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Loss of teeth leads to functional and esthetic problems within the oral cavity. The opposing teeth move into the edentulous space, if not treated in timely manner. Many a times loss of intermaxillary space due to long term edentulism results in compromised prosthetic outcome. Decreased interocclusal spaces can be a challenging task for prosthetic management of partial edentulism. In this kind of cases regaining the lost interocclusal space is the prime requirement for successful prosthetic rehabilitation. Several procedures are used to increase vertical dimension. In this case report, the author presents a special surgical technique, “calibrated alveolectomy”, and discussed about regaining adequate inter arch space for implant supported prosthesis.

Cilj: Cilj ovog istraživanja bio je utvrditi kardiovaskularne promjene mobilnim EKG uređajem u pacijenata za vrijeme alveotomije donjeg umnjaka ovisno o spolu i razini dentalne anksioznosti. Materijali i metode: Uzorak se sastojao od 30 zdravih ispitanika (15 žena i 15 muškaraca) prosječne dobi 25,9±5,9 godina, koji su bili podvrgnuti alveotomiji donjeg umnjaka. Prije zahvata, ispitanici su ispunili Norman Corahov upitnik za procjenu dentalne anksioznosti (DAS) te im je postavljen mobilni EKG uređaj (Savvy , Institut ''Jožef Stefan'', Ljubljana, Slovenija) za praćenje srčane frekvencije i ritma te pulsni oksimetar za praćenje SaO2. Parametri su promatrani kroz osam vremenskih razdoblja: baseline razdoblje, jednu minutu prije aplikacije lokalnog anestetika, jednu minutu nakon aplikacije lokalnog anestetika, razdoblje incizije i odizanja režnja, tijekom vađenja zuba, za vrijeme šivanja, u trenutku skidanja kirurške pregače i kraj zahvata. Rezultati: Prosječna srednja vrijednost DAS svih ispitanika bila je 8,6±2,62. Žene su se izjasnile značajno anksioznije od muškaraca (80% : 33,3%, p=0,0318). Anksiozni muškarci su imali nešto više ili jednake razine srčane frekvencije od onih u skupini bez anksioznosti, dok su anksiozne žene imale između 13% i 21% više razine srčane frekvencije od neanksioznih, ali bez statističkog značaja. Neovisno o spolu i DAS vrijednosti, primijećene su promjene srčane frekvencije u ispitanika za vrijeme alveotomije donjeg umnjaka. Statistički značaj dosegla je razlika između razdoblja najviših vrijednosti srčane frekvencije: razdoblje incizije i odizanja režnja (100,2±18,8 otkucaja/min) te razdoblje prije aplikacije lokalnog anestetika (98,6±18,8 otkucaja/min) u usporedbi s razdobljem najnižih vrijednosti srčane frekvencije: za vrijeme šivanja (86,0±16,8 otkucaja/min) (p, Objectives: To evaluate cardiovascular effects of anxiety in patients during surgical removal of lower third molars in relation to gender and anxiety score. Materials and methods: The sample consisted of 30 healthy normotensive subjects (15 females and 15 males) with average age of 25,9±5,9 years, who required surgical removal of lower third molars. Before the procedure, the participants completed the Norman Corah Dental Anxiety Scale test (DAS), and a mobile ECG device (Savvy, Institute ''Jožef Stefan'', Ljubljana, Slovenia) was applied to evaluate heart rate (HR) and heart rhytm. Also, pulse oxymeter was used to measure oxygen saturation (SaO2). The parameters were assesed at eight different time periods: baseline period, one minute before the application of local anesthetic, one minute after the application of local anesthetic, during incision and flap elevation, during tooth extraction, during suturing, in the moment of taking the surgical drape off, at the end of the procedure. Results: Average DAS score was 8,6±2,62. Women were significantly more anxious than men (80% : 33,3%, p=0,0318). Anxious men had slightly higher or the same mean HR than the ones in the non anxious group, while anxious women had between 13% and 21% higher mean HR than the nonanxious women, but with no statistical significance. Non-related to gender and DAS score, there was a change in mean HR during different time periods. The difference between time periods of the highest mean HR values ; the period of incision and flap elevation (100,2±18,8 bpm) and the period just before application of local anesthesia (98,6±18,8 bpm) compared to the time period with minimal mean HR values : during suturing (86,0±16,8 bpm) reached statistical significance (p

Dental extractions are commonly performed in general veterinary practice for a variety of reasons. Owing to a lack of education in veterinary dentistry, veterinary surgeons often struggle with a consistently successful approach to tooth extraction. Without such education the occurrence of complications associated with tooth extraction will increase, including root fracture, jaw fracture and the formation of oronasal communications. A consistent approach, using a few well-practiced techniques, will allow for fewer complications and less frustration. This article aims to cover some of those basic techniques.

