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Domic D, Kappenberger J, Bertl K, Hirtler L, Heimel P, Ulm C. The mylohyoid line is highly variable but does not affect the microarchitecture of the edentulous alveolar bone - an anatomical micro-CT study. BMC Oral Health 2024; 24:528. [PMID: 38702714 PMCID: PMC11069156 DOI: 10.1186/s12903-024-04293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES To evaluate in the absence of teeth the variability of the mylohyoid line (ML), the microarchitecture of the adjacent bone, and whether the variable prominence/width of the ML is associated with the quality of the adjacent bone. METHODS µCT scans of 28 human mandibles from anatomical specimens were analyzed. The following parameters were assessed in four edentulous areas (first and second premolar (PM), first, second, and third molar (M1/2/3)): ML width, cortical thickness (CtTh), average cortical- (Avg.Ct.BV/TV), and trabecular bone volume fraction (Avg.Tb.BV/TV). RESULTS The ML width increased from the PM towards the M2 region, which also showed the highest variance (range: 0.4-10.2 mm). The CtTh showed a decrease in the M3 region, while Avg.Ct.BV/TV and Avg.Tb.BV/TV hardly differed among the regions. In the multivariable model on the effect of the various parameters on the ML width, only gender and tooth region were significant. Specifically, male specimens were associated with a wider ML width compared to female specimens and the M2 region was associated with a wider ML width compared to the other tooth regions. CONCLUSION The ML width was not associated with the cortical and trabecular bone quality in the adjacent bone, while gender and tooth region had a significant effect. Specifically, the ML width was lower in female, but peaked in the M2 region with a median width of 3-4 mm. CLINICAL RELEVANCE From a clinical point of view, it was confirmed that the ML is in general a highly variable structure, especially in the M2 region, but the ML width does not allow any conclusions on the bone quality. Altogether, this underlines the need for an individual and accurate diagnostic prior to any surgical intervention.
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Affiliation(s)
- Danijel Domic
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, 1090, Austria
| | - Julia Kappenberger
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, 1090, Austria
| | - Kristina Bertl
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, 1090, Austria
- Department of Periodontology, Dental Clinic, Faculty of Medicine, Sigmund Freud University, Freudplatz 3, Vienna, 1020, Austria
- Department of Periodontology, Blekinge Hospital, Byggnad 13, Hälsovägen, Karlskrona, 371 41, Sweden
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Währinger Strasse 13, Vienna, 1090, Austria
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue Histology and Bone Regeneration, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, 1090, Austria
- Ludwig Boltzmann Institute for Traumatology, The research centre in cooperation with AUVA, Donaueschingenstrasse 13, Vienna, 1200, Austria
- Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, Vienna, 1200, Austria
| | - Christian Ulm
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, 1090, Austria.
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Alqutaibi AY, Alghauli MA, Aboalrejal A, Mulla AK, Almohammadi AA, Aljayyar AW, Alharbi SO, Almuzaini ES, Alsaeedi AK, Arabi LF, Alhajj MN, Halboub E. Quantitative and qualitative 3D analysis of mandibular lingual concavities: Implications for dental implant planning in the posterior mandible. Clin Exp Dent Res 2024; 10:e858. [PMID: 38345362 PMCID: PMC10860544 DOI: 10.1002/cre2.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the type of ridge (degree of angulation of the lingual concavity) and the buccolingual dimensions in the area of the first and second molars in both genders of different ages and how this will affect implant placement in the posterior mandible. MATERIALS AND METHODS This retrospective cross-sectional study comprised cone beam computed tomography images of 150 dental patients (75 males and 71 aged ≥30). The following were measured/reported: type (morphology) of the ridge (convex [C], parallel [P], or undercut [U]), buccolingual width at the base and the crest of the ridge, and ridge height. The concavity angle, depth, and length of the U-shaped ridge were measured too. RESULTS The prevalence of type U ridge ranged from 32.7% in the first molar region to 62.7% in the second molar region. Almost all measurements and ridge type distributions were comparable amongst the age groups (p > .05). Very few significant differences were found when comparing #36 versus #37 and #46 versus #47 teeth, with no differences in the distribution of the ridge types (p > .05). Quite the inverse, all measurements were statistically different when comparing #36 versus #37 and #46 versus #47 teeth, and type U ridge was more frequent in second molar compared to the first molar regions, respectively (p < .05). Many measurements were statistically higher in females; the inverse was true for a few measurements (p < .05). Type U ridge in #36 and #37 was found more frequently among males (p < .001). In contrast, the ridge types in #37 and #47 were not statistically different gender-wise. CONCLUSIONS The U type of ridge was more prevalent in the investigated population, encountered more frequently in the second molars generally and in the first molars of males than females. Most posterior mandibular measurements are similar age- and side-wise but seem different gender- and tooth-wise.
