Placement of immediate dental implants in extraction sockets exhibiting the apical pathosis. A meta-analysis.

Objectives: It is commonly accepted that immediate implantation is the best option for patients since it shortens the time patients must wait for ultimate restoration and provides a predictable functional and aesthetic result. However, this approach is still controversial in patients with apical pathosis. The goal of this systematic review and meta-analysis was to determine the efficacy of immediate implant insertion in patients with apical pathosis. Material and methods: Between 2000 and 2023, PRISMA-compliant keywords were used to search PubMed, MEDLINE, CENTRAL, and the Cochrane Library. All English-language clinical studies that met PICOS criteria were included in a manual search. The included studies' demographic profile and event data for immediate dental implantation success in patients with or without apical pathosis were meta-analyzed using RevMan. The implant survival rate was assessed using risk ratio of plaque index and bleeding index. Begg's test using MedCalc and RevMan risk of bias assessment assessed publication bias. Results: A meta-analysis of 10 trials with 849 dental implantation patients found a substantial difference in initial implant placement success rates in infected sites. The pooled risk ratio for plaque index is 0.59 (95% CI: 0.36-0.96) with heterogeneity of Tau2 = 0.62, chi2 = 109.69, df = 11, I2 = 90%, z = 2.12, and p < 0.05. While, the pooled risk ratio for bleeding index is 0.77 (95% CI: 0.60 to 0.98) with Tau2 = 0.16, chi2 = 103.67, df = 11, I2 = 89%, z = 2.12, and p < 0.05. The pooled odds ratio of implant survival rate is 2.08 (95% CI: 1.56 to 1.79) with Tau2 0.16; chi2 52.43; df 9; I2 83%; z 4.93 and p < 0.05. As evidenced by the funnel plot and statistically insignificant Begg's test p values of 0.45. Conclusion: The placement of immediate implants in locations affected by apical pathosis is a clinically beneficial surgery, resulting in favorable aesthetic and functional outcomes for patients.

Awareness of Medication-Related Osteonecrosis of the Jaws Amongst Patients on Antiresorptive and Antiangiogenic Medications.

Background Medication-related osteonecrosis of the jaws (MRONJ) is a rare but severe condition that has garnered increasing attention in recent years. It primarily affects individuals undergoing treatment with antiresorptive and antiangiogenic medications, such as bisphosphonates and denosumab, commonly prescribed for osteoporosis and cancer-related bone metastases. Therefore, the present study aimed to assess awareness and understanding of MRONJ among patients receiving antiresorptive and antiangiogenic medications. Methods A cross-sectional survey was conducted among 110 patients receiving antiresorptive and antiangiogenic medications in a clinical setting. Participants were given a structured questionnaire to assess their awareness of MRONJ. The questionnaire covered aspects such as MRONJ, bisphosphonate usage, and awareness of the condition's potential complications. Demographic information was also collected. Chi-square and Fisher's tests were performed using SPSS statistical software. Results In terms of gender distribution, 63.6% of the participants were female. Concerning age distribution, the majority (43.6%) fell within the 21 to 40 age group, whereas only 5.5% were aged over 60. Regarding educational attainment, a substantial majority (58.2%) of the participants held a bachelor's degree. The study findings reveal that a considerable proportion (35.5%) of participants possess awareness regarding jaw osteonecrosis, and this association is statistically significant (p=0.002). A substantial number of participants administered the medication orally (30.9%), while others utilized various administration routes, including injection (IV and others) (40%), and this difference was also statistically significant (p=0.001). Most participants took bisphosphonates for osteoporosis (41.8%) or cancer (13.6%), both statistically significant (p<0.01). Gender had no significant impact (p>0.01), but age showed potential associations (p=0.07 for awareness, p=0.003 for medication use). Educational backgrounds had no significant link, except for bisphosphonate usage (p<0.01) and side effects reporting (p<0.01). Conclusion Notably, a small percentage of participants demonstrated awareness of this condition, indicating a need for continued education and awareness campaigns. Further research and interventions may be warranted to address the specific needs of different age groups and educational backgrounds in promoting safe and effective medication management.

The Association Between Skeletal Facial Types and Third Molars Impaction in a Saudi Arabian Subpopulation: A CBCT Study.

Purpose: To assess the state of mandibular and maxillary third molars in relation to different facial types in a Saudi population using cone-beam computed tomography (CBCT) records. Patients and Methods: A retrospective study was performed on CBCTs. Statistical analysis determined the relationship between impacted maxillary and mandibular third molars and different skeletal facial types. The degree of third molar impaction was evaluated. Results: A total of 198 CBCTs from subjects were evaluated, with a mean age of 34.2 years. Archer II classification was found to be significantly associated with all skeletal profiles. The incidence of mesioangular impactions in lower third molar showed a notable increase in the brachyfacial group, which was statistically significant. Conclusion: In conclusion, this study demonstrates that different facial types are associated with the angulation of third molar impactions.

