[Avascular necrosis of the jaw bone after bisphosphonate therapy]

Bisphosphonates have an antiosteolytic effect by the inhibition of osteoclastic action. Although the exact mode of action is not completely understood, major progress on both the cellular and molecular levels has been made in recent years. Bisphosphonates alleviate pain and reduce complications, such as pathologic fractures, or hypercalcemia. Dental and periodontal research has shown great interest in clinical applications of bisphosphonates' antiosteolytic and antiosteoclastic traits, since they can be applied to counteract bone loss in chronic periodontitis. Investigations have associated avascular necrosis events in the jawbones with bisphosphonate therapy. Maxillary and mandibular osteonecrotic foci accompanied by pain, inconvenience and purulent exudates were incidentally found in patients who were taking pamidronate (Aredia), zolendronate (Zometa) and even alendronate (Fosalan). Our institutional database search over the past year yielded ten patients who were admitted to the Oral and Maxillofacial Surgery Unit at the Tel Aviv Sourasky Medical Center, due to an osteonecrotic bone lesion coupled with a prior history of bisphosphonate therapy. All these patients also had a recent dental extraction. They were all treated according to the osteomyelitis protocol, and their response to therapy varied from several weeks to many months, with some cases requiring repeat surgical intervention (curettage or sequestrectomy). This article strives to alert on the possible linkage between drug therapy using bisphosphonates and the serious event of avascular jawbone necrosis. The important role of the oral surgeon in following up on this group of patients should not be underestimated.

The Clinical Effectiveness of 6 mm Diameter Implants

BACKGROUND

Five- and 6 mm diameter screw-type endosseous implants have been used for the last decade. While some studies have reported very promising results (94% to 98% success rate), others have demonstrated survival rates below those clinically acceptable (75% to 87%). Moreover, such implants have been associated with increased cervical bone resorption and thread exposure.

METHODS

Between June 1999 and July 2003, 43 patients received treatment with 6 mm diameter tapered hydroxyapatite (HA)-coated implants. A total of 45 implants were placed. All patients were recalled annually after implant exposure. One patient was lost to follow-up after 1 year. Forty-four implants were evaluated at the recall examinations. All implants supported a fixed prosthesis; in the majority of patients (35 implants), it was a single-tooth fixed prosthesis. The mean loading time was 23.4 months (range, 1 to 54 months).

RESULTS

No implants were lost during the loading period. The overall survival rate was 100%. Crestal bone remodeling was examined using periapical radiographs. After a mean of 23.4 months in function, only one implant presented bone loss beyond the first thread.

CONCLUSIONS

This study showed that high survival rates can be obtained after prosthetic treatment with 6 mm-wide tapered HA-coated implants. Long-term prospective studies are needed to confirm these results.

Patients’ perception of recovery after exposure of impacted teeth: A comparison of closed- versus open-eruption techniques

PURPOSE

This prospective study compared the patients perception of immediate postoperative recovery after surgical exposure of impacted teeth, treated with a closed-eruption versus an open-eruption surgical technique.

PATIENTS AND METHODS

Sixty patients (41 females and 19 males; mean age, 15.4 +/- 2.8 years) were given a Health-Related Quality of Life (HRQOL) questionnaire to be completed each postoperative day (POD) for 7 days. The questionnaire was designed to assess the patients perception of recovery regarding pain, oral function, general activity measures, and other parameters. The impact of possible predictor variables, such as age, gender, length of surgical procedure, tooth location, height of impaction, and the need for bone removal, was assessed.

RESULTS

Substantial impairment and recovery time of pain and analgesic consumption, oral function (ability to eat and enjoy food, swallowing and mouth opening), and food accumulation were longer after an open-eruption exposure. No differences were recorded concerning general activity. Palatal impaction and the need for bone removal resulted in delayed recovery after exposure with an open-eruption technique.

CONCLUSIONS

The immediate postoperative recovery was longer and more substantially impaired after open-eruption versus closed-eruption surgical techniques. The present study provides information to patients and clinicians assisting them in choosing the most appropriate surgical modality in relation to quality of health parameters.

