A Rare Case of Maxillary Mucormycosis in a Child With Juvenile Diabetes Mellitus.

Mucor and Rhizopus species are recognized as the primary culprits responsible for mucormycosis, a severe fungal infection known for its opportunistic nature. This infection primarily targets individuals with compromised immune systems, including those with diabetes mellitus and patients undergoing glucocorticoid therapy, where the immune response is weakened. This article aims to underscore the pivotal role of prompt diagnosis and intensive treatment in managing mucormycosis, particularly in pediatric patients, as it can avert death and mitigate serious morbidity. This case report emphasizes the urgency of identifying fungal infections in patients with diabetes early on and subsequently treating them aggressively to prevent adverse outcomes. It highlights the potential for excellent treatment outcomes when mucormycosis is promptly diagnosed and managed with intensive therapy. By doing so, significant morbidity and mortality associated with this condition can be effectively prevented, underscoring the importance of vigilance and proactive management in patients with predisposing factors for fungal infections.

Central dentinogenic ghost cell tumor of the maxilla: a case report with new imaging findings and review of the literature.

A dentinogenic ghost cell tumor (DGCT) is a rare benign odontogenic tumor that commonly shows characteristics of solid proliferation and has a relatively high risk of recurrence after surgical treatment. We herein report a case of a central DGCT that occurred in the maxilla and resulted in bone expansion. This study highlights new imaging findings (particularly magnetic resonance imaging) along with histopathological observations. In addition, we conducted a review of the existing literature on this rare tumor. A 37-year-old man developed swelling around the right cheek. A benign odontogenic tumor such as ameloblastoma was suspected based on the imaging examination findings (including bone expansion and the internal characteristics of the tumor) on panoramic imaging, computed tomography, and magnetic resonance imaging. The lesion was surgically excised from the right maxilla. Postoperative histopathological examination led to a definitive diagnosis of central DGCT. The tumor comprised epithelial neoplastic islands, resembling ameloblastoma, inside tight fibroconnective tissue; masses of ghost cells and formation of dentin were also observed. We had suspected that the minute high-density region around the molars on the imaging examinations represented alveolar bone change; however, it represented dentin formation. This led to difficulty diagnosing the lesion. Although DGCT may present characteristic findings on imaging examinations, its occurrence is infrequent, and in some cases, the findings may include the presence or absence of an impacted tooth without obvious calcification. The present case suggests that we should consider the possibility of an odontogenic tumor with calcification when high-density structures are observed inside the lesion.

Central Myoepithelioma of the Maxilla.

Myoepithelioma is a benign salivary gland tumor. Central myoepitheliomas are very rare. The aim of this report was to describe a case of maxillary myoepithelioma. A 14-year-old female patient presented with an multilocular lesion in the anterior maxilla, with nearly 8 months of duration. The lesion was asymptomatic, and the patient's dental history was unremarkable. The diagnostic hypothesis was an odontogenic tumor. Biopsy specimen consisted of nests of plasmacytoid cells in a myxoid stroma without duct formation. No cellular atypia or bone and cartilage formation were noted. The neoplastic cells were positive for Pan-cytokeratin, S100, CK7, and CK8. The final diagnosis was myoepithelioma. The patient was treated by surgical excision followed by bone curettage, and no signs of recurrence were found after 8 years of treatment.

Clinical achievements of implantology in the pterygoid region: A systematic review and meta-analysis of the literature.

The purpose of the study is to evaluate the survival rate of pterygoid implants compared to implants placed in different maxilla area and to settle as an alternative solution for the rehabilitation of the posterior maxilla atrophy. Studies that were included for this systematic review were selected using different database of references: PubMed Medline, Lilacs and Cochrane Library. Other journal platforms were also used for the research. Five articles met the strict inclusion/exclusion criteria of the 180 articles founded. This systematic review was registered on Prospero (CRD42023409706) and followed PRISMA statement. A total of 768 implants placed presented 97.43 % with a peak of 100 % of survival rate. Follow-up period varies from a minimum of 1 year to a maximum of six years. Pterygoid implants could be a valid alternative in patients presenting a posterior maxilla atrophy, but results should be interpreted cautiously due to the difficulty of the surgical technique. Further studies in the future should be taken in consideration to confirm the success rate of pterygoid implants since there is only one prospective RCT, potentially incorporating modern technologies such as guided surgery or navigated surgery could be a solution for the success of pterygoid implants, minimizing the risk and less dependent on the operator.

