Inflammatory reaction to foreign body (amalgam) in the maxillary sinus misdiagnosed as an ethmoid tumor

A patient with chronic unilateral maxillary sinusitis caused by a foreign body (dental amalgam) and mistaken diagnosis of extensive ethmoid neoplasm is presented. The imitation of tumour symptoms was due to a long presence of foreign body in the maxillary sinus and chronic inflammation of maxillary, ethmoid and sphenoid sinuses.

Tooth morphology in function of selfprotective mechanism

The degree of curvature of vestibular and oral tooth surfaces is determined by the shape sequence from the tooth crown to the epithelial attachment and the alveolar bone, and directly influences the health of gingiva and the entire tooth support system. The goal of this research was to determine vestibulo-oral planes of upper and lower permanent premolars and molars and the thickness of the associated alveolar osseous wall, and 2,727 measurings were processed using pertinent statistical procedures. The results have shown the degree of curvature of vestibular and oral tooth surfaces to be higher in upper teeth than in lower ones (p > 0.05); vestibular convexities higher than oral ones and especially noticeable at the junction from the meandle to the lower third of the crown. Higher vestibular curvature also entailed thicker osseous wall. All results were higher than the ones found in literature. We consider our results to be relevant for our population. The research on the relationship of teeth and the alveolar bone should be continued by using even more test points and more sophisticated research procedures.

Relationship between body mass index and local quality of mandibular bone structure in elderly individuals

BACKGROUND

Human bones decrease in density and increase in porosity beginning at about the third decade of life. The objective of this study was to determine whether mandibular bone mineral density (BMD) and some linear radiomorphometric measurements on dental panoramic radiograph (DPR) are correlated with different categories of body mass index (BMI) in elderly individuals.

METHODS

Cortical width at gonion (GI), at antegonion (AI), and below mental foramen (MI) and the appearance of the cortex of the lower border of the mandible distal to the mental foramina due to resorptive changes (mandibular cortical index [MCI]) were measured bilaterally on the mandible on 136 DPRs of elderly individuals. Using DPRs and copper stepwedge, mandibular BMD was investigated densitometrically. All BMD values were expressed in equivalents of the actual stepwedge thickness. The patients with BMIs from 20 to 25 kg/m(2) were classified as category 1 (the generally accepted range of normal BMI), and the patients with BMIs higher than 25 were classified as category 2 (heavy individuals with a heavy skeleton and a large amount of fat in the body).

RESULTS

The results revealed statistically significant differences in all measured indices between different BMI categories (p <.05 for MI; p <.001 for GI and AI). Statistically significant differences were also found in BMD values between different BMI categories (p <.05); the differences were more pronounced in women. The patients with MCI category 3 had significantly lower BMD values in comparison to MCI category 2 (p <.01). Intraobserver agreement in GI, AI, MI measurement, and MCI assessments was excellent.

CONCLUSIONS

Heavy people have higher BMD and higher values in linear radiomorphometric measurements than lighter people.

Epidemiological analysis of oral surgery procedures

The epidemiological study was conducted to assess oral health of patients referred to the Department of Oral Surgery at Clinical Hospital Center in Rijeka. The distribution of particular diagnoses and surgical interventions in relation to frequency of occurrence was tested. The total of 1,268 patients aged from 5 to 89 years, both sexes, were included in the study. All the patients were treated under local anesthesia. The most common reason for referral to oral surgery was chronic periapical lesion (33.3%), followed by retained root (26.7%), impacted tooth (12.7%), and radicular cyst (8.3%). The majority of patients, residents of Rijeka city area, were treated for the diagnosis of adult periodontitis, while the radicular cysts and hypertrophy of the upper frenulum were more frequent referral diagnoses in patients coming from the areas around Rijeka. Extractions were performed more frequently in patients from Rijeka, while cystectomies with apicectomies and frenulectomies in other patients.

PTCH gene altered in dentigerous cysts

Motivated by the evidence that odontogenic keratocysts are associated with genetic alterations, we examined the possibility that development of other odontogenic cysts can be attributed to gene malfunctioning, in particular to the PTCH gene. Cyst epithelium was examined for polymorphism on chromosome 9q22.3, the region that contains the PTCH gene. Loss of heterozygosity (LOH) for the D9S287 marker and/or D9S180 marker was observed in about 50% of dentigerous cysts, whereas radicular cysts gave no indication of lesions in the PTCH region. As a more direct argument for PTCH involvement in cystic growth, we report evidence of PTCH expression in dentigerous cyst lining, which indicates malfunctioning of the relevant signaling pathway. While we found no reason to believe that PTCH should be associated with radicular cysts, other genes may be implicated in their development. We performed immunohistochemical comparisons of keratocysts, dentigerous and radicular cysts for the nonmetastatic marker Nm23. A graded response placed radicular cysts in between the other two types, suggesting a similar neoplastic character for their epithelial proliferation.