U oralnoj kirurgiji danas se obavljaju bezbolni zahvati, ali i nakon toga adekvatno kontrolira bol. Jedan od najčešćih operativnih zahvata u oralnoj kirurgiji jest operativno uklanjanje trećeg kutnjaka ili alveotomija umnjaka kada se odiže mukoperiostalni režanj, uklanja kost i rana zašiva. Takvi zahvati praćeni su poslijeoperacijskom boli, oteklinom i trizmusom. Autori mnogobrojnih istraživanja bavili su se smanjenjem boli i što boljom kontrolom one postoperativne, a jedan od najčešćih modela u istraživanjima jest alveotomija umnjaka. Tramadol je dobro poznat centralno djelujući opioidni analgetik koji se upotrebljava u liječenju mnogobrojnih bolnih stanja kao što su poslijeoperacijska bol, bol tijekom porođaja, zatim bol u terminalnoj fazi maligne bolesti, koronarna bol i u slučaju neuropatske boli. No to je i atipični opioid koji, primijenjen lokalno, pokazuje analgetska i anestetska svojstva. Cilj ovoga rada jest prezentirati nove spoznaje o lokalnom djelovanju tramadola u oralnoj kirurgiji., In modern times, all procedures in oral surgery need to be painless and management of postoperative pain needs to be adequate. The surgical extraction of the third molar or alveolectomy of the wisdom tooth is one of the most common surgical procedures carried out in oral surgery and it includes rising a flap, bone removal and suturing. These surgical procedures usually cause swelling, trismus and moderate to severe pain. Third molar surgery is often used as a model in clinical trials that are directed toward reducing postoperative pain and improving its management. Tramadol is a well-known central acting opioid analgesic that produces analgesia against multiple pain conditions such as postsurgical pain, obstetric pain, terminal cancer pain, pain of coronary origin and neuropathic pain. Tramadol is an atypical opioid. When administered locally, it has both analgesic and anesthetic properties. The aim of this paper was to present new findings on local effects of tramadol in oral surgery.

Purpose The treatment of patients with medication-related osteonecrosis of the jaw (MRONJ) is challenging. The purpose of the present study was to estimate the frequency and identify the factors associated with clinical improvement during treatment. Patients and Methods We designed and implemented a retrospective cohort study and enrolled a sample of subjects diagnosed with MRONJ between 2004 and 2015. The primary predictor variables were a set of heterogeneous variables grouped into the following categories: demographic (age and gender) and clinical (location of necrosis, therapy duration, medication type, disease stage, and treatment type). The primary outcome variable was the treatment outcome, defined as stable or worse and improved or healed. The descriptive, bivariate, and multiple logistic statistics were computed, and statistical significance was defined as P < .05. Results The sample included 337 subjects with a mean age of 68.9 years. Of the 337 subjects, 256 were women (76%). A total of 143 patients (42.2%) experienced spontaneous necrosis. Twenty-four (7.1%) had had exposure to targeted antiangiogenic agents. Those with stage 1 or 2 disease were more likely to have better outcomes than those with stage 3 disease (stage 1, adjusted odds ratio [OR] 3.4, P = .005; stage 2, adjusted OR 2.2, P = .03). Treatment type was a significant variable. Subjects undergoing surgery were 28 times more likely to have a positive outcome than those receiving nonoperative therapy (adjusted OR 28.7, P < .0001). Conclusions Subjects with MRONJ who presented with less severe disease or who underwent operative treatment were most likely to have improvement or complete healing of their MRONJ-related lesions.

Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered passive eruption, cervical root resorption and short clinical abutment, and its aim is to re-establish the biologic width in a more apical position. While the procedure in posterior areas of the dentition has been thoroughly investigated, crown lengthening performed for esthetic reasons in the anterior areas is still a matter of debate and an evidence-based technique is not available. This paper provides accurate descriptions of the surgical and restorative phases of the esthetic crown-lengthening procedure by answering the following questions: what is the ideal surgical flap design? how much supporting bone should be removed? how should the position of the flap margin relate to the alveolar bone at surgical closure? and how should the healing phase be managed in relation to the timing and the position of the provisional restoration with respect to the gingival margin?