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Affiliation(s)
- Ahmed Yaseen Alqutaibi
- Substitutive Dental Science Department, College of DentistryTaibah UniversityAl‐MadinahSaudi Arabia
- Department of Prosthodontics, Faculty of DentistryIbb UniversityIbbYemen
| | | | - Afaf Aboalrejal
- Oral Biology Department, College of DentistryIbb UniversityIbbYemen
| | | | | | | | | | | | | | - Lina F. Arabi
- College of DentistryTaibah UniversityAl MadinahSaudi Arabia
| | | | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of DentistryJazan UniversityJazanSaudi Arabia
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Sun Y, Hu S, Xie Z, Zhou Y. Relevant factors of posterior mandible lingual plate perforation during immediate implant placement: a virtual implant placement study using CBCT. BMC Oral Health 2023; 23:76. [PMID: 36747164 PMCID: PMC9903431 DOI: 10.1186/s12903-022-02696-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To explore the influence of cross-sectional type and morphological parameters at the mandibular molar sites on lingual plate perforation (LPP) during the immediate implant placement (IIP). METHODS 181 implants were virtually placed in the mandibular molar sites on the cone beam computed tomography (CBCT). Each cross-section of the implantation site was divided into the Undercut (U)/Parallel (P)/Convex (C) types. Morphologically relevant parameters were measured on the cross-sections, including width of the upper end (Wb), width of the lower end (Wc), vertical height (V), angle between the natural crown axis and the alveolar bone axis (∠β), LC depth (LCD), LC height, and angle between the horizontal line and the line connecting the most prominent point and the most concave point of lingual plate (∠α). Besides, the distance from the end of the virtual implant and the lingual bone plate of the cross-section (DIL) was calculated. Relationships between all the morphologically relevant parameters and the DIL were further analyzed. RESULTS A total of 77 (42.5%) cross-sections were classified as U-type, which was the most common one, accounting for 63% of the second molar regions. All LPP cases and most of the nearly LPP (87.9%) cases occurred at the U-type cross-sections, and the relationship between the DIL and the morphological parameters can be expressed by a multivariate linear equation. CONCLUSIONS The occurrence rate of U-type cross-sections in the second molar region was very high, and the risk of LPP should be considered during IIP. Except for the U-type, significant large LCD, small Wc, and large ∠β were the important relevant factors. CBCT and multivariate linear equations could help to assess the LPP risk and provide a reference for implant placement design pre-surgery.
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Affiliation(s)
- Yingjia Sun
- grid.13402.340000 0004 1759 700XStomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000 People’s Republic of China
| | - Sai Hu
- grid.13402.340000 0004 1759 700XThe Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, 322000 Zhejiang People’s Republic of China
| | - Zhijian Xie
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000, People's Republic of China.
| | - Yiqun Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000, People's Republic of China.
