2023 Apr-Jun; Vol 14, No 2
Horizontal Alveolar Ridge Augmentation with Xenogenic Block Grafts Compared with Autogenous Bone Block Grafts for Implant-retained Rehabilitation: a Systematic Review and Meta-Analysis
J Oral Maxillofac Res 2023;14(2):e1
Objectives: The objective of the present systematic review and meta-analysis was to test the 0-hypothesis of no difference in implant treatment outcome after horizontal alveolar ridge augmentation with xenogenic block compared with autogenous bone block.
Material and Methods: A literature search was conducted using PubMed, Embase and Cochrane Library databases in combination with a hand-search of relevant journals until 25th of January 2022. Comparative and non-comparative studies evaluating horizontal alveolar ridge augmentations with xenogenic blocks were included. Quality and risk of bias were evaluated by Cochrane Collaboration’s revised tool and Newcastle-Ottawa scale.
Results: Meta-analysis revealed no statistically significant difference in implant survival rate after more than 6 months of functional implant loading (P = 0.71), no difference in alveolar ridge width (P = 0.07) or gain of alveolar ridge width at re-entry (P = 0.13). Non-comparative studies revealed moderate to high short-term implant survival rate and gain in alveolar ridge width, however, complications including dehiscences, graft exposure and graft failure were observed in several studies.
Conclusions: No significant difference could be identified in short-term implant treatment outcome following horizontal alveolar ridge augmentation using xenogenic block compared with autogenous bone block with the limited data available. A high incidence of healing complications and implant failures necessitates further investigation, as well as long-term results on implant survival rate.
Keywords: alveolar bone grafting; alveolar bone loss; alveolar ridge augmentation; bone substitutes; dental implants; review.
Management of Mandibular Condyle Fractures in Paediatric Patients: a Systematic Review
J Oral Maxillofac Res 2023;14(2):e2
Objectives: This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of mandibular condyle fractures in paediatric patients.
Material and Methods: An electronic literature search was conducted of three well known databases - Ovid, PubMed and Web of Science. Studies included were conducted paediatric patients, in humans, written in English and published from January 1st 1996 until April 1st 2022. Data collection was carried out by two independent reviewers. Data collated from studies without high risk of bias was pooled for surgical vs non-surgical management and total tallies of all outcomes presented. Presence or absence of complications was recorded in 4 x 4 tables for each outcome and compared using a Chi-Square test.
Results: After duplicate records were removed, 182 records were screened. After exclusion of unsuitable reports, 20 were included in the review. Further analysis showed the included studies had high risk of bias. Given this, comparison of this pooled data showed no significant difference between management methods.
Conclusions: Presently it appears conservative management is functionally adequate without risks associated with surgical management, even though incidence of these risks was shown to be low in the studies included in this review.
Keywords: pediatrics; trauma; review literature.
Can the Position of the Impacted Third Molars Be an Early Risk Indicator of Pathological Conditions? A Retrospective Cone-Beam Computed Tomography Study
J Oral Maxillofac Res 2023;14(2):e3
Objectives: The aim of this retrospective study was to evaluate the prevalence of pathologies associated with impacted third molars in relation to tooth position on cone-beam computed tomography images.
Material and Methods: In 348 cone-beam computed tomography images, the position of 640 impacted third molars (mesiodistal angulation, buccolingual inclination, impaction depth, and contact point localization) and the presence of pathologies (distal caries, external root resorption, marginal bone loss, and pathological follicular space) were evaluated. The data were analysed statistically with a significance level set at P < 0.05.
Results: Distal caries was mostly detected in relation to Class A (20.4%) and contact point at (12.5%) and above (10.5%) the cementoenamel junction (CEJ) (P = 0.000; P < 0.05). External root resorption and marginal bone loss were more common in mesioangular angulation (52.3% and 80.1%, respectively), Class C (53% and 73.8%, respectively), and contact point below the CEJ (53.2% and 73.3%, respectively) (P = 0.000; P < 0.05). Lingual inclination was identified as a new risk factor for associated pathologies (P < 0.05). Pathological follicular space was significantly more likely to occur in those with inverted angulation (100%) and absence of contact (31.5%) (P = 0.000 and P = 0.010, respectively; P < 0.05).