Retrospective study of jaw osteonecrosis treatment in patients using the "Krokodil" drug from 2009 to 2013. On the territory of the former USSR countries there is widespread use of a self-produced drug called "Krokodil". Codeine containing analgesics ("Sedalgin", "Pentalgin" etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use "Krokodil". The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". 40 "Krokodil" drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of "Krokodil" use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla. According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". Cessation of drug use and jaw resection minimize the rate of recurrences in such patients.

Aneurysmal bone cyst (ABC) is a nonneoplastic rare pathologic entity of the jaws. Its locally aggressive nature and high recurrence rate after curettage make surgical resection a better treatment option. Here, we present a case of ABC of maxillary alveolus and its management by alveolectomy followed by white head varnish pack application in the surgical defect.

This study evaluated use of a solid-state laser to avoid the flap technique and suturing. An Er:YAG laser was used in 26 consecutive patients referred for osseous crown lengthening in 32 posterior teeth. The distance from the planned restoration margin to the alveolar crest (B) satisfied a 3-mm dentogingival complex. No tissue necrosis and no significant change in the distance from the gingival margin to B or probing depth were detected at 3 and 6 months. Minimally invasive Er:YAG laser surgery decreases the time needed to establish the gingival margin necessary for definitive restoration.

The success of autogenous tooth transplantation depends on the vitality of the periodontal ligament attached to the donor tooth, and its viability decreases when it is exposed extraorally. This report describes the case of a 16-year-old patient in whom a rapid prototyped tooth model was performed using cone-beam technology and a surgical template guide for autotransplantation as an effective technique for a critical time-based procedure.

Excessive gingival display (EGD) has a negative impact on a pleasant smile. Minimally invasive therapeutic modalities have become the standard treatment in many dentistry fields. Therefore, the aim of this study is to compare the clinical outcomes of open-flap (OF) and minimally invasive flapless (FL) esthetic crown lengthening (ECL) for the treatment of EGD.A split-mouth randomized controlled trial was conducted in 28 patients presenting with EGD. Contralateral quadrants received ECL using OF or FL techniques. Clinical parameters were evaluated at baseline and 3, 6, and 12 months post-surgery. The local levels of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) were assessed by enzyme-linked immunosorbent assay at baseline and 3 months. Patients' perceptions regarding morbidity and esthetic appearance were also evaluated. Periodontal tissue dimensions were obtained by computed tomography at baseline and correlated with the changes in the gingival margin (GM).Patients reported low morbidity and high satisfaction with esthetic appearance for both procedures (P0.05). RANKL and OPG concentrations were increased in the OF group at 3 months (P0.05). Probing depths were reduced for both groups at all time points, compared with baseline (P0.05). There were no differences between groups for GM reduction at any time point (P0.05).FL and OF surgeries produced stable and similar clinical results up to 12 months. FL ECL may be a predictable alternative approach for the treatment of EGD.

Objective: The aim of this study was to present the authors’ experience with a new surgical technique to correct mild laterognathia and malocclusion by means of an L-inverted midline osteotomy. Patient and Methods: The patient was a 26-year-old woman diagnosed with left laterognathia and ipsilateral posterior crossbite. She was operated by using this novel technique in November 2009 at Hogar Clínica San Rafael, Maracaibo, Venezuela. Bicortical midline symphyseal vertical osteotomy was executed, followed by block removal of the central right inferior incisor and its surrounding alveolar bone. The mandibular segmentation was completed by means of a right hemimentoplasty. After this, a 4-mm right mandibular rotation was made, and titanium plates and monocortical screws of the 2.0 system were used to achieve the rigid fixation. Results: The patient showed outstanding aesthetic and functional results after 5 years. Conclusions: This technique provides a new treatment option for the correction of mild laterognathia cases associated with dental malocclusion.

Local recurrence remains the most important sign of relapse of disease after treatment of advanced cancer of the maxilla and sinonasal region. In this retrospective study we describe patterns of recurrence in a group of patients who had had open resection for cancer of the sinonasal region and posterior maxillary alveolus with curative intent. Casenotes and imaging studies were reviewed to find out the pattern of any relapse, with particular reference to local recurrence. The minimum follow-up period was 12 months. Of 50 patients a total of 16 developed recurrences, 11 of which were local. Of those 11, a total of 8 were in posterior and superior locations (the orbit, the infratemporal and pterygopalatine fossas, the traversing neurovascular canals of the body of the sphenoid to the cavernous sinus, the Gasserian ganglion, and the dura of the middle cranial fossa). Advanced cancer of the midface often equates with disease at the skull base. Treatment, including surgical tactics, should reflect that.