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Ikbal M, Shen YW, Ruslin M, Fuh LJ, Hsu JT. Assessment of sagittal root position, alveolar bone concavity, and labial bone perforation in the mandibular anterior tooth region for immediate implant placement. J Dent Sci 2023. [DOI: 10.1016/j.jds.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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Risk assessment of labial bone perforation in the anterior mandibular region: a virtual immediate implant placement study. Int J Implant Dent 2021; 7:68. [PMID: 34308500 PMCID: PMC8310813 DOI: 10.1186/s40729-021-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the prevalence of labial bone perforation (LBP) related to the associated anatomic factors in anterior mandibular region using a virtual immediate implant placement procedure. METHODS Series qualified CBCT images of 149 participants (894 teeth) were selected to analyze the assigned anatomical parameters, including concavity depth, concavity angle, torque, and deep bone thickness. Four classes of crestal and radicular dentoalveolar bone phenotypes (CRDAPs) of mandibular anterior teeth were categorized according to the thickness of dentoalveolar bone at both crestal and radicular zones. Data were adjusted for categorical (gender and CRDAP) and continuous (age, cavity angle, cavity depth, and deep bone thickness) variables using a multivariable logistic regression analysis with generalized estimating equation method. RESULTS The overall probability of LBP after virtual implant placement was 21.6%. There is statistically significant higher prevalence of LBP at canine (28.5%) and CRDAP class II (29.2%) regions (p < 0.001). After adjusting confounding variables, CRDAP class II and class IV regions are more likely to have LBP when compared with CRDAP class I (control) regions (p < 0.01). The risk of LBP at canine site is 6.31 times more likely than at the central incisor (control) (p < 0.01). CONCLUSIONS Using a virtual immediate implant placement technique, the prevalence of LBP is significantly higher at the mandibular canine site and thin radicular dentoalveolar phenotype in the anterior mandibular region.
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Tan WY, Ng JZL, Ajit Bapat R, Vijaykumar Chaubal T, Kishor Kanneppedy S. Evaluation of anatomic variations of mandibular lingual concavities from cone beam computed tomography scans in a Malaysian population. J Prosthet Dent 2021; 125:766.e1-766.e8. [PMID: 33752904 DOI: 10.1016/j.prosdent.2021.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
STATEMENT OF PROBLEM Lingual plate perforation can be life-threatening when vital structures are damaged during implant placement. Knowledge of the anatomy of lingual concavities is imperative for safe implant surgery. PURPOSE The purpose of this clinical study was to determine the prevalence of type of posterior mandibular ridge morphology in a Malaysian population and to evaluate the buccolingual width of the alveolar ridge (Wb and Wc); alveolar ridge height (Vcb); and concavity angle, length, and depth for both left and right first and second molars in different age groups and sexes by using cone beam computed tomography (CBCT). MATERIAL AND METHODS Bilateral posterior mandibular lingual concavities at the first and second molars were retrospectively studied in cross-sectional views of 150 CBCT scans (n=600 sites evaluated). The sample size was calculated at a power of 80%, confidence interval of 95%, and margin of error of .05. The buccolingual width from the base and crest of the ridge and the ridge height were measured to determine the type of ridge. For the U-shaped ridge, the concavity angle, length, and depth were assessed. The independent t test was used to compare mean values of CBCT measurements between sexes and tooth type, while the ANOVA and Pearson chi-squared test were used to determine the correlations with age groups and types of ridge morphology, respectively. To compare the left and right readings for first and second molars in the same patient, the paired t test was performed (α=.05 for all tests). RESULTS The Pearson correlation showed a strong agreement between the 2 examiners with an interobserver reliability of 87.3%. Significant difference was noted in all dimensional measurements when comparing right and left first and second molars (P<.001). The degree of concavity was significantly different (P<.05), except for the depth of the concavity at the left molars (P=.075). The type C ridge (51.7%) was the most prevalent ridge among a Malaysian population. Only dimensional measurements were significantly different when compared among age groups (P<.05). Ridge width and height were significantly greater in men (P<.05). Men exhibited greater concavity depth than women in the left second molar region (P=.03). CONCLUSIONS Lingual concavity was found in the mandible in 32.8% of a Malaysian population. Significant differences were found in dimensional measurements and degree of concavity between left and right first and second molars, with deeper concavity depth found in second molars. Significant age and sex-related variations were found in the dimensional measurements of the mandible between left and right sides with no significant difference in degree of concavity.