Patients' perceptions of recovery after surgical exposure of impacted maxillary teeth treated with an open-eruption surgical-orthodontic technique

This study assessed patient perceptions of immediate post-operative recovery after the surgical exposure of impacted maxillary teeth with an open-eruption technique. Thirty patients (24 females and six males) underwent surgical exposure of 39 impacted maxillary teeth using this technique. After surgery the patients were contacted by telephone daily for 7 days, to complete a health-related quality of life (HRQOL) questionnaire, which assessed their perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. Severe pain was reported by 30 per cent of the patients in the first post-operative day (POD 1), which declined to 6.7 per cent by POD 6. Consumption of analgesics declined gradually over the post-operative days (POD 1: 80 per cent, POD 7: 20 per cent). Difficulty in eating required 5 days to reach minimal levels; enjoying everyday food, 2.5 days; school attendance, limitations in daily routine, swallowing, and speech, 2 days each; swelling, bad taste/smell, 1.5 days each; within 1 day all other measures attained minimal levels. The need for bone removal during the exposure resulted in delayed recovery with regard to the ability to eat. In general, females reported delayed recovery for pain. The present data may serve as basic guidelines against which future studies which assess post-operative management of patients after surgical exposure of impacted teeth by an open-eruption technique may be compared.

Quality of Life following Parotidectomy for Malignant and Benign Disease

Parotidectomy is performed for benign or malignant tumors and for selected benign inflammatory and autoimmune conditions. Possible associated complications include facial nerve paralysis, pain, loss of sensation, gustatory sweating, and facial scarring. Global quality of life in patients undergoing parotidectomy has not been reported. The implications of facial surgery with the catastrophic potential of facial nerve paralysis may severely affect quality of life. A quality-of-life study was conducted in patients undergoing parotidectomy for benign and malignant diseases to define the significance of associated morbidity and its impact on quality of life. A quality-of-life instrument was specifically created, based on the principles of the University of Washington Quality of Life questionnaire, and mailed to the patients. Questions addressed recognized complications of parotidectomy. Patient group results were compared for age above and below 45 years, sex, benign versus malignant disease, presence or absence of Frey syndrome, and presence or absence of benign pleomorphic adenoma. Forty-six percent of 125 patients meeting the study criteria fully replied to the questionnaire. The global health score was 3.5, corresponding with "good" to "very good." Except for local sensation, which had a score of 50, all other domains scored above 76. Change in appearance, gustatory sweating, and pain were reported by 70 percent, 57 percent, and 30 percent, respectively. Importance attributed to all domains except facial function was low. Pain was encountered significantly less in patients younger than 45 years of age, and scores for appearance were also highly significant in this age group. Postoperative sequelae were noted in the majority of patients. The dominant sequelae were altered sensation, change in appearance, Frey syndrome, and pain. A degree of permanent postoperative facial nerve impairment was reported by 10 patients. Nevertheless, overall, parotidectomy does not seem to severely affect quality of life.

The effect of sinus membrane perforation and repair with Lambone on the outcome of maxillary sinus floor augmentation: a radiographic assessment

PURPOSE

The present study compared the regenerative outcome of sinus graft procedures in a group of patients who underwent the repair of an intraoperatively diagnosed sinus membrane perforation to that of a group of patients without sinus membrane perforations.

MATERIALS AND METHODS

A sinus floor augmentation procedure was performed in 73 sinuses in 63 patients. In 28% of these sinuses a significant (> 5 mm) membrane perforation was observed intraoperatively. In these cases, the perforation was sealed with a freeze-dried human lamellar bone sheet, and the grafting procedure was carried out as planned. The following parameters were measured on panoramic radiographs immediately postoperatively and at the 6- and 24-month follow-up examinations: (1) the distance between the occlusal edge of the implant and the preoperative sinus floor, (2) the distance between the occlusal edge of the implant and the postoperative sinus floor, and (3) the distance between the occlusal edge of the implant and the alveolar crest.

RESULTS

The patients whose sinus membranes were perforated experienced no complications. No statistically significant differences were found between the 2 groups in the parameters measured.

DISCUSSION

Lambone was used in all cases in the present study. In no case did the sinus augmentation procedure have to be abandoned.

CONCLUSION

It can be concluded that membrane elevation must be carefully executed to avoid membrane perforation, but that if it occurs, it is still possible to continue the procedure safely after repair.