Management Modalities of Aggressive Brown Tumor of the Jaws-a Case Series.

Primary hyperparathyroidism is an endocrine disorder occurring due to increased secretion of parathormone resulting in clinical, anatomical, and biochemical alterations. On the other hand, excision of a parathyroid adenoma can normalize the metabolic status. Brown tumors represent the terminal stage of the remodeling processes during primary or secondary hyperparathyroidism. They are erosive bony lesions caused by rapid osteolysis and peritrabecular fibrosis, resulting in a local destructive phenomenon. Facial skeleton is involved in about 2% of all cases of which the mandible is frequently affected. We report a case series of four patients who presented with brown tumor of both maxilla and mandible. A complete assessment of the medical history, blood investigations and radiological findings combined with biopsy results is necessary for a correct diagnosis. The standard treatment of the Brown tumors is not a surgical resection, but the treatment of the cause of the tumor, which in this case is hyperparathyroidism. However in our case, the extent of the lesion and the non resolution after the parathyroidectomy necessitated a surgical approach in two of our patients however two responded well to medical management alone.

Comparative Evaluation of Sinus Complication and Survival Rates of Quad Zygoma versus Bizygoma in Combination with two Regular Implants in Atrophic Maxilla: A Systematic Review and Meta-Analysis.

Aim: To systematically review existing scientific literature to determine, compare and evaluate the sinus complication and survival rates of quad zygoma against two zygomatic implants with combination of two regular implants in atrophic maxilla in adults. Methods: Review was performed in accordance with preferred reporting items for systematic reviews and meta-analysis guidelines and registered in PROSPERO-CRD42023392721 Electronic databases like PubMed, Google scholar and EBSCO host were searched from 2000 to December 2022 for studies reporting treatment of Atrophic maxilla with either quad zygoma or two zygomatic implants in combination with two regular implants. Quality assessment was evaluated using Cochrane risk of bias-2 tool for randomized controlled trials (RCT). The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The odds ratio (OR) and standardized mean difference (SMD) were used as summary statistic measure with random effect model and p value < 0.05 as statistically significant. Results: Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the odds ratio 0.59 signifies that the quad zygomatic implants on an average has 0.59 (0.18-1.93) times or odds of developing sinus complications while the SMD signifies that better survival rate (SR) on an average is 0.35 (- 0.61 to 1.30) times more by two zygomatic implants with combination of two regular implants as compared to quad zygomatic implants (p > 0.05). Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity. Conclusion: Two zygomatic implants in combination with two regular implants provides better survival rate and less sinus complications compared to quad zygoma in atrophic maxilla. Despite the high SR observed, there is a need to conduct more randomized controlled clinical trials to examine their efficacy in comparison with other techniques.

Biomechanical Evaluation of Zygomatic Implant Versus Pterygoid Implant in Atrophic Maxilla: An In vitro Finite Element Study.

Background and Purpose: Dental implants are considered to be one of several treatment options that can be used to replace missing teeth. The objective of the study is to examine and compare the biomechanics of zygomatic and pterygoid implants planned on the atrophic maxilla with three different bone types. Materials and Methods: An in vitro finite element study was conducted on a three-dimensional model of zygomatic and pterygoid implants. In a total of 24 implants, two bilateral zygomatic and pterygoid implants with two anterior dental implants were inserted in models. 150 N vertical occlusal and 300 N load on masseter and medial pterygoid were simulated on the modeled prosthesis. The data were processed with ANSYS software. The stress on and deformations of the bones and implants were observed and compared. Results: When comparing the D4, D3, and D2 bones in subgroup I with zygomatic implants, the D2 bone was subjected to less stress compared to D3 and D4. The smallest displacement (0.125784 mm) was seen in D4 followed by the largest displacement (0.74073 mm) in D2. Similarly, when comparing the D2, D3, and D4 bone in subgroup II with pterygoid implants, the D2 bone in the atrophic maxilla received the least amount of stress from the pterygoid implants compared to D3 and D4. Furthermore, the smallest displacement (0.030934 mm) was seen in D2, and the largest (0.046319 mm) in D4. Conclusion: Results suggest firstly, that the overall stress was better distributed in D2 bone and secondly, the pterygoid implant showed higher stress concentration than the zygomatic implant.

Sclerostin antibody enhances implant osseointegration in bone with Col1a1 mutation.

