 examiners using standardised methods. A third examiner was consulted in cases of disagreement. RESULTS: The prevalence of LAIC was 62.3% (249 maxillary antra) among the study population. The mean distance between the most inferior point of the alveolar bone and the inferior border of the LAIC in the posterior maxillary region was 19.83±3.12 mm. There was a significant difference (P=0.05) between the maxillary molar and premolar regions in mean distance from the most inferior point of the alveolar bone and the inferior border of the LAIC. There was no statistically significant difference in mean distance between the most inferior point of the alveolar bone and the inferior border of the LAIC between dentulous and edentulous areas (P=0.1). The G3-intrasinusal type canal less than 1mm in diameter was the most common type of LAIC. CONCLUSION: This study established the approximate location of the LAIC in a United Arab Emirates cohort, which will assist the oral surgeon in selecting the appropriate site for sinus lift procedures with reduced risk of surgical hemorrhage.

Application of a Cone-Beam Computed Tomography-Based Index for Evaluating Surgical Sites Prior to Sinus Lift Procedures-A Pilot Study.

OBJECTIVES: Radiography-based indices can help surgeons perform detailed examinations of the surgical site and predict the surgical difficulty of cases. We aimed to develop and validate a novel CBCT-based index that can predict the surgical difficulty of sinus-augmentation procedures. MATERIALS AND METHODS: In the first stage, five experienced dental specialists performed a review of the literature and closed group discussions and designed the novel index. In the next stage, the index was validated. CBCT scans of 30 patients scheduled for sinus-augmentation procedures were evaluated and assigned presurgical CBCT evaluation scores (PSCESs) by five examiners. Subsequently, one oral surgeon performed sinus augmentation using the lateral antrostomy technique and assigned surgical difficulty scores (SDSs) to each of the 30 cases along with 2 observers. The PSCESs and SDSs were statistically analysed to determine the interrater reliability and validity of the index. RESULTS: The interrater agreement of the PSCES among the five presurgical evaluators was 0.85. The PSCES of the five evaluators had highly significant correlation (P < 0.001, r = 0.68 to 0.76) with the SDS. Regression analysis revealed that for every unit increase in the PSCES, there is 0.46 to 0.57 increase in the SDS value. CONCLUSION: The results of this pilot study revealed that a novel CBCT-based index can be used as a reliable tool for predicting the surgical difficulty of sinus-augmentation procedures. However, the novel index needs to be tested on a larger sample of patients and evaluators for a more concrete validity and reliability.

Biomechanical Evaluation of Stress Distribution in Subcrestal Placed Platform-switched Short Dental Implants in D4 Bone: In Vitro Finiteelement Model Study.

The present study was carried out to assess stress distribution in the maxillary posterior bone region (D4 bone) with the help of a short platform switched subcrestal dental implants using the FEM model. Missing teeth surfaces related to the maxillary posterior region were stimulated. The bone model had a cancellous core of (0.5 mm) which represents D4 bone. A 7.5x4.6 mm screw type implant system with 3.5 platform switch abutment was selected. ANSYS WORKBENCH was used to model all the finite element structures. Force of 100 N was tested and adapted at an angle of 0º, 15º, 30º on the tooth model. Overall results from the current study showed that a high amount of stress was seen in cortical than in relation to cancellous bone. Stress values reduced from equicrestal to subcrestal (2 mm) placement of dental implants irrespective of angulation of load from 0o to 30o in both types of bone. However higher stress values were seen when force was applied in an oblique direction (30o) in comparison to a vertical load (0o). Least amount of stress was noticed when platform switched implants were placed 0.5 mm subcrestatlly irrespective of angulations of a load. Platform switched short subcrestal implants reduced the stress in the D4 cortical bone than in contrary equicrestal implant placement. This results in the preservation of marginal bone leading to implant success.

Assessment of alveolar bone level and furcation involvement in periodontal diseases using dental cone-beam computed tomography (CBCT): a systematic review / Avaliação do nível ósseo alveolar e envolvimento da furca em doenças periodontais usando a Tomografia computadorizada de feixe cônico odontológica: uma revisão sistemática

The advent of CBCT has contributed significantly to dental imaging. In the field of periodontics, CBCT provides a multi-planar view to assess the alveolar bone in three dimensions. This helps the dentist to make measurements at any location that could significantly improve periodontal diagnosis. Objective: The aim of this systematic review is to evaluate the accuracy of using CBCT in the assessment of alveolar bone level and furcation involvement in periodontal diseases. Material and Methods: PubMed, LILACS and Google Scholar databases were searched for literature related to the application of CBCT in periodontal diseases. Keywords used for the search were CBCT, furcation involvement, measurement and their synonyms. Results: Fifteen full-text English language research papers were eligible for the systematic review using the PRISMA guidelines. Conclusion: From the results of the systematic review it can be concluded that conebeam computed tomography imaging technique offers significantly reliable images of the furcation involvement and height of the alveolar bone. (AU)

O advento da Tomografia computadorizada de feixe cônico (TCFC) contribuiu significativamente para a imageologia. No campo da periodontia, a TCFC fornece uma visão multiplano para avaliar o osso alveolar em três dimensões. Isso ajuda o dentista a fazer medições em qualquer local que possa melhorar significativamente o diagnóstico periodontal. Objetivo: O objetivo desta revisão sistemática foi avaliar a precisão do uso da TCFC na avaliação do nível ósseo alveolar e do envolvimento da furca em doenças periodontais. Material e Métodos: As bases de dados PubMed, LILACS e Google Scholar foram pesquisadas na literatura relacionada à aplicação da TCFC em doenças periodontais. As palavras-chave utilizadas para a pesquisa foram TCFC, envolvimento da furca, mensuração e seus sinônimos. Resultados: Quinze trabalhos de pesquisa em inglês com texto completo foram elegíveis para a revisão sistemática usando as diretrizes do PRISMA. Conclusão: A partir dos resultados da revisão sistemática, pode-se concluir que a técnica de imagem por tomografia computadorizada de feixe cônico oferece imagens significativamente confiáveis do envolvimento da furca e da altura do osso alveolar.(AU)

Herbal medicine as adjunct in periodontal therapies- A review of clinical trials in past decade.

The aim of this paper was to analyze the literature published in the research related to herbal medicine as adjunct in periodontal therapies. An internet search using search engines- Google, Researchgate and PubMed was carried out. The keywords used for search were-periodontal therapy, adjunct, herbal, and periodontitis. Full text articles of the articles were collected from the year 2007-2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.