Identification of Specific Panoramic High-Risk Signs in Impacted Third Molar Cases in Which Cone Beam Computed Tomography Changes the Treatment Decision.

PURPOSE: The aim of this study was to investigate the treatment decisions of oral-maxillofacial surgeons in the management of impacted lower third molars (M3s) according to panoramic radiography (PR) and cone beam computed tomography (CBCT) risk analysis. PATIENTS AND METHODS: Ten surgeons analyzed 40 deliberately selected M3 cases showing 1 or more panoramic high-risk signs: 1) darkening of the root, 2) interruption of the white line, 3) diversion of the inferior alveolar canal (IAC), 4) narrowing of the IAC, and 5) 2 or more signs occurring simultaneously (including darkening and/or interruption of the IAC). After evaluating the PR images, the observers analyzed the patients' CBCT images. The treatment decision (extraction vs coronectomy) and surgical technique (number of planned tooth sections) were recorded. RESULTS: On the CBCT coronal slices, direct contact between the M3 and IAC, together with narrowing and/or fenestration of the IAC, was observed most frequently when 2 or more panoramic signs were seen simultaneously on the PR images (odds ratio [OR], 7.2; P = .021). CBCT findings led to a significant decrease in the number of coronectomy decisions (23% vs 14.5%, P = .002), which was most prominent in the groups showing panoramic signs of darkening (approximately 50%, P = .007) and narrowing (approximately 66%, P = .044). A significant number of extraction decisions were modified to coronectomy when 2 or more panoramic signs occurred together (OR, 7.9; P < .001). However, there were no significant differences regarding the number of planned hypothetical tooth sections. CONCLUSIONS: The results showed that the surgeons' confidence in the treatment decision increased after CBCT imaging, resulting in fewer coronectomy decisions. CBCT information that changed a previous coronectomy decision to extraction was most frequently observed in cases showing darkening and narrowing PR signs. The chance of changing an extraction decision to a coronectomy decision after evaluating the patient's CBCT images was the highest when 2 or more PR signs were observed simultaneously.

The influence of the chosen in vitro bone simulation model on intraosseous temperatures and drilling times.

There is no consensus about the most suitable in vitro simulating material investigating heat generation during bone preparation. The aim was to compare heat increases and drilling times of bone removals in different bone simulating materials and to compare them to fresh human cadaver bone. A cavity was drilled in the following samples: (1) bovine rib; (2) pig rib; (3) 20 PCF (lb/ft3) polyurethane (PU) block with 3 mm (50 PCF) cortical layer; (4) 20PCF PU without cortical; (5) 30 PCF PU with 2 mm (40 PCF) cortical; (6) 30 PCF PU with 1 mm (40 PCF) cortical; (7) 30PCF PU without cortical; (8) poly-methyl-methacrylate (PMMA); (9) fresh human cadaver rib. Data were analyzed with ANOVA followed by Tukey's post hoc tests. P < 0.05 was considered significant. Highest heat increases and slowest drilling times were found in bovine ribs (p < 0.001). Regarding temperatures, human ribs were comparable to the pig rib and to PUs having cortical layers. Considering drilling times, the human rib was only comparable to the 20 PCF PU with 3 mm cortical and to 30 PCF PU without cortical. By the tested in vitro bone removals, only the 20 PCF PU with 3 mm cortical was able to simulate human ribs, considering both temperature increases and drilling times.

Tooth sectioning for coronectomy: how to perform?

OBJECTIVES: The aim of this study was to determine the increase in heat production, preparation time, and cutting surface quality of conventional, high-speed rotating instruments and piezoelectric preparation for coronectomy procedures. MATERIALS AND METHODS: One hundred intact extracted molars were sectioned horizontally, sub-totally, 1 mm under the cemento-enamel line with five methods: (1) tungsten carbide torpedo (TcT), (2) round (TcR) drills using a conventional speed surgical straight handpiece (< 40,000 min-1), (3) tungsten carbide fissure (TcF), (4) diamond torpedo (DT) drills using a surgical high-speed, contra-angle handpiece (~ 120,000 min-1), or (5) a saw-like piezoelectric tip (PT). Temperatures, preparation times, and cutting surface irregularities were registered and the differences were analyzed with ANOVA, Tukey's HSD post hoc test (temperature, time) and with chi-square test (irregular surface). RESULTS: Rotating instruments produced a maximal temperature increase of less than 1 °C. TcF produced the least heat (ΔT = - 3.92 °C to the baseline), while PT produced significantly the highest temperature increases (ΔT = 12.38 °C, p < 0.001). Tungsten carbide drills were the fastest for coronectomy (from 55.9 to 64.3 s), while DT (169.7 s) while PT (146.8 s) were significantly slower. TcT and TcR drills produced an irregular root surface more frequently. CONCLUSIONS: During coronectomy, rotating instruments produced entirely acceptable heat, while PT produced unacceptable temperatures. Tungsten carbide drills performed coronectomies effectively, but the diamond torpedo and PT seemed clinically questionable. Considering heat, speed, and the cutting surface quality simultaneously, TcF in a surgical high-speed handpiece seems to be the best choice for coronectomy. CLINICAL RELEVANCE: The correct insert can significantly reduce excessive heat and operation time during coronectomy procedures.