We evaluated the potential of sclerostin antibody (SclAb) therapy to enhance osseointegration of dental and orthopaedic implants in a mouse model (Brtl/+) mimicking moderate to severe Osteogenesis Imperfecta (OI). To address the challenges in achieving stable implant integration in compromised bone conditions, our aim was to determine the effectiveness of sclerostin antibody (SclAb) at improving bone-to-implant contact and implant fixation strength. Utilizing a combination of micro-computed tomography, mechanical push-in testing, immunohistochemistry, and Western blot analysis, we observed that SclAb treatment significantly enhances bone volume fraction (BV/TV) and bone-implant contact (BIC) in Brtl/+ mice, suggesting a normalization of bone structure toward WT levels. Despite variations in implant survival rates between the maxilla and tibia, SclAb treatment consistently improved implant stability and resistance to mechanical forces, highlighting its potential to overcome the inherent challenges of OI in dental and orthopaedic implant integration. These results suggest that SclAb could be a valuable therapeutic approach for enhancing implant success in compromised bone conditions.

Denosumab-Induced Maxillary Osteonecrosis: A Case Study on Long-Term Complications in Multiple Myeloma Treatment.

Background: Targeted therapies like denosumab have revolutionized multiple myeloma (MM) treatment, improved patient outcomes while introducing long-term complications. This study explores a rare instance of delayed maxillary osteonecrosis post-denosumab therapy, delving into its pathophysiology and management. Methods: A 40-year-old male MM patient who developed a painful palatal lesion post denosumab treatment and diagnosed of maxillary osteonecrosis by computed tomography scan and surgical biopsy is presented. Treatment history, symptom progression, and response to the PENTOCLO protocol were analyzed. Results: Post-denosumab discontinuation osteonecrosis highlights its prolonged impact on bone metabolism. PENTOCLO treatment protocol led to significant improvement. Genetic factors influencing osteonecrosis susceptibility have been discussed and considered. Conclusions: This case underscores the need for vigilance regarding long-term complications in MM survivors, preventive strategies, including regular dental evaluations and reducing invasive dental procedures, are crucial. We advocate for an interdisciplinary approach and further research into tailored prevention and management of osteonecrosis in cancer survivors.

Myofibrosarcoma of Maxilla - Case Report and Review of Literature.

Myofibrosarcoma is a distinct mesenchymal malignancy which commonly occurs in head and neck region. It has a high tendency for local recurrence and distant metastasis. 39-year-old male presented with epistaxis, nasal obstruction and left sided complete loss of vision. He underwent functional endoscopic sinus surgery and guided biopsy. MRI scan showed a lesion epicentred in the left maxillary sinus, superiorly extending into the orbit. He underwent Class 4b maxillectomy with neck dissection, tracheostomy and free flap reconstruction. Histopathological examination yielded final diagnosis as myofibrosarcoma of maxilla. The patient was planned for adjuvant radiotherapy and has been disease free for 3 years.

Exploring Prevalence Trends of Jaw Bone Pathologies: A Three-Year Institutional Study.

Background Head and neck bone pathologies cover various conditions with diverse causes. Infections like osteomyelitis and dental abscesses can spread to soft tissues and bones, causing tissue death, inflammation, and systemic effects. Benign and malignant tumors can develop from soft tissue, cartilage, or bone, posing challenges for diagnosis and treatment. Studies on their prevalence in local populations are rare, obscuring our understanding of regional health dynamics. Aim In this study, we aimed to assess the prevalence of bone pathologies documented over the last three years from 2021 to 2023. Materials and methods Histopathologically confirmed cases of bone pathologies at Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India, were gathered from the institutional database (DIAS: Dental Information Archiving Software) from January 1, 2021, to December 31, 2023. They were categorized into groups of infectious and inflammatory lesions, fibro-osseous lesions, malignancies originating from bone, malignancies invading bone, and miscellaneous conditions. The data was then compiled into a Google spreadsheet (Google, Inc., Mountain View, USA) for further analysis. Graphs were created to visualize the prevalence of bone pathologies enabling a descriptive exploration of temporal trends. Results A total of 2626 biopsy records were reviewed. Among these, 242 (9.21%) cases of bone-related pathologies were included, and the remaining 2384 (90.79%) entities without any mention of bone were excluded. Overall, considering all three years, 43.8% (100) bone-related lesions were reported in 2021, 30.3% (77) in 2022 and 25.9% (65) in the year 2023. Under each category, infectious and inflammatory lesions for 40.5% (98), fibro-osseous lesions for 14.9% (36), benign lesions for 2.9% (7), malignancies originating from bone for 1.7% (4), malignancies invading bone for 38% (93), and miscellaneous conditions for 1.65% (4) were reported. The highest number of infectious and inflammatory pathologies (53%) were reported in 2021. A steep fall was observed in 2022 and 2023 under the infectious and inflammatory category. The malignancies invading the bone showed almost similar distribution in all three years. Conclusion The observed variations highlight the unpredictability of bone pathologies, involving the jaw bones. We emphasize continuous observation and analysis to comprehend changing patterns in bone health.