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Affiliation(s)
- Wan Yee Tan
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Jacklyn Zhi Ling Ng
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Ranjeet Ajit Bapat
- Senior Lecturer, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Haj Yahya B, Chaushu G, Hamzani Y. Computed Tomography for the Assessment of the Potential Risk After Implant Placement in Fresh Extraction Sites in the Posterior Mandible. J ORAL IMPLANTOL 2021; 47:2-8. [PMID: 32662837 DOI: 10.1563/aaid-joi-d-18-00227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Immediate implant placement (IIP) is considered a reliable procedure, with survival rates of 94.9%-98.4%. Nevertheless, in the posterior mandible, it poses a high risk of damage to anatomic structures. The aim of this study was to determine the risk of anatomic structures injury associated with IIP in the posterior mandible based on apical primary stability, respecting a safe distance from the inferior alveolar nerve and lingual plate, and to evaluate the influence of different factors on those risks. Pre-extraction cone beam computed tomography scans of 100 patients were retrospectively analyzed. Measurements were taken from tooth apices to lingual plate and to mandibular canal. Values of <4 mm of the former and <6 mm of the latter were categorized as considerable risk. Values of <2 mm at both measurements were considered high risk. Two-sided P < .05 was considered statistically significant. Mean root-to-alveolar canal distance was 7.6 ± 2.7 mm in the first molar, 6.5 ± 3mm in the second premolar, and 5.4 ± 3 mm in the second molar (P < .005). The mean distance to the outer lingual cortex was 3.9 ± 2.1 mm in the first molar and 3.2 ± 0.1 mm in the second molar. Thus, second molars were at higher risk of inferior alveolar nerve injury and lingual plate perforation during IIP. Background factors associated with higher IIP risk were female sex and age < 40 years. In the mandible, the anatomic risk posed by IIP is greatest for second molars and lowest for first molars. Several background factors affect the distances between root apices and the mandibular canal.
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Affiliation(s)
- Bahaa Haj Yahya
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafit Hamzani
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Koga S, Sato I, Li Z, Miyaso H, Kawata S, Itoh M. Analysis of the mylohyoid nerve in elderly Japanese cadavers for dental implant surgery. Clin Exp Dent Res 2021; 7:20-32. [PMID: 33230980 PMCID: PMC7853905 DOI: 10.1002/cre2.341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Injury to the mandibular nerve (MN) branches may cause pain and irregular occlusal movement during mastication after mandibular dental treatments. Growing evidence indicates that the calcitonin gene-related peptide (CGRP) plays a key role in the development of peripheral sensitization and the associated enhanced pain, suggesting it may be a sign to ensure a safe and reliable dental implant treatment. Our focus was on the distribution of the MN branches and their communication with the lingual nerve (LN), the localized expression of CGRP, and the identification of a pain area related to the mylohyoid muscle (MM) fascia in the mandibular floor. MATERIAL AND METHODS In this study, MM samples from 440 sides of 303 human cadavers aged 61-103 years were examined microscopically and immunohistochemically. These data were further evaluated by the use of principal component analysis. RESULTS A complex but weak attachment site was identified for the fascia of the MM. CGRP expression was mainly located in small vessels and was scattered throughout the whole fascia of the MM. Communication between the MN and LN was found in 62.5% (275/440) of the samples. The results from the principal component analysis showed that the positive contributions were from the descending branch in the premolar region (correlation coefficient value R = 0.665), the ascending branch in the molar region (R = 0.709) and the intermediate branch of the digastric branch (R = 0.720) in component 1. In the fascia off the MM, strongly labeled CGRP-positive cells were also found around the blood vessels and the nerve. CONCLUSIONS The findings reported in this study indicate that there is a risk of damage when pulling the fascia off the MM at the border of the molar and premolar regions during dental implant surgery.