Foramen mandibulae as an indicator of successful conduction anesthesia

Comparative measurements were made of 144 orthopantomographs in 50 patients with successful and 94 patients with unsuccessful inferior alveolar nerve block anesthesia. The results show that the bony lingula is prominent in 28.5% of all patients, or in 56.0% of those with unsuccessful anesthesia. The variables mandibular notch vs. mandibular foramen (MN-MF) and the anterior ramus ridge vs. mandibular foramen (ARR-MF) show greater distances in the group of patients with successful anesthesia, while the variables of posterior ramus ridge vs. mandibular foramen (PRR-MF) and mandibular angle vs. mandibular foramen (MA-MF) were greater in the group of patients with unsuccessful anesthesia (p > 0.05). It is concluded that the variability in position of the mandibular foramen among others may be responsible for an occasional failure of inferior alveolar nerve block.

Early post-operative complications in oral implantology

Hematoma, postoperative bleeding, edema, early infection, dehiscence, emphysema, air embolism, loss of primary stability of the implant, acute sinusitis, postoperative cutaneous or mucosal anesthesia and loss of central visual field are early postoperative complications. The incidence of early post-operative complication during the first days of postoperative follow-up was inquired. Eleven patients were implanted by 27 DPI implants. The patients were followed up the first day, the second day and the tenth day after the one-phase surgical technique. Dehiscence in 2 patients, edema in 10 patients, hematoma in 2 patient and postoperative bleedings in 3 patients were established. Three implants were removed because loss of primary stability. It is indicated that by proper preoperative and intraoperative as well as postoperative approach it is possible to influence early postoperative complications. Even though postoperative complications are sometimes unavoidable, choosing the most appropriate surgical technique and keeping oral cavity hygiene are the most important factors in prevention. It is concluded that only the loss of primary stability is incorrigible and successes of implanto-prosthetic rehabilitation can be properly and fully evaluated only after 5 to 10 years of follow up period.

Computer assisted densitometric image analysis (CADIA) of bone density in periradicular bone defects healing

CADIA can only be performed on geometrically standardized images converted in Al equivalents. The aim of this study was to develop the ability of the new CADIA software to quantify bone density on dental radiographs without previous standardization. A total of 36 examines with periradicular lesions were treated surgically, the defects were filled with Hydroxylapatite and followed up for 1, 6, and 12 months. Before and after surgery the operated areas were clinically evaluated using intraoral radiographs, tooth mobility index and relapses. Clinical results revealed satisfactory bone healing in 27 cases and relapses in 9 cases. The radiographs were then digitized with a high resolution CCD camera. Densitometric analysis was done in 10 points at the edge of the bone defect. Correction of geometric and brightness distortions was done with mathematical manipulation from three referral points positioned at the same place on each radiograph. Density values observed no bone loss in 23 cases and loss of bone in 13 cases. The differences between clinical evaluation and CADIA were not statistically significant.

Assessment of position of foramen mandibulae in recent adult population

Accurate knowledge about the morphology and topography of foramen mandibulae is of great practical importance in anaesthesia of inferior alveolar nerve. A certain number of skeletotopical relations may be used as valuable orientation points. Because of the controversies about these marking points it has been decided to perform measurements on a large sample of macerated mandibulae that are significant to location and shape of foramen mandibulae (FM) and lingula in relation to the surrounding orientation points. The measurements were taken in antero-posterior and infra-superior directions. In AP direction the distance between PRR and FM was measured; the obtained sample average was 15.03 at variability of Qv 12.18%; ARR-FM distance had the average value of 17.52 at Qv of 50%; the CT-FM distance had the average of 14.81 at Qv of 8.17%. In infra-superior direction the following measurements were made: AM-FM with the average of 21.10 at Qv of 13.98%; IM-IF with the average of 25.19 at Qv of 16.18%; PCO-FM with the average of 44.17 at Qv of 10.48%; and PCR-FM with the average of 42.79 at Qv of 10.87%. Extreme heterogeneity was noticed in the measurements of lingula. In the antero-posterior plane the FM is located in the middle of the CT-PRR distance, i.e., in measurements in which the external oblique line was used as anterior point, FM was located at the juncture of two anterior thirds and the posterior third of ramus mandibulae. In infra-superior direction the lowest FM point was closer to AM than to IM, indicating a somewhat lower position of FM. The mean value of FM depth was 4.31 and the most commonly found shape of the foramen was that of the elongated type (45%). The lingula was prominent, although unevenly, in 51% of study samples.