The presurgical workup before third molar surgery: how much is enough?

PURPOSE

We sought to assess the indications for patient referral for computed tomography (CT) scan before third molar extraction. The influence of the data obtained from the CT scans on the surgical outcome and morbidity was also evaluated.

PATIENTS AND METHODS

There were 189 patients in the study (120 females and 69 males). Sixty-five patients were referred to receive CT and formed the study group. The remaining patients were included in the control group.

RESULTS

There were no statistically significant differences between the groups with regard to demographic data and tooth and root angulations. Indications for tooth extraction such as pain, swelling, pericoronitis, caries, endodontic problems, pathology, and prosthetic considerations were similar. The proximity of the tooth root to the inferior alveolar canal was the only statistically significant difference between the 2 groups (P <.001). The treatment plan outcomes for extraction, surgical extraction, and follow-up were comparable. The surgeon changed the initial decision from "surgical extraction" to "follow-up" in only 1 case after CT scan.

CONCLUSIONS

Within the limits of the present study, it can be concluded that the main reason for CT scan referral is the proximity of the third molar root to the inferior alveolar canal (<1 mm). The data obtained from the CT scan had minimal effect on the final surgical outcome. The routine use of CT scan in cases of third molar extractions cannot be recommended.

Patients' perceptions of recovery after exposure of impacted teeth with a closed-eruption technique

This prospective study evaluated patients' perceptions of recovery after surgical exposure of impacted teeth treated with a closed-eruption surgical-orthodontic technique. Twenty-nine patients (16 female, 13 male; mean age, 16 +/- 2.8 years) were given a health-related quality of life questionnaire to be completed each postoperative day (POD) for 7 days. The questionnaire was designed to assess the patient's perception of recovery: pain, oral function, general activity, and other parameters. The impact of possible predictor variables, such as age, sex, length of surgical procedure, tooth location, height of impaction, and need for bone removal were assessed. Severe pain (27.6%, 13.8%, 3.4%) and consumption of analgesics (76%, 41%, 17%) declined gradually over the first 3 PODs. Improvement in oral function and other symptoms was evident by PODs 3 and 4. Absence from school outweighed interference in daily activity by 3 days (POD 6 vs POD 3). Buccolingual tooth location was the most significant predictor variable, with results showing a delayed recovery for patients with buccally impacted teeth. The most striking difference was reported with regard to swelling (P <.0001), followed by mouth opening (P =.008) and speech (P =.05). When the surgical procedure lasted 30 minutes or longer, there was prolonged recovery from pain (P =.01). This study provides information to patients and clinicians on postoperative recovery after surgical exposure of impacted teeth by the closed-eruption surgical-orthodontic technique.

Orthosurgical treatment with lingual orthodontics of an infraoccluded maxillary first molar in an adult

The biological mechanism that leads to a cessation in the normal passive eruption of a tooth is unclear, and there are differing views as to whether ankylosis is involved. When infraocclusion of a permanent molar occurs in the permanent dentition, its effects are seen (1) locally, with exaggerated tipping and relative under-eruption of the adjacent teeth; (2) regionally, with overeruption of the opposing tooth or teeth; and (3) farther afield, with deviation of the dental midline to the affected side. Treatment aimed at eliminating these adverse conditions is warranted, and this might involve the skills of both an orthodontist and an oral surgeon. When the condition occurs in an adult, the changes in facial appearance that will be caused by traditional fixed orthodontic appliances might undermine the patient's willingness to accept treatment. This report describes the successful orthosurgical treatment with lingual orthodontics of an infraoccluded maxillary first molar in an adult. The challenges, treatment alternatives, and technical refinements are emphasized.

The role of digital volume tomography in the imaging of impacted teeth

AIM

Digital volume tomography is presented here as an alternative to routine computerized tomography in the diagnosis and treatment planning of impacted teeth.

MATERIAL AND METHODS

A sample of 20 patients with a variety of types of tooth impaction was investigated and five representative cases are described. The potential disadvantages of digital volume tomography--inferior spatial resolution of subtle structures and limited representation of soft tissues--were of no clinical significance in the presented cases of impacted teeth. The method provides 3-dimensional images closely akin to regular computerized tomography imaging, yet the amount of radiation produced is less than one sixth that for regular computer tomography and its cost is considerably less.