Previous studies on crown lengthening (CL) report contradictory results regarding stability of crown length gained at the time of surgery. The "3-mm rule" has dictated the amount of alveolar bone to be removed during CL surgery for decades. With the current understanding of wide variations in supracrestal gingival tissue (SGT) dimensions, bone removal can be customized to the situation. The purpose of this study is to assess alterations in periodontal tissue levels 6 months after CL surgery and to evaluate factors that may influence stability of CL achieved over time.Sixty-four patients requiring CL surgery on 64 teeth are included in this study. Clinical parameters were recorded along six surfaces of treated tooth and neighboring teeth. Sites were labeled as treated sites, adjacent sites, and non-adjacent sites. Bone was reduced based on the minimal amount of tooth structure required for restorative purpose and SGT dimensions at each site. Patients were re-evaluated at 3 and 6 months.Significant soft-tissue rebound (0.77 ± 0.58 mm) was observed 6 months after CL surgery. This rebound was found to be significantly correlated with periodontal biotype (r = 0.325, P = 0.000) and post-suturing flap position (r = -0.601, P = 0.000). SGT was not reestablished to its preoperative dimensions by the end of 6 months (P = 0.001).Crown length gained during surgery significantly decreased 6 months post-surgery. Suturing the flap ≤3 mm from the osseous crest and thick-flat biotype were associated with greater tissue rebound.

The purpose of this study was to evaluate the effects of segmental osteotomy on the blood vessels and osteoclasts in rats using micro-computed tomography (micro-CT) and histomorphometric analysis. After segmental osteotomy was performed around the maxillary first molars of 36 male Sprague-Dawley rats (n = 72), the samples were divided into a control group (no displacement), 0.5 D group (0.5 mm buccal displacement) and 1.0 D group (1.0 mm buccal displacement) (n = 24/group). At 1, 2, 4 and 8 weeks after surgery, changes in the blood vessel volume were investigated using micro-CT with perfusion of radiopaque silicone rubber. Tartrate-resistant acid phosphatase (TRAP) staining was used for histomorphometric analysis. Two-way repeated measures analysis of variance (rmANOVA) was performed to compare the volume of blood vessels and number of TRAP-positive osteoclasts among the groups. Regarding blood vessel volume, the displacement groups had no significant effects, while the time points had significant effects (p = 0.014). The blood vessel volume at 1 week was significantly smaller than that at 2, 4, and 8 weeks (p = 0.004, p = 0.026, and p = 0.005, respectively). Regarding TRAP cell count, the displacement groups had no significant effects, while the time points had significant effects (p < 0.001). The number of TRAP-positive osteoclasts at 8 weeks was significantly smaller than that at 1, 2, and 4 weeks (p < 0.001, p < 0.001, and p = 0.002, respectively), and the count at 4 weeks was smaller than that at 1 week (p = 0.011). Therefore, a regional osteoclast-related acceleratory phenomenon was maintained until 4 weeks after surgery.

Ameloblastic fibroodontoma (AFO) is a rare entity of mixed odontogenic tumors and frequently arises from posterior portion of the maxilla or mandible in first two decades of life. Herein, a 35-year-old woman with a noncontributory medical history who presented with a progressive left maxillary toothache, left maxillary first molar tooth mobility, and swelling in the left maxillary molar area for the last 2 months was reported. Radiologically, a tumor that originated from periapical area of the second mature molar teeth of maxilla was seen and additively unerupted tooth was not detected. The histopathologic examination revealed AFO. The patient is disease-free for five years after treated with limited segmental alveolectomy combining with Caldwell-Luc procedure.

Purpose Close proximity of the inferior alveolar nerve (IAN) to mandibular third molars (MTMs) may result in nerve injury during the extraction of third molars. Alternative surgical techniques, such as coronectomy, have been suggested to decrease this risk. This study examined a new alternative technique, the pericoronal ostectomy (PO), that is intended to decrease IAN injury in high-risk cases. Patients and Methods This prospective clinical cohort study consisted of 14 patients with 17 MTMs in close relation to the IAN. All patients were subjected to 2- and 3-dimensional preoperative radiographic evaluations. Selected patients with mesioangular and vertical bone impactions were treated by the staged PO technique. An institutional review board approval from the University of the Pacific was given to this study. Results Because of the PO procedure, all 17 high-risk MTMs in the study erupted to a more occlusal position away from the danger zone of the IAN and were eventually removed (mean distance of eruption