Conclusions: Pathologies arising in second molars in relation to impacted third molars are significantly associated with the three-dimensional position of impacted third molars, and watchful monitoring or prophylactic removal of impacted third molars should be considered, taking into account the relevant risk parameters for the related pathologies.
Keywords: cone-beam computed tomography; impacted tooth; pathology; risk factor; third molar.
Glandular Odontogenic Cyst: a Case Report and Literature Review
J Oral Maxillofac Res 2023;14(2):e4
Background: The glandular odontogenic cyst is now a well-known entity comprising < 0.5% of all odontogenic cysts with a recent review tabulating about 200 cases in the English literature. Glandular odontogenic cyst shows epithelial features that simulate salivary gland or glandular differentiation. The importance of glandular odontogenic cyst relates to the fact that it has a high recurrence rate and shares overlapping histologic features with central mucoepidermoid carcinoma. The purpose of this paper is to describe the clinical, radiological, and histopathological features of a case of glandular odontogenic cyst with the course of treatment and 9-years follow-up, followed by a review of the literature.
Methods: A 63-year-old male was referred for further investigation of a mandibular radiolucency observed by his general dental practitioner. The main complaint was a murmuring sensation in the lower jaw right side. Radiological examination revealed a well-defined, unilocular, radiolucent lesion, involving the right mandible with 17 and 68 mm in mediolaterally and anteroposterior dimension, respectively.
Results: A total enucleation of the cystic lesion and surgical extraction of tooth #46, #47 and #48, was performed under local anaesthesia. Histopathologic examination revealed a glandular odontogenic cyst.
Conclusions: Glandular odontogenic cyst shows no pathognomonic clinico-radiographic characteristics, and therefore in many cases it resembles a wide spectrum of lesions. Diagnosis can be extremely difficult due to histopathological similarities with dentigerous cyst, lateral periodontal cyst and central mucoepidermoid carcinoma. Therefore a careful histopathological examination and a long-term follow-up (preferably seven years) are required to rule out recurrences.
Keywords: jaw cyst; oral surgical procedures; review.
Long Term Outcome of Avulsed Immature Mandibular Incisor with Progressive External Root Resorption: 9 Years Follow-Up
J Oral Maxillofac Res 2023;14(2):e5
Background: Avulsion of permanent teeth is the most common in young permanent dentition. Replantation of immature teeth after avulsion represents a major challenge in terms of treatment management and long–term prognosis. This case report describes 9 years of follow-up for an avulsed and replanted immature mandibular lateral incisor with progressive external root resorption.
Methods: A 7-year-old patient following an accident in which his mandibular left central incisor was avulsed and replanted within one hour after being stored in a physiological storage medium. However, radiographic examination conducted six weeks after the dental injury revealed inflammatory root resorption of the replanted tooth #31. To address root resorption, endodontic treatment was performed involving the use of calcium hydroxide as an intracanal medication for a short period of time, followed by root canal obturation with mineral trioxide aggregate placed below the crestal bone margin.
Results: Three months later the root resorption had progressed. Consequently, a decision was made to perform periodontal surgery. While the long-term follow-up revealed that the inflammatory root resorption had damaged half of the root, the tooth remained functional and aesthetically favourable.
Conclusions: Despite the challenges associated with replantation of an immature tooth following avulsion, this case demonstrated favourable outcomes. The tooth maintained its functionality, exhibited favourable aesthetic, and the dimensions of the alveolar ridge were preserved, allowing for the physiological expansion of the dental arch.
Keywords: etiology; mandible; root resorption; tooth avulsion; tooth injuries; tooth replantation.