RESULTS AND CONCLUSION

There is reason to recommend the routine adoption of digital volume tomography imaging for positional diagnosis in most cases of impaction of teeth that are candidates for orthodontic resolution.

[The use of autogenous block graft for augmentation of the atrophic alveolar ridge]

The use of osseointegrated implants has become a standard treatment option in modern dental rehabilitation. Adequate bone quantity and quality is a prerequisite for good esthetic and biomechanical result. Alveolar ridge defects can be the result of trauma, periodontal diseases or other pathologic conditions. In these cases, alveolar ridge augmentation is needed if endosseous implants are to be used. While xenografts, alloplastic bone grafts and allografts have been proposed for alveolar ridge augmentation, the use of autogenous bone grafts represents the "gold standard" for bone augmentation procedures. Either intraoral or extraoral sites may be considered for donor sites. Although the iliac crest is the most common donor site in maxillofacial reconstruction, the mandibular symphysis or ramus offer important advantages like avoidance of general anesthesia, convenience due to the proximity between the donor site and the augmentation site and avoidance of cutaneous scar. Bone harvested from intraoral donor site is less associated with resorption when compared with iliac bone because membranous grafts revascularize more quickly than endocondral bone grafts. The main disadvantage of the intraoral donor sites is the limited amount of available bone. Alveolar ridge augmentation using autologous bone block, can be done during implant placement or staged with implant placement, after bone graft healing. In the staged technique, a better implant positioning and the use of wide diameter implants are possible. The overall implant success is higher in the staged technique. Alveolar ridge augmentation using autogenous block graft is a predictable way of treatment, for the atrophic alveolar ridge before implant placement.

Preservation of the facial artery in excision of the submandibular salivary gland

BACKGROUND

The accepted method for submandibular gland excision traditionally includes ligation of the facial artery (FA) as suggested by a host of surgical atlases. Preservation of the FA may be significant in reconstructive procedures of the head and neck and its ligation may altogether be obviated.

OBJECTIVE

Prospective feasibility study of FA preservation in submandibular gland excision.

MATERIALS AND METHODS

Patients undergoing excision of the submandibular salivary glands from September 1999 through August 2001 were prospectively included. The FA was dissected and only its glandular branches ligated. Exclusion criteria were primary benign or malignant tumors of the submandibular salivary gland or metastatic disease involving the gland or level I of the neck. In cases where the primary tumor involved the floor of mouth, anterior tongue or mandible, resection of level I contents included the FA even in N0 necks.

RESULTS AND CONCLUSIONS

104 patients (116 procedures) were included in the study. 81 patients underwent resection of the gland with preservation of the FA. The vessel was sacrificed in 35 necks because of metastases or primary tumor and in two cases of chronic sialadenitis. One patient had a postoperative hematoma following neck dissection requiring re-exploration. The source of bleeding was not found to be related to the FA. Contrary to accepted methodology, the FA may readily be preserved in surgery of the submandibular salivary glands. We suggest preservation of the FA in all cases of procedures for benign disease and in selected cases of malignancy.

Parotid salivary immunoglobulins, recurrent respiratory tract infections and gingival health in institutionalized and non-institutionalized subjects with Down's syndrome

BACKGROUND

The purpose of the present study was to evaluate the possible correlation between recurrent respiratory infections (RRIs), gingival health and the secretion rates of salivary immunoglobulins (Igs) in institutionalized (I) and non-institutionalized (NI) individuals with Down's syndrome (DS).

METHODS

Stimulated parotid saliva was collected from nine I and 14 NI subjects with DS. Salivary flow rate, secretion rates of total salivary IgM, IgG and IgA, and the incidence of RRIs were determined. Gingival health was recorded by using the plaque index, the gingival index and the percentage of bleeding surfaces (BS).

RESULTS

The mean salivary flow rate and parotid Ig secretion rates in the I group were 25% of those of the NI group. The prevalence of RRIs in the I group was more than twice that in the NI group. Oral hygiene and gingival health were significantly better in the NI group.