Intracanal temperature changes during bone preparations close to and penetrating the inferior alveolar canal: Drills versus piezosurgery.

PURPOSE: The aim of this in vitro study was to investigate temperature increases in the inferior alveolar canal (IAC), when different bone preparation methods approximate and penetrate the IAC. MATERIALS AND METHODS: In pig mandible, buccal bone removals were performed until the neurovascular bundle became visible. Temperatures were registered with thermocouple probes and with infrared thermometer. Preparations were performed with diamond drills (DD), tungsten carbide drills (TCD), piezoelectric diamond sphere (PT_D) and saw (PT_S) tips, and a combined preparation method was also performed whereby the superficial three-fourths of the bone was removed with TCD and the deepest one-fourth of the bone with PT_D (TCD + PT_D_7 °C) or PT_S (TCD + PT_S_7 °C), using cooled irrigation (7 °C). RESULTS: Preparations using room temperature irrigation caused significantly less heat on the bone surface than in the IAC. Piezosurgery in the IAC produced significantly higher temperatures (>13 °C) than the drills (<4 °C). Heat productions of the piezoelectric tips were reduced significantly by applying the combined bone removal methods. The speed of PT_S and TCD + PT_S_7 °C were comparable to the speed of TCD, whereas TCD + PT_D_7 °C was found to be significantly slower. CONCLUSION: The speed of piezosurgery is comparable to that of the drills; however, it produces the highest, potentially nerve-harming temperatures. To eliminate the heat consequences during piezosurgery in the IAC, the use of cooled irrigation at 7 °C and predrilling is recommended.

Effect of pre-drilling on intraosseous temperature during self-drilling mini-implant placement in a porcine mandible model.

This in vitro study investigated intraos seous heat production during insertion, with and without pre-drilling, of a self-drilling orthodontic mini-implant. To measure temperature changes and drilling times in pig ribs, a special testing apparatus was used to examine new and worn pre-drills at different speeds. Temperatures were measured during mini-implant placement with and without pre-drilling. The average intraosseous temperature increase during manual mini-implant insertion was similar with and without pre-drilling (11.8 ± 2.1°C vs. 11.3 ± 2.4°C, respectively; P = 0.707). During pre-drilling the mean temperature increase for new drills was 2.1°C at 100 rpm, 2.3°C at 200 rpm, and 7.6°C at 1,200 rpm. Temperature increases were significantly higher for worn drills at the same speeds (2.98°C, 3.0°C, and 12.3°C, respectively), while bone temperatures at 100 and 200 rpm were similar for new and worn drills (P = 0.345 and 0.736, respectively). Baseline bone temperature was approximated within 30 s after drilling in most specimens. Drilling time at 100 rpm was 2.1 ± 0.9 s, but was significantly shorter at 200 rpm (1.1 ± 0.2 s) and 1,200 rpm (0.1 ± 0.03 s). Pre-drilling did not decrease intraosseous temperatures. In patients for whom pre-drilling is indicated, speeds of 100 or 200 rpm are recommended, at least 30 s after pilot drilling.

[Giant sialolithiasis: Diagnosis and management. Case reports]. / Óriásnyálkövek: Diagnózis és kezelés.