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Affiliation(s)
- Shintaro Koga
- Department of AnatomyTokyo Medical UniversityTokyoJapan
| | - Iwao Sato
- Department of AnatomyTokyo Medical UniversityTokyoJapan
| | - Zhong‐Lian Li
- Department of AnatomyTokyo Medical UniversityTokyoJapan
| | | | | | - Masahiro Itoh
- Department of AnatomyTokyo Medical UniversityTokyoJapan
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Ribas BR, Nascimento EHL, Freitas DQ, Pontual ADA, Pontual MLDA, Perez DEC, Ramos-Perez FMM. Positioning errors of dental implants and their associations with adjacent structures and anatomical variations: A CBCT-based study. Imaging Sci Dent 2020; 50:281-290. [PMID: 33409136 PMCID: PMC7758259 DOI: 10.5624/isd.2020.50.4.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The objective of the present study was to evaluate the prevalence of dental implants positioning errors and their associations with adjacent structures and anatomical variations by means of cone-beam computed tomography (CBCT). Materials and Methods CBCT images of 207 patients (584 dental implants) were evaluated by 2 oral radiologists. The distance between the implant and the adjacent teeth/implants was measured and classified as adequate (≥1.5 mm and ≥3 mm, respectively) or inadequate. The presence of thread exposure, cortical perforation, implant dehiscence, implant penetration into adjacent structures, and anatomical variations was also recorded. The incisor canal diameter and the depth of the concavity of the submandibular fossa were measured in order to evaluate their correlations with the frequency of implant penetration in these structures. Descriptive analyses, the Fisher exact test, and Spearman correlation analysis were performed (α=0.05). Results The overall prevalence of positioning errors was 82.9%. The most common error was the inadequate distance between the implant and the adjacent teeth/implants. The presence of anatomical variations did not significantly influence the overall prevalence of errors (P>0.05). There was a positive correlation between the diameter of the incisor canal and the frequency of implant penetration in this structure (r=0.232, P<0.05). Conclusion There was a high prevalence of dental implant positioning errors, and positioning errors were not associated with the presence of anatomical variations. Professionals should be aware of the space available for implant placement during the preoperative planning stage.
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Affiliation(s)
- Beatriz Ribeiro Ribas
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Andréa Dos Anjos Pontual
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Danyel Elias Cruz Perez
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Amin SA, Elsheikh AK, Meyer RA, Bagheri SC. Incidence of Pre-Existing Lingual Cortex Perforation Before Removal of Mandibular Third Molars. J Oral Maxillofac Surg 2020; 78:2129-2137. [PMID: 32916133 DOI: 10.1016/j.joms.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to determine the relationship between the mandibular third molar tooth (Md3) and the adjacent lingual cortical bone and determine the incidence of lingual cortex perforation by Md3s. PATIENTS AND METHODS This retrospective study was designed and implemented from 100 cone-beam computed tomographic scans (CBCTs) of patients with age ranging from 18 to 65 years old. The primary outcome was to assess the incidence of mandibular third molars (Md3s) with existing lingual cortex perforation by their roots. Perforation was assessed at the level of root apex and the most lingual portion on the apical half of the root. Other outcome variables included average thickness of covering lingual bone in the nonperforation group, lingual cortex morphology, impaction, and demographics. Descriptive statistics were computed. RESULTS More than half the radiographs showed lingual cortex perforation at the level of root apex and most lingual portion on the apical one half of the root (51.2% and 52.8%, respectively). The average thickness of the covering lingual bone was 1.25 mm around the root apex and 0.93 mm around the most lingual portion on the apical half of the root. The most common lingual cortex morphology was the undercut shape. There was statistically significant association between the presence of Md3 impaction and perforation at both root levels [(P value < .001, Effect size = 0.378) and (P value < .001, Effect size = 0.445)]. CONCLUSIONS Perforation of the lingual cortex by Md3s, whether erupted or impacted, was found in >50% of patients as determined by a preoperative CBCT scan. Therefore, the finding of lingual cortex perforation after removal of Md3s is likely to be evidence of a pre-existing condition rather than a result of surgery.