CONCLUSIONS

The lower parotid Ig secretion rates in I individuals with DS might be a possible factor involved in their susceptibility to recurrent infections compared to NI subjects with DS.

A link between parotid salivary Ig level and recurrent respiratory infections in young Down's syndrome patients

The purpose of the present investigation was to assess the correlation between recurrent respiratory infections and the levels of salivary Ig in a group of young Down's syndrome (DS) individuals. Twenty-three DS and 10 age- and sex-matched healthy individuals were included. DS individuals who had experienced three or more upper respiratory tract infections (n = 10) in the previous 12 months were compared to DS individuals who had not experienced recurrent respiratory infections (n = 13) and to healthy controls (n = 10). A statistically significant reduction in the Ig salivary secretion rate was recorded in the subgroup with recurrent respiratory infections. No significant differences were seen between the subgroup without recurrent respiratory infections and controls. It is suggested that the secretory immune system provides local immune protection against pathogens in the respiratory tract. Detection of salivary Ig levels may serve as a predictor of the susceptibility of DS individuals to recurrent respiratory tract infections.

Severe impairment of secretory Ig production in parotid saliva of Down Syndrome individuals

Infections associated with Down Syndrome (DS) are prevalent in the mucosal-gastrointestinal and respiratory systems, for reasons that are uncertain. The purpose of the present study was to assess the levels of parotid salivary immunoglobulins (Ig) in a group of DS individuals as a possible factor in the susceptibility of mucosal surfaces to infections. Twenty-nine DS and 10 age- and sex-matched healthy individuals were included. Salivary flow rate and IgA, IgG, and IgM concentrations were recorded. The secretion rates of IgA and IgG were diminished by 83% (p < 0.001) and 75% (p = 0.05), respectively, whereas the secretion rate of IgM was not statistically significantly lower. Analysis of the data suggests that DS individuals are immunodeficient in the humoral mucosal immune response. This may explain, in part, the high incidence of recurrent infections in target organs of the secretory immune system in DS subjects.

Medicolegal aspects of altered sensation following implant placement in the mandible

PURPOSE

Altered mandibular sensation following implant surgery may result in liability claims. Therefore the authors conducted a retrospective analysis of all liability claims related to persistent altered sensation following placement of mandibular implants reported to the Medical Consultants International (MCI) Company from 1992 to 1999.

MATERIALS AND METHODS

Reports related to persistent altered mandibular sensation in 16 patients (12 women and 4 men) who underwent implant surgery in Israel were examined. The MCI files were retrospectively evaluated according to a structured form. The parameters studied included patient age and gender, implant location and length, imaging modality, and the time between actual damage and filing of a claim (ie, letter of demand or lawsuit).

RESULTS

The time in months between actual damage and filing of claim ranged from 0 to 60 months (mean 21.5 months). No cases were found involving transient changes in sensation. The female/male ratio was 3:1. Implant length was equal to or longer than 13 mm in 6 of 7 implants placed in the molar region. In the premolar area, nerve injury was evident in 6 of 7 cases where implants shorter than 12 mm were used.

CONCLUSIONS

Transient nerve injury rarely results in legal action. Maximum effort should be devoted to accurately determining the appropriate implant length in the mandible.

Risk management aspects of implant dentistry

PURPOSE

To categorize and review complications related to implant dentistry that have resulted in legal actions.

MATERIALS AND METHODS

The records of 61 patients (39 women and 22 men) were retrospectively evaluated according to a structured form. Ages ranged from 28 years to 78 years (mean 49 +/- 12 years). The time lag in months between actual damage and legal action ranged from 0 months to 60 months (mean 12.7 months).

RESULTS

Implant type, length, width, and locations varied widely and had no impact on the liability report. Half of the lawsuits were filed as a result of actual body damage (loss of sensation, oroantral fistula, life-threatening bleeding); 35% of the lawsuits were filed because of late complications; and 15% were related to immediate complications not leading to actual body damage. The dental consultants acknowledged liability in 41 of 61 cases. The clinician's errors that led to the reported complication were classified as preoperative in 39 of 41 cases. The doctor's attitude was considered positive in 40 cases and negative in 17 cases.