Characteristics of Maxillary Sinus Septa: A Cone-Beam Computed Tomography Evaluation.

Objective: Our study aimed to determine the prevalence, location, and morphological differences of the septa using CBCT images. Methods: This retrospective study was conducted on CBCT examinations. The sample included both mixed and permanent dentition and edentulous patients. The images were viewed in 3 planes (sagittal, coronal, and axial) and the left and right maxillary sinuses were evaluated for the septa's prevalence, location, and morphological differences. Results: The measurements were statistically analyzed using SPSS software. Out of 200, 122 patients showed one or more bony septa in the maxillary sinus. The septal location and angulation were not limited to a specific area or a specific range. Significant differences between genders were found. Conclusions: The increased surface area of the septa using plane 2-dimensional radiographs is impossible. CBCT has improved the planning of any sinus procedure and offers adequate information compared to conventional radiographs.

Effectiveness of different socket dressing materials on the postoperative pain following tooth extraction: a randomized control trial.

We aimed to prospectively evaluate and compare the effectiveness of Alvogyl and Cutanplast as intra-alveolar dressings for managing pain associated with extraction and incidence of dry socket. All patients who underwent maxillary and mandibular teeth extraction and fulfilled our inclusion and exclusion criteria from Feb 2021 to Oct 2021 were included in our study. Patients who were diagnosed with postoperative pain after tooth extraction were randomly allocated to three groups: Group A (Alvogyl), Group B (Cutanplast), and Group C (placebo). Pain relief and healing of the socket were compared between these groups. The collected data were analyzed using the Chi-square test and Z test of proportionality. Alvogyl was superior to the other medication for providing initial pain relief, and the incidence of dry socket was significantly lower than in the Cutanplast and placebo groups (p<0.05). However, wound healing was statistically non-significant among groups A, B, and C (p>0.05). Alvogyl is still the material of choice in terms of pain relief, wound healing, and low incidence of dry socket. Furthermore, no statistically significant difference was detected between the groups in the biographic information, location, and condition of the extracted tooth, presence of a radiologic pathology, or type of extraction procedure. Moreover, whether it is the first extraction or not, Alvogyl and Cutanpast are comparable in postoperative pain management as intra-alveolar dressing materials.

A Case Report on Surgical-Orthodontic Correction of Skeletal Class III Malocclusion with Severe Prognathic Mandible and Retrognathic Maxilla.

Mandibular prognathism combined with a retrognathic maxilla is a skeletal discrepancy that is difficult to correct. We report a case of a 25-year-old Saudi male patient with skeletal class-III malocclusion due to severe prognathic mandible who was referred to an orthodontist at Prince Sultan Military Medical City. Complete clinical examination, radiographic assessment, and study models revealed class-III malocclusion due to anteroposterior deficiency of the maxilla and severe prognathic mandible. Orthognathic surgery was performed 18 months after the presurgical orthodontic phase. A 10-mm LeFort I advancement of the maxillary arch, with impaction of 3 mm, was performed with a bilateral sagittal split osteotomy (BSSO) of 11 mm. Stable occlusion and superior aesthetics were observed at the 1-year follow-up. Surgical-orthodontic treatment endows an adult patient with a class-III malocclusion or mandibular prognathism with a stable occlusion and superior aesthetics.

Efficacy of Different Sterilization Techniques for Toothbrush Decontamination: An Ex Vivo Study.

Background Contaminated toothbrushes can cause several oral and systemic illnesses. This study aimed to identify the most rapid, effective, and affordable method for toothbrush decontamination. In addition, the most prevalent bacterial species colonizing toothbrushes were determined. Methodology Toothbrushes were collected after two weeks of use by 55 volunteers. The bacterial count was measured before and after sterilization using 0.2% chlorhexidine gluconate, 0.1% Listerine, 70% white alcohol, 10% povidone-iodine, 1% sodium hypochlorite, 2% glutaraldehyde, ultraviolet radiation, microwave irradiation, 3% hydrogen peroxide, and 100% white vinegar, with tap water rinse as the control. Results A marked reduction in the bacterial count was observed pre- and post-sterilization. All sterilization methods were effective for toothbrush disinfection. Sterilization using 2% glutaraldehyde and 3% hydrogen peroxide solutions resulted in the most significant reduction in the mean bacterial count and percentage reduction in the total bacterial count, respectively. The toothbrush samples were also colonized by several different types of bacteria. The most common colonizing bacterial species included Bacillus subtilis (28% prevalence), Sacrina (26% prevalence),and Streptococcus pneumoniae (24% prevalence). Conclusions Because bacterial contamination cannot be eliminated and different species colonize toothbrush surfaces, cleaning and disinfection are essential to prevent disease transmission.