Laser-Assisted Treatment for Maxillary Peripheral Odontogenic Fibroma: A Case Report.

Most odontogenic tumors are intraosseous growths. A peripheral odontogenic fibroma presents as a slow-growing and firm swelling on the gingiva. It develops more commonly on the mandibular than the maxillary region. It can be found on either the palatal or lingual and on the labial or buccal surface of the jaw. It usually does not ulcerate. The most common type is a peripheral odontogenic fibroma, which is a benign odontogenic neoplasm of the periodontal soft tissues. In this case report, a 53-year-old male patient with peripheral odontogenic fibroma was treated using a laser.

Effect of selective trimming of nasoavleolar molding on maxillary arch growth in patients with unilateral cleft lip and palate.

AIM: Presurgical Nasoalveolar molding (PNAM) is a technique used for cleft lip and palate patients prior to cheiloplasty. However, concerns exist regarding its negative impact on maxillary arch growth.This study aimed to assess the effect of selective trimming in NAM on maxillary arch growth in patients with unilateral cleft lip palate. METHODOLOGY: The retrospective observational study analyzed the study casts of 30 patients before and after undergoing nasoalveolar molding treatment. Study casts which were repositories of the institute were analyzed and segregated as Group A: NAM given with selective trimming of the appliance, and Group B: NAM without selective trimming of the appliance. Pre and post-treatment casts were assessed digitally at L-L' (Intercleft segment width), C-C' (Intercanine width), T-T' (Alveolar arch width), L-TT' (Alveolar arch length from major cleft segment), and L'-TT' (Alveolar arch length from minor cleft segment) RESULTS: A notable significant difference between Group A's and B's mean Alveolar arch width and Intercleft segment width was seen. Whereas parameters such as intercanine width, and alveolar arch length as functions from major and minor segments showed no significant variance. CONCLUSION: Although NAM has been known to affect the growth of the maxillary arch, this study proposes that techniques such as selective trimming can help counteract this drawback.

Conservative Management of Odontogenic Fibromyxoma of the Maxilla: A Case Report.

Odontogenic fibromyxoma typically presents as painless swelling in the jaw, and clinically, it grows slowly, becoming benign and asymptomatic. It causes the cortical plates to expand gradually, which leads to mobility and drifting of the teeth. Root resorption is also common. The tumor is locally aggressive in nature. It is also known to have a high recurrence rate. We present the case of a 30-year-old female patient who was diagnosed and treated for odontogenic fibromyxoma of the maxilla conservatively with enucleation. The radiograph showed a multilocular lesion, which can be confused with ameloblastoma, aneurysmal bone cyst, or odontogenic keratocyst. Hence, with proper clinical, radiographic, and histopathological examination, a correct diagnosis can be made and adequate treatment can be planned.

Relationship between the mandibular curve of Spee and the maxillary compensating curve with dentoskeletal morphology : A cross-sectional study in Chinese young adults with normal occlusion.