DISCUSSION AND CONCLUSIONS

Clinicians should report as soon as possible to their insurance companies to get professional help. The main causes for lawsuits are actual body injury and major disappointment. Practitioners should dedicate a significant part of the entire treatment time to preoperative diagnosis and planning.

Quality of life of nasopharyngeal carcinoma patients

BACKGROUND

Quality of life (QOL) issues in patients with head and neck carcinoma are of importance beyond the incidence of these tumors because of the impact of the disease and its treatment on external appearance and function of the upper aerodigestive tract. Nasopharyngeal carcinoma (NPC) patients comprise a unique subgroup in whom, to our knowledge, QOL has not been studied directly.

METHODS

Adult patients with NPC treated during the past 15 years at the Chaim Sheba Medical Center with a minimum follow-up of 6 months were included in the current study. Patients were mailed the revised University of Washington quality of life (UW-QOL) questionnaire and data pertaining to their disease were recorded. Patients with recurrent disease or another malignancy or those whose present status could not be ascertained were excluded from the study. QOL scores were analyzed based on treatment, disease stage, and patient age.

RESULTS

Twenty-eight patients of 35 disease-free patients (80%) responded to the questionnaire sent to patients meeting the study criteria. The mean score for general health was 3.1 (range, 1-5). Pain was not a significant factor. Other domains without noteworthy problems were speech and shoulder disability. The majority of patients described their appearance as normal or with minor changes, and questions concerning activity, recreation/entertainment, employment, and swallowing all scored > 70 (range, 0-100). Dry mouth, chewing, and ear problems were of major concern with the majority of patients and affected the QOL indices. Nevertheless, the overall mean QOL score of these patients was rated as "good" (4.2 on a scale of 1-6).

CONCLUSIONS

In the current study, patients with NPC reported ear problems, difficulties in chewing, and dry mouth but their overall QOL appeared to be good. Ear problems such as secretory otitis media should be recognized at the time of presentation and treated. Conformal radiotherapy techniques sparing the salivary glands and temporal bone most likely will be useful in reducing the morbidity associated with treatment.

Lateralization of the inferior alveolar nerve with simultaneous implant placement: a modified technique

PURPOSE

Several nerve repositioning techniques have ben presented in the literature, each with limitations. This article presents a new technique involving the use of 2 osteotomies, with minimizes particularly the potential duration of sensory disruption and the risk of nerve paresthesia and inadvertent nerve transection or compression.

MATERIALS AND METHODS

Ten patients ranging in age from 47 to 67 years were selected for nerve lateralization utilizing the modified technique. A total of 23 cylindrical implants were placed. An average follow-up period was 29.8 months.

RESULTS

Of the 10 patients, 4 experienced total return of sensation within 3 to 4 weeks. One patient experienced complete recovery at 6 weeks.

DISCUSSION

Creating 2 osteotomies as described minimizes the chances for postoperative neuropraxia and nerve paresthesia or anesthesia.

CONCLUSION

When there is moderate-to-severe bone resorption of the mandible posterior to the mental foramen, repositioning the inferior alveolar nerve using both an anterior and posterior osteotomy allows for more bone to accommodate ideal placement and greater length of implant.

The use of orthodontic treatment and immediate implant loading to restore the traumatic loss of a maxillary central incisor

This clinical case describes a new orthodontic/surgical concept for immediate loading of hydroxyapatite-coated cylindric implants, placed at the end of orthodontic treatment, to restore a traumatically lost maxillary central incisor. Further clinical and histologic studies are necessary to promote routine clinical application of this technique.

On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease

BACKGROUND

Premature death in men is known to be significantly associated with coronary heart disease (CHD). More and more studies are pointing toward a possible association between periodontal disease and increased risk of cardiovascular disease. The association of poor oral hygiene and atherosclerosis can be explained by the effect of chronic inflammatory disease on blood rheology. The purpose of the present study was to assess the relationship between CHD and periodontal disease.

PATIENTS AND METHODS

The study population included 1094 Israeli army service men aged 26-53 years (mean: 39+/-5 years). The study group comprised 151 subjects classified as having coronary heart disease CHD, i.e., myocardial infarction, and or anginal syndrome with angiographic evidence of significant coronary disease, or suffer from atherosclerotic risk factors, i.e., diabetes (fasting glucose) and HTN according to strict, well-established criteria. Blood levels of cholesterol and triglycerides were also determined. The severity of periodontal disease was assessed by the aid of CPITN. The control group comprised 943 healthy subjects. Statistical analysis was performed with chi2 test.