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Affiliation(s)
- Sara A Amin
- Oral & Maxillo-Facial Radiologist, Former Internal Resident, Department of Oral & Maxillo-Facial Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Ahmad K Elsheikh
- General Dentist, Private Practitioner, Chief Dental Officer, 360 Imaging, Atlanta, GA
| | - Roger A Meyer
- Private practice: Georgia Oral & Facial Reconstructive Surgery, Marietta, GA; Active Staff, Department of Surgery, Northside Hospital, Atlanta, GA; and Director, Maxillofacial Consultations, Ltd, Greensboro, GA
| | - Shahrokh C Bagheri
- Georgia Oral & Facial Reconstructive Surgery, Attending Oral and Maxillofacial Surgeon, Northside Hospital, Director of Fellowship Program in Facial Cosmetic and Reconstructive Surgery, Atlanta, GA
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Huang C, Zhou C, Xu M, Zou D. Risk factors for lingual plate fracture during mandibular third molar extraction. Clin Oral Investig 2020; 24:4133-4142. [PMID: 32356209 DOI: 10.1007/s00784-020-03286-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to predict the risk of lingual plate fracture during mandibular third molar (M3) extraction. MATERIALS AND METHODS Cone beam computed tomography (CBCT) data from 264 mandibular M3s (erupted and impacted) from 264 patients (104 males and 160 females; age range, 17-75 years) were retrospectively analyzed. Lingual plate thicknesses at the levels of the mid-root and root apex of the M3s were measured and defined as "thicker" (bone thicker than 1 mm), "thinner" (bone thinner than 1 mm), or "perforated" (bone perforated by the M3 root). These measurements were correlated with potential risk factors for thinner and perforated lingual plates: tooth position of the mandibular M3, morphology of the lingual plate, and patient characteristics (age and sex). RESULTS The mean thickness of the lingual plate was 1.49 ± 1.38 mm at the mid-root of the M3s, and 2.35 ± 2.03 mm at the root apex. Multivariate regression analyses revealed that mesioangularly and horizontally impacted M3s were significantly associated with thinner and perforated lingual plates at the mid-root (P < 0.001), whereas the M3s in infra-occlusion positions (in infra-occlusion when compared with the adjacent second molar) had thinner lingual bone at the root apex (P = 0.022 and P = 0.027, depending on the level of impaction). Female patients were less likely to have lingual plate perforation (P = 0.036). CONCLUSIONS Mesioangulation, infra-occlusion, and male sex were risk factors for lingual plate fracture. CLINICAL RELEVANCE When the risk of lingual plate fracture is high, a sufficiently large flap, osteotomy, and tooth section by bur or piezosurgery are recommended to create a good operative field and avoid excessive pressure on the lingual plate.
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Affiliation(s)
- Cheng Huang
- Department of Stomatology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, 1878, North Sichuan Road, Shanghai, 200081, China
| | - Chun Zhou
- Department of Stomatology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, 1878, North Sichuan Road, Shanghai, 200081, China
| | - Minhua Xu
- Department of Stomatology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, 1878, North Sichuan Road, Shanghai, 200081, China
| | - Derong Zou
- Department of Stomatology, Sixth People's Hospital, Shanghai Jiao Tong University, 600, Yishan Road, Shanghai, 200233, China.