Maxillofacial war injuries in civilians and servicemen during the aggression against Croatia

Although civilian populations have been heavily involved in most of the recent wars and conflicts throughout the world, most reports analyzed casualty data of military personnel, often leaving civilian casualties excluded or underestimated. A comparison of epidemiologic and medical data for maxillofacial injuries between civilians and servicemen (policemen, soldiers, and United Nations Protection Forces) during the aggression against Croatia is attempted. Of the 220 casualties admitted to the Department of Maxillofacial Surgery in Zagreb between August 1991 and December 1992, almost one-fourth were civilians. A significant difference between civilians and servicemen was noted in age and sex distribution. The incidence and severity of maxillofacial and associated injuries is almost equal, and the pattern of injuries is of the same type for civilian and military personnel.

Primary hyperparathyroidism: evaluation of different treatments of jaw lesions based on case reports

On the basis of three case reports, different treatment modalities of primary hyperparathyroidism of the jaws are presented. Surgical intervention made as the result of misdiagnosis in the first case caused an unnecessary bone defect and delayed bone regeneration for several months. Two other cases showed spontaneous regeneration of bone after parathyroidectomy. The second case disproved the earlier opinion that regeneration of the bone lesions could last for several years, and that the normal morphology could be restored. Complete resolution of the central giant-cell lesion was found 6 months after removal of the parathyroid adenoma.

[Recurrent meningitis in a familial defect of the beta-subunit of the 8th complement component]

Bacterial meningitides occurred in two members of a Yugoslavian family. In one case meningitis remained a singular event, Neisseria meningitidis being identified in the CSF. The second patient developed five episodes of recurrent purulent meningitis associated with petechiae and in one instance also with arthritis of the left knee but no causative germ was found. In both patients the Western blot technique revealed a defect of the beta-subunit of the eighth component of complement that was completely eliminated by purified C8. This proved that the C8 defect was isolated and that no other component was deficient.

An alternative method of fixation of alveolar ridge mucosa during the vestibuloplasty procedure

The authors present a new design of splintage for fixation of the alveolar ridge mucosa following various vestibuloplasty procedures. From 1981-1987 50 acrylic buccal splints and 76 palatal splints were used, fixed by AO screws, in vestibuloplasty procedures. By using screws a controlled pressure equally distributed over the mucosa was achieved. The results demonstrate that screw fixation of the splints can avoid some of the common problems found especially with suture or nails. The acrylic buccal splint fixed by AO screws on to the alveolar bone is more convenient for the patient and produces a better operative result. The authors recommend it as the method of choice for submucosal and some modified submucosal vestibuloplasties.

Immunoblot analysis of the eighth component of human complement. Demonstration of subunits and detection of C8 alpha-gamma double and triple bands

Using SDS-PAGE/immunoblot analysis of the eighth component of human complement, C8, we have been able to demonstrate an 85 kDa C8 alpha-gamma and a 62 kDa C8 beta subunit in normal human serum. Serum from an undiagnosed patient who presented undetectable hemolytic C8 activity possessed only the 85 kDa subunit, suggesting a defect in the C8 beta subunit. Serum of a patient with known C8 alpha-gamma deficiency possessed only the complementary 62 kDa subunit. Both sera used together were able to lyse antibody-sensitized sheep erythrocytes, whereas individual sera could not. Optimum conditions for C8 immunoblotting were determined using small amounts of serum or plasma, during low voltage electrophoresis and a sensitive staining technique (nitrobluetetrazolium/bromochloroindoxylphosphate). Using these conditions, the C8 alpha-gamma subunit was found to be composed of up to three bands, termed C8 alpha-gamma 1, -2 and -3. All three bands were found in pooled normal sera. Individual sera had at least the C8 alpha-gamma 2 and C8 alpha-gamma 3 bands. Two C8 beta-deficient sera from two unrelated patients exhibited only the C8 alpha-gamma 2 and C8 alpha-gamma 3 bands. We conclude that immunoblotting of C8 permits a detailed analysis of the molecular composition of this component and helps to establish a precise diagnosis in inherited C8 deficiencies.