Objectives: It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present study was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery.

Material and Methods: Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed.

Results: In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle.

Conclusions: A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that osteotomies in implant dentistry should not be developed in the posterior mandible until the position of the mandibular canal is established.

Objectives: The purpose of the present study was to review the literature of how to identify the mental foramen, mandibular incisive canal and associated neurovascular bundles during implant surgery and how to detect and avoid the damage of these vital structures during implant therapy.

Material and Methods: Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular incisive canal, mental foramen, mental nerve, anterior mental loop. The search was restricted to English language articles, published from 1979 to November 2009. Additionally, a manual search in the major anatomy, dental implant, and periodontal journals and books was performed.

Results: In total, 47 literature sources were obtained and reviewed. The morphology and variations of the mandibular incisive canal, mental foramen and associated neurovascular bundles were presented as two entities. It suggested that clinicians should carefully assess these vital structures to avoid nerve/artery damage.

Conclusions: The mandibular incisive canal, mental foramen and associated neurovascular bundles exist in different locations and possess many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that the clinicians should carefully identify these anatomical landmarks, by analyzing all influencing factors, prior to their implant surgical operation.

Objectives: Peptide-15 (P-15) is an analogue of the cell binding domain of collagen. P-15 has been shown to facilitate physiological to process in a way similar to collagen, to serve as anchorage for cells, and to promote the binding, migration and differentiation of cells. However, how P-15 alters osteoblast activity to promote bone formation is poorly understood. To study the osteoinductive properties of peptide P-15, we analyzed the expression levels of bone related genes in human mesenchymal stem cells treated with this biomaterial.

Material and Methods: Using real time Reverse Transcription-Polymerase Chain Reaction the quantitative expression of specific genes, like transcriptional factors (RUNX2 and SP7), bone related genes (SPP1, COL1A1, COL3A1, BGLAP, ALPL, and FOSL1) and mesenchymal stem cells marker (ENG) were examined.

Results: P-15 causes a considerable induction of osteoblast transcriptional factor like osterix (SP7) and of the bone related genes osteopontin (SPP1) and osteocalcin (BGLAP). In contrast the expression of endoglin (ENG) was markedly decreased in stem cells treated with P-15 respect to untreated cells, indicating the differentiation effect of this biomaterial on stem cells.

Conclusions: The present study shows the effect of P-15 on mesenchymal stem cells in the early differentiation stages: P-15 is an inducer of osteogenesis on human stem cells as indicated by the activation of bone related markers SP7, SPP1 and BGLAP.
The results may allow a better understanding of the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.

Objectives: The purpose of the present study was to determine the measurement accuracy and subjective image quality for periodontal disease diagnosis when using two X-ray tube voltages with a digital photostimulable storage phosphor sensor.

Material and Methods: A digital photostimulable storage phosphor (PSP) sensor (Vistascan) and a multipulse X-ray generator (Prostyle Intra) with two tube voltages were used in this study. The front, premolar and molar region of two adult human cadaver skulls jaws were imaged using the X-ray tube at 63 kV and 70 kV, both at 8 mA and decreasing exposure times (160 ms, 120 ms and 80 ms). A standardized exposure protocol containing waxed occlusal keys and an aiming device ensured proper and reproducible beam alignment. Three observers assessed the digital radiographs for 31 selected periodontal bone loss sites. Radiographic measurements were compared to physical measurements (Standard). Subjective ratings of lamina dura, crater defect and furcation involvement visibility, contrast perception and bone quality were also performed.

Results: Multiple regression equation of the variables kV and exposure time demonstrated no significant difference for the periodontal bone level measurements (P > 0.05). In 90.3% and 96.7% of the measurements for 70 kV and 63 kV respectively, deviation was within 1 mm. The subjective ratings produced similar findings in terms of image quality for both tube voltages and the three exposure times.

Conclusions: The results of the present study revealed that tube voltages of 63 kV and 70 kV provided similar accuracy and image quality for periodontal disease diagnosis.

Objectives: The purpose of the present study was to investigate the reliability of both periapical radiographs and orthopantomograms for exact detection of tooth root protrusion in the maxillary sinus by correlating the results with cone beam computed tomography.