Effect of religious beliefs on bone graft selection for oral and maxillofacial surgery in Saudi Arabia.

BACKGROUND: As a plethora of graft materials have become available in the field of oral and maxillofacial surgery to replace bony defects, there is an increased demand to understand different patients' preferences towards various graft materials and other contributing variables that led to their decision. OBJECTIVES: To evaluate the influence of religious beliefs on the selection of different grafts used in oral and maxillofacial surgery and to deliver a better, more specific, and individualized treatment plan considering various religious backgrounds. MATERIAL AND METHODS: A self-administered anonymous questionnaire with a cross-sectional design was completed by 563 of 577 participants. It was a sociodemographic questionnaire concerning the acceptance and rejection of all types of bone grafts, including intraoral autografts, extraoral autografts, allografts, porcine xenografts, bovine xenografts, and alloplasts. The data included predisposing factors such as gender, age, and religion, as well as enabling factors such as education level and employment status. RESULTS: The porcine xenograft (63.1%) had the highest percentage of rejection, followed by bovine xenograft (41%), allografts (13.5%), alloplasts (10.5%), extraoral autografts (6.2%), and intraoral autografts (5.7%). Xenografts were rejected due to conflicts with the participants' religious beliefs. Sociodemographic characteristics such as gender, age, education level, and employment status had no statistical influence. CONCLUSION: Xenograft selection was found to have a statistically significant relationship with religious beliefs, unlike other types of bone grafts.

Facial fistula. Long-term sequelae of a complicated exodontia.

Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with dermatological infection, and hence, mistreated. We report a case of facial fistula that developed 8 years following a dental extraction, presenting its clinical appearance, radiographical findings, and treatment approach.

A prospective randomized clinical trial compared the effect of various types of local anesthetics cartridges on hypertensive patients during dental extraction.

OBJECTIVES: To evaluate hemodynamic changes of blood pressure and heart rate on hypertensive patients undergoing tooth extraction using various types of local anesthesia (LA). STUDY DESIGN: A prospective randomized clinical trial was conducted on 45 hypertensive patients who were divided equally into 3 parallel groups according to LA received. Group 1: Lidociane 2% with epinephrine 1: 80,000. Group 2: Prilocaine 3% with Felypressin 0.03 IU/ml. Group 3: Mepivacaine 3% plain. INCLUSION CRITERIA: hypertensive patients, under medical management with blood pressure ≤ 159/99. EXCLUSION CRITERIA: Blood pressure ≥160 /100 and patients receiving ß blockers. Negative aspiration was mandatory before the injection of 2 cartridges of LA. Blood pressure and heart rate were evaluated by Electronic Sphygmomanometer and Pulse Oximeters in 3 different time-points; 3 minutes before LA, three minutes after LA and three minutes after extraction. RESULTS: The mean of systolic blood pressure (SBP) had increased after LA injection, and then decreased after extraction in the 3 groups of patients. Increase of SBP after extraction with (Mepivacaine plain) was higher than (Lidociane with Epinephrine) and the difference was statistically significant using ANOVA (p=0.037). The differences in the mean heart rates and mean diastolic blood pressures in the 3 groups were not significant. CONCLUSIONS: The increase of blood pressure with Epinephrine and Felypressin is negligible. Therefore, it is safe to use 2 cartridges of Lidociane 2% with Epinephrine 1:80,000 or Prilocaine 3% with Felypressin 0.03 IU/ml for hypertensive patients whose blood pressure ≤ 159/99 provided negative aspiration is verified before injection. Key words:Local anesthesia, tooth extraction, hypertensive patients, vasoconstrictors, epinephrine, Felypressin.

Spindle cell lipoma of the mandibular mucogingival junction: a case report of unusual oral neoplasm.

Spindle cell lipoma (SCL) is a benign lipomatous neoplasm typically located in the posterior neck and back of older males. It presents as a well-circumscribed mass in the buccal mucosa, tongue, floor of the mouth or hard palate. There are only two case reports of SCL in the gingiva and alveolar ridge. Here, we report a case of SCL in the mandibular mucogingival junction of a 68-year-old male. Clinical, histopathological and immunohistochemical findings are presented. Although oral SCL is rare, it should be considered in the differential diagnosis of spindle cell neoplasms occurring in the oral cavity.