Sialolithiasis is one of the most frequent form of calcifications in the maxillofacial area. 0.45% of the population is affected by symptoms caused by salivary calculi, though the estimated frequency including asymptomatic form may exceed 1% in adult population. Radiographs presenting a large portion of the maxillofacial region (panoramic radiography, computed tomography) could detect salivary calculi with high accuracy. The size of the sialoliths is usually less than 10 mm in diameter. Salivary calculi larger than 15 mm (considering the largest diameter) are classified as giant sialoliths and most of them are located in the submandibular gland or in its duct. Two unusually large submandibular salivary calculi cases are represented (diameters of 27 and 34 mm), whereas in one of the cases development and dimensional changes of the calculus are described via a seven years period. This case report represents diagnostic and therapeutic consequences in giant sialolithiasis and demonstrates possible differential diagnostic difficulties. Orv. Hetil., 2016, 157(49), 1967-1972.

[Dental and oral surgical treatment of medication-induced bleeding patients: Audit of the national guideline in Hungary]. / A gyógyszer indukálta vérzékeny betegek fogorvosi, szájsebészeti ellátása: a 2015-ös hazai szakmai ajánlás alkalmazása és értékelése.

INTRODUCTION: In 2015 a new Hungarian guideline was published regarding dental treatment and management of anticoagulated patients in agreement of the Hungarian Association of Oral and Maxillofacial Surgeons and the Dental Implantology Association of Hungarian Dentists. AIM: The aim of the authors was to evaluate the efficiency and safety of local hemostatic measures recommended by the guideline in anticoagulated patients. METHOD: In these patients, postoperative bleeding episodes were examined after dental and oral surgical treatments, retrospectively. RESULTS: Overall 263 bleeding risk cases were treated; 138 patients with vitamin K antagonists, 97 patients with antiplatelet therapy and 6 patients with novel oral anticoagulants. Six patients (2.3%) had minor postoperative bleeding after the "one hour control", while one patient needed a night duty support (0.5%). In contrast, 86 patients who were treated in rural practices neglecting the guideline attended the night duty with postoperative bleeding (3 patients treated with vitamin K antagonists, 24 patients taking low molecular weight heparin, 30 patients receiving antiplatelet therapy and one patient on novel oral anticoagulant therapy. CONCLUSIONS: The Hungarian guideline can be applied safely, without increasing the risk of postoperative bleeding, however, rural dental practices are frequently unprepared for these treatments. Orv. hetil., 2016, 157(43), 1722-1728.

[Sunitinib and zoledronic acid induced osteonecrosis of the jaw]. / Sunitinib és zoledronsav által indukált állcsont-osteonecrosis.

The tendency for bisphosphonate and non-bisphosphonate (eg.: antiresorptive or anti-angiogenesis drugs) induced osteonecrosis is increasing. Treatment of these patients is a challenge both for dentists and for oral and maxillofacial surgeons. Cooperation with the drug prescribing general medicine colleagues to prevent osteonecrosis is extremely important. Furthermore, prevention should include dental focus elimination, oral hygienic instructions and education, dental follow-up and, in case of manifest necrosis, referral to maxillofacial departments. Authors outline the difficulties of conservative and surgical treatment of a patient with sunitinib and zoledronic acid induced osteonecrosis. The patient became symptomless and the operated area healed entirely six and twelve months postoperatively. A long term success further follow-up is necessary to verify long-term success.

[Dental and oral surgical treatment of a B haemophilic patient with high inhibitor level. Case report]. / Magas inhibitor titeru B-haemophiliás beteg fogorvosi-szájsebészeti ellátása. Esetismertetés.

More than 1000 hemophilic male patients are registered in Hungary, from which only a trace number suffers from factor IX inhibitory hemophilia. For correct dental and oral surgical treatment of these patients mandatory cooperation is required among medical specialties, exerting multi-staged haemostatic principles. Authors represent in this case report the dental and oral surgical treatment of a B hemophilic patient with high inhibitor level and describe possible local haemostatic measures.

[The specific panoramic radiographic signs and their relation with inferior alveolar nerve injuries after mandibular third molar surgery]. / A jellegzetes panorámaröntgen-jelek szerepe a nervus alveolaris inferior sérülések várható megítélésében alsó bölcsességfogak eltávolításakor.

The aim of the authors was to describe the classic specific panoramic signs (indicating a close spatial relationship between dental canal and third molar's root) on panoramic radiographic images and determine their role in the risk assessment, predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal. The authors represented an informative case, where the IAN was visible during the surgery. The exact knowledge of classic panoramic radiographic signs should help the determination of "high risk" cases predicting IAN paresthesia after mandibular third molar removal. The authors keep panoramic radiography rather a routine than the most superior diagnostic tool in third molar surgery.