PURPOSE: The purpose of this cross-sectional study was to use multiple regression analysis to evaluate the relationship between the mandibular curve of Spee (COS) and the maxillary compensating curve with dentoskeletal morphology in young Chinese adults with normal occlusion. METHODS: This study comprised 62 young adults (31 males, mean age: 24.1 ± 2.2 years; 31 females, mean age: 23.3 ± 3.3 years) with Angle class I normal occlusion. For every subject, intraoral scan models of the maxillary and mandibular arches and lateral cephalograms were acquired. The depth of the COS and compensating curve were assessed on the intraoral scan models. Multiple dental arch dimensional and cephalometric variables were screened by univariate analysis. Subsequently, a multiple linear regression model (forward stepwise selection) was constructed to determine which variables were significantly correlated with the two curve depths. RESULTS: In the mandible, the COS depth was deepest at the mesiobuccal cusp of the first molar. Overjet, mandibular arch width and mandibular-occlusal plane angle significantly correlated with the COS depth (P < 0.05), accounting for 33.1% of the variation in the mandibular COS. In the maxilla, the deepest point of the compensating curve was at the distobuccal cusp of the first molar. Mandibular arch perimeter and overbite significantly correlated with the maxillary compensating curve (P < 0.05), explaining 23.3% of the variation. CONCLUSIONS: Overjet, overbite, mandibular-occlusal plane angle, mandibular arch width and perimeter should be considered when reconstructing occlusal curves in clinical orthodontic treatment and in prosthetic restoration.

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review.

OBJECTIVE: This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm. STUDY DESIGN: A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included. RESULTS: Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk. CONCLUSION: This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

Interdisciplinary Role of Orthodontist in Screening and Managing Obstructive Sleep Apnea in Children and Adults.

Obstructive sleep apnea (OSA) can affect children and adults, and, if left untreated, could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have an interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by a sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. Currently the evidence in the literature for prophylactic growth modification in children to prevent OSA is weak. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective.

Successful treatment of nasopalatine duct cyst after maxillary anterior implant surgery: a case report.

BACKGROUND: Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. PURPOSE: We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded one year after maxillary anterior implant placement following periodontally hopeless teeth extraction. MATERIALS AND METHODS: The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. RESULTS: 7 years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. CONCLUSIONS: For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

Factors influencing speech improvement following maxillary complete-arch implant-supported restorations: A retrospective study.

OBJECTIVE: This study explored factors affecting speech improvement in patients with an edentulous maxilla after the delivery of a complete-arch implant-supported fixed dental prosthesis (IFDP). MATERIALS AND METHODS: Patients who had received IFDP for edentulous maxilla were enrolled, and various potential speech improvement-related factors were considered, including patient demographics, anterior residual bone volume, preoperative facial features, preoperative acoustic parameters, and adaptation time. Acoustic analysis and perceptual ratings were used to assess three fricatives [s], [f], and [ɕ]. Correlation and regression analyses were conducted to assess the association between changes in fricatives and potential factors (α = .05). RESULTS: The study included 50 patients (18 females and 32 males, aged 50.62 ± 15.71 years, range 19-76). Significant correlations were found among the change in the center of gravity (ΔCoG) of [s] and anterior residual bone volume, zygomatic implants number and proportion (p < .05). These correlations were largely mirrored in the perceptual score (ΔPS) changes. After controlling for age, sex, preoperative acoustic parameters, and adaptation time, the ΔCoG and ΔPS of fricatives were mainly correlated with the anterior residual bone volume, preoperative acoustic parameters, and adaptation time. CONCLUSION: Speech improvements post-IFDP delivery are mainly related to preoperative speech characteristics, anterior residual bone volume, and adaptation time. The residual bone volume's impact on consonants varies with specific articulatory gestures. This study provides insights into forecasting speech outcomes following IFDP restoration and provides recommendations and methods for data collection in developing future prediction models.

A new patient-specific helical maxillary distractor: a cadaver test.

The primary objective of this cadaver study was to assess the feasibility of a novel custom helical distraction system and a patient-specific antral maxillary distractor. The study involved two fresh cadaver heads and followed a systematic procedure. First, virtual planning was conducted for an asymmetric maxillomandibular advancement. Custom patient-specific hardware was then fabricated to enable sequential mandibular advancement and gradual maxillary distraction. The mandibular lengthening procedures were found to be highly accurate, with only minor deviations from the planned results. In terms of maxillary distraction, the patient-specific antral distractors demonstrated favorable outcomes, with two noteworthy exceptions. Ideal forward maxillary advancement was short by a modest 2-3 mm in both cadavers. Additionally, cadaver 2 exhibited an unplanned pitch malrotation. However, an excellent occlusion was achieved in cadaver 1 and an acceptable anterior occlusion in cadaver 2, albeit with bilateral posterior open bites that could be readily corrected with interdental elastics in a clinical setting. This cadaver model study provides compelling evidence for the feasibility of patient-specific antral helical distractors, highlighting their potential to yield positive outcomes. Importantly, the study results suggest that patient-specific antral distractors may offer superior results compared to the current standard of linear distractors.