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Magat G. Radiomorphometric analysis of edentulous posterior mandibular ridges in the first molar region: a cone-beam computed tomography study. J Periodontal Implant Sci 2019; 50:28-37. [PMID: 32128271 PMCID: PMC7040440 DOI: 10.5051/jpis.2020.50.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022] Open
Abstract
Purpose The aim of our study was to determine the prevalence and degree of lingual concavities in the first molar region of the mandible to reduce the risk of perforating the lingual cortical bone during dental implant insertion. Methods A total of 163 suitable cross-sectional cone-beam computed tomography images of edentulous mandibular first molar regions were evaluated. The mandibular morphology was classified as a U-configuration (undercut), a P-configuration (parallel), or a C-configuration (convex), depending on the shape of the alveolar ridge. The characteristics of lingual concavities, including their depth, angle, vertical location, and additional parameters, were measured. Results Lingual undercuts had a prevalence of 32.5% in the first molar region. The mean concavity angle was 63.34°±8.26°, and the mean linear concavity depth (LCD) was 3.03±0.99 mm. The mean vertical distances of point P from the alveolar crest (Vc) and from the inferior mandibular border were 9.39±3.39 and 16.25±2.44, respectively. Men displayed a larger vertical height from the alveolar crest to 2 mm coronal to the inferior alveolar nerve (Vcb) and a wider LCD than women (P<0.05). Negative correlations were found between age and buccolingual width at 2 mm apical to the alveolar crest, between age and Vcb, between age and Vc, and between age and LCD (P<0.05). Conclusions The prevalence of lingual concavities was 32.5% in this study. Age and gender had statistically significant effects on the lingual morphology. The risk of lingual perforation was higher in young men than in the other groups analyzed.
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Affiliation(s)
- Guldane Magat
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
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Avanesov AM, Sedov YG, Mordanov OS. [Morphology of mandibular lingual concavities]. STOMATOLOGII︠A︡ 2019; 98:113-117. [PMID: 31701940 DOI: 10.17116/stomat201998051113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The literature review on assessment of lingual concavities in posterior mandibula with CBCT to prevent complications such as perforations during dental implant placement. METHODS The electronic search of full-text articles on lingual concavity studies with CBCT was performed. The data on the prevalence, depth and angle of concavities was analyzed. RESULTS The analysis included 5 articles from 2011 to 2016 years. Totally 1713 mandibular concavities were evaluated in 1232 patients. The prevalence was 46.7-68%; mean depth was from 2.4 mm to 5.4 mm; and the mean angle varied from 143 to 156.6 degrees. CONCLUSION Though morphologic data of lingual concavities showed similar pattern it is necessary to provide CBCT evaluation prior to dental implant placement to define available bone and its morphology. It is recommended to use guided surgery if U-type is evident.
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Affiliation(s)
- A M Avanesov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - Yu G Sedov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - O S Mordanov
- Peoples' Friendship University of Russia, Moscow, Russia
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Clark D, Barbu H, Lorean A, Mijiritsky E, Levin L. Incidental findings of implant complications on postimplantation CBCTs: A cross-sectional study. Clin Implant Dent Relat Res 2017. [PMID: 28631287 DOI: 10.1111/cid.12511] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Survival rates of dental implants are reported to be very high and seem to indicate minimal complications related to dental implants. PURPOSE The aim of this report was to evaluate in a cross-sectional study the prevalence of implant positioning complications as appears in postimplantation Cone-Beam Computerized Tomography (CBCT) in two of the major imaging facilities in Bucharest, Romania. METHODS Demographic and implant data was collected from two of the three main CBCT facilities in Bucharest, Romania. All postimplantation CBCT imaging were assessed and evaluated for the presence of different implant positioning related complications. Data were entered into Excel spreadsheet and analyzed statistically. RESULTS Of the 2323 CBCT's that were analyzed, a total of 160 (6.89%) presented with implant positioning related complications. Out of those, 62 cases revealed penetration of the implant to adjacent anatomic structure. More specifically, there were 21 instances of sinus penetration, 19 instances of nasal cavity penetration, 9 instances of inferior alveolar canal penetration, and 13 instances of lingual plate perforations. There were also 15 cases of adjacent tooth injury noted. CONCLUSIONS Despite the popularity of dental implants, the surgical placement of these implants is not a riskless procedure. Implant mal-positioning might be life-threatening and can lead to serious bleeding, airway obstruction, and unnecessary postoperative surgeries. Complications of dental implants are not obsolete and dental implant associated problems may not be apparent immediately. Surgeons must have proper training and use evidenced-based treatment planning in order to prevent dental implant complications.