RESULTS

Statistical analysis showed a significant association of CPITN score 4 with hypercholesterolemia and a possible association with CHD.

CONCLUSIONS

The generation of higher cholesterol blood levels is proposed as a possible link between chronic periodontal inflammation and atherosclerosis.

Recurrent oral ulcerations associated with recurrent herpes labialis--two distinct entities?

We investigated the prevalence of recurrent aphthous ulcerations (RAU) and recurrent herpes labialis (RHL) in a young adult population. The study group consisted of 20,689 soldiers (aged 18-21 years, mean 19.8 +/- 1 years). There were 14,991 men and 5,698 women. Every patient was asked to complete a self-report health questionnaire which requested information about the occurrence of either RAU or RHL. Data were analyzed using the chi-square test, and the odds ratio was also determined. The prevalence of RAU and RHL was 6.2% and 5.4%, respectively. The prevalence among women was significantly higher (P<0.001), than among men for both RAU (7.1% and 5.8%, respectively) and RHL (6.8% and 4.9%, respectively). Among women, the chance of having RAU for those who were RHL positive was 6.88 greater than for those RHL negative. Among men, the chance of having RAU for those who were RHL positive was 12.37 greater than for those RHL negative. In women, the chance of having RHL for those who were RAU positive was 6.88 greater than for those who were RAU negative. In men, the chance of having RHL for those who were RAU positive was 12.37 greater than for those who were RAU negative. It is concluded that a similar underlying pathological process or unknown cofactor may be involved in both RAU and RHL.

Anterior loop of the mental canal: an anatomical-radiologic study

This study sought to characterize the anatomical dimensions of the anterior mental loop and to determine the accuracy of conventional radiographs in identifying its presence and dimensions. The study group consisted of 46 hemimandibles fixed in formalin. Radiographs of the area between the mental foramen and the midline were obtained and evaluated for each hemimandible, followed by dissection and physical examination of the same area. Anatomically, an anterior loop of the mental nerve was observed in only 13 hemimandibles (28%). The anterior extension of the loop ranged from 0.4 to 2.19 mm. No correlation was found between the radiographic image and the anatomical shape of the loop. Of the radiographically diagnosed loops, 40% were not seen in anatomical examination. In cases with a false radiologic loop, a correlation was found between the diameter of the origin of the incisive canal and the radiologic interpretation of the loop. The radiologic appearance or diagnosis of the anterior mental loop in cadaver mandibles does not disclose the true ramification of the inferior alveolar nerve to the mental and incisive nerve.

The effect of precise reattachment of the mentalis muscle on the soft tissue response to genioplasty

PURPOSE

This study compares vertical and horizontal profile changes of the lower lip and chin after genioplasty with or without precise reattachment of the mentalis muscle.

PATIENTS AND METHODS

Ten patients in whom the mentalis muscle was isolated, identified, marked, and precisely reapproximated comprised the study group. Eleven patients treated without precise reattachment of the mentalis comprised the control group. Preoperative (3 to 6 days before the surgery) and postoperative (6 months after surgery) lateral cephalograms were analyzed to assess the horizontal and vertical soft tissue changes of the lower lip and chin area.

RESULTS

All the significant changes in the present study were noted in the vertical parameters. In most of the study group, the length of the lower lip was either maintained or increased. In the control group, the lower lip length was either preserved or decreased. The mean vertical difference between the 2 groups was nearly 6 mm. Consequently, the study group displayed the same or less of the lower incisors postsurgery compared with the original presurgery exposure in the rest position. The opposite was true for the control group, in which the exposure of the lower incisor crowns at rest increased. Similar changes were noticed in the distance from the vermilion to the reference plane. The vertical position of the soft tissue supramentale remained unchanged in the study group, whereas in the control group the soft tissue supramentale was located in an inferior position (mean = 2.14 mm). The clinical expression of this phenomena is chin ptosis.

CONCLUSIONS

Precise reattachment of the mentalis muscle during an intraoral surgical approach produces a superior result.