Material and Methods: A database of 1400 patients scanned with cone beam computed tomography (CBCT) was searched for matching periapical (PA) radiographs and orthopantogram (OPG) images of maxillary premolars and molars. Matching OPG images datasets of 101 patients with 628 teeth and PA radiographs datasets of 93 patients with 359 teeth were identified. Four observers assessed the relationship between the apex of tooth root and the maxillary sinus per tooth on PA radiographs, OPG and CBCT images using the following classification: root tip is in the sinus (class 1), root tip is against the sinus wall (class 2) and root tip is not in the sinus (class 3).

Results: Overall correlation between OPG and CBCT images scores was 50%, 26% and 56.1% for class 1, class 2 and class 3, respectively (Cohen’s kappa [weighted] = 0.1). Overall correlation between PA radiographs and CBCT images was 75.8%, 15.8% and 56.9% for class 1, class 2 and class 3, respectively (Cohen’s kappa [weighted] = 0.24). In both the OPG images and the PA radiographs datasets, class 1 correlation was most frequently observed with the first and second molars.

Conclusions: The results demonstrated that both periapical radiographs and orthopantomograms are not reliable in determination of exact relationship between the apex of tooth root and the maxillary sinus floor. Periapical radiography is slightly more reliable than orthopantomography in determining this relationship.

Objectives: The purpose of the present study was to explore the maxillary sinus anatomy, its variations and volume in patients with a need for maxillary implant placement.

Material and Methods: Maxillary sinus data of 101 consecutive patients who underwent spiral computed tomography (CT) scans for preoperative implant planning in the maxilla at the Department of Periodontology, University Hospital, Catholic University of Leuven, Leuven, Belgium were retrospectively evaluated. The alveolar bone height was measured on serial cross-sectional images between alveolar crest and sinus floor, parallel to the tooth axis. In order to describe the size of the maxillary sinus anteroposterior (AP) and mediolateral (ML) diameters of the sinus were measured.

Results: The results indicated that the alveolar bone height was significantly higher in the premolar regions in comparison to the molar region (n = 46, P < 0.01). The age showed negative relation to bone dimension (r = - 0.32, P = 0.04).
Anterior and posterior border of the maxillary sinuses were mostly located in the first premolar (49%) and second molar (84%) regions, respectively. Maxillary sinus septa were indentified in 47% of the maxillary antra. Almost 2/3 (66%) of the patients showed major (> 4 mm) mucosal thickening mostly at the level of the sinus floor. The present sample did not allow revealing any significant difference (P > 0.05) in maxillary sinus dimensions for partially dentate and edentulous subjects.

Conclusions: Cross-sectional imaging can be used in order to obtain more accurate information on the morphology, variation, and the amount of maxillary bone adjacent to the maxillary sinus.

Background: The hard and soft tissue deficiency is a limiting factor for the prosthetic restoration and any surgical attempt to correct the anatomic foundation needs to be precisely executed for optimal results. The purpose of this paper is to describe the clinical steps that are needed to confirm the treatment plan and allow its proper execution.

Methods: Team work and basic principles are emphasized in a step-by-step description of clinical methods and techniques. This clinical report describes the interdisciplinary approach in the rehabilitation of a partially edentulous patient. The importance of the transitional restoration which sets the guidelines for the proper execution of the treatment plan is especially emphasized along with all the steps that have to be followed.

Results: The clinical report describes the diagnostic arrangement of teeth, the ridge augmentation based on the diagnostic evaluation of the removable prosthesis, the implant placement with a surgical guide in the form of the removable partial denture duplicate and finally the special 2-piece design of the final fixed prosthesis.

Conclusions: Clinical approach and prosthesis design described above offers a predictable way to restore partial edentulism with a fixed yet retrievable prosthesis, restoring soft tissue and teeth and avoiding an implant supported overdenture.

Background: This current clinical case report highlights three cases of Hereditary angioedema (HAE) patients who are all members of the same family (father and his two daughters). The father has C1–INH deficiency, while his daughters have low C1–INH levels: the first possesses only 10% function and the second has low C1–INH level with 0% function. Of note, the second daughter was discovered to have HAE at the age of 2, thus making her the youngest known HAE case report in the English literature.

Methods: Assess the efficacy of administration of C1-INH before dental operation as regards the prevention of HAE episode, when total or partial C1-INH deficiency exists.

Results: Acute angioedema leading to laryngeal oedema is a possibly fatal complication for HAE patients undergoing dental procedures. Use of both short-term and long-term HAE prophylaxis prior to dental operations might be life saving for those patients.

Conclusions: Prevention and early recognition of potential laryngeal oedema that can occur as a complication of dental procedures may be lifesaving for HAE patients.