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Affiliation(s)
- Danielle Clark
- Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Horia Barbu
- Department of Oral Surgery and Oral Implantology, Faculty of Dental Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Adi Lorean
- Department of Oral Surgery and Oral Implantology, Faculty of Dental Medicine, Titu Maiorescu University, Bucharest, Romania
| | | | - Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Canada
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Wang D, He X, Wang Y, Zhou G, Sun C, Yang L, Bai J, Gao J, Wu Y, Cheng J. Topographic relationship between root apex of mesially and horizontally impacted mandibular third molar and lingual plate: cross-sectional analysis using CBCT. Sci Rep 2016; 6:39268. [PMID: 27991572 PMCID: PMC5171861 DOI: 10.1038/srep39268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/21/2016] [Indexed: 11/08/2022] Open
Abstract
The present study was aimed to determine the topographic relationship between root apex of the mesially and horizontally impacted mandibular third molar and lingual plate of mandible. The original cone beam computed tomography (CBCT) data of 364 teeth from 223 patients were retrospectively collected and analyzed. The topographic relationship between root apex and lingual plate on cross-sectional CBCT images was classified as non-contact (99), contact (145) and perforation (120). The cross-sectional morphology of lingual plate at the level of root apex was defined as parallel (28), undercut (38), slanted (29) and round (4). The distribution of topographic relationship between root apex and lingual plate significantly associated with gender, impaction depth, root number and lingual plate morphology. Moreover, the average bone thickness of lingual cortex and distance between root apex and the outer surface of lingual plate were 1.02 and 1.39 mm, respectively. Furthermore, multivariate regression analyses identified impaction depth and lingual plate morphology as the risk factors for the contact and perforation subtypes between root apex and lingual plate. Collectively, our findings reveal the topographic proximity of root apex of impacted mandibular third molar to the lingual plate, which might be associated with intraoperative and postoperative complications during tooth extraction.
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Affiliation(s)
- Dongmiao Wang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China
| | - Xiaotong He
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Yanling Wang
- Department of oral prosthodontics, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Guangchao Zhou
- Department of Oral and Maxillofacial Radiology, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Chao Sun
- Department of Oral and Maxillofacial Radiology, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Lianfeng Yang
- Department of Oral and Maxillofacial Radiology, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Jianling Bai
- Department of Biomedical Statistics, College of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Jun Gao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China
| | - Yunong Wu
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
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Herranz-Aparicio J, Marques J, Almendros-Marqués N, Gay-Escoda C. Retrospective study of the bone morphology in the posterior mandibular region. Evaluation of the prevalence and the degree of lingual concavity and their possible complications. Med Oral Patol Oral Cir Bucal 2016; 21:e731-e736. [PMID: 27694785 PMCID: PMC5116115 DOI: 10.4317/medoral.21256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In order to choose the appropriate implant size and to prevent complications, an oral surgeon must know the size and shape of the mandible. In the posterior mandibular region, a lingual undercut is often found and could represent a difficulty hard to manage if a lingual or buccal perforation occur. A large series of computed tomography (CT) images of the mandibular first molar was evaluated and the bone morphology, the prevalence and the degree of the lingual concavity in the first molar region were studied. MATERIAL AND METHODS One hundred and fifty-one computed tomography (CT) examinations of patients were retrospectively evaluated to determine anatomical variations in bone morphology in the submandibular fossa region. RESULTS A total of 151 subjects were included, consisting of 64 males (M) (42.4%) and 87 females (F) (57.6%). The under-cut type ridge was present in 64.2% of the cases. The concavity angle was 66.6 ± 8.9° (M) and 71.6 ± 8.4° (F) and the linear concavity depth 4.5 ± 2.3 mm (M) and 3.1 ± 1.7 mm (F) (p>0.05). CONCLUSIONS Mandibles with any lingual concavity present a potential increased risk of lingual cortical perforation during implant placement surgery. CT imaging allows characterizing the anatomy of the submandibular fossa and provides other important information for the preoperative assessment of the posterior mandible for dental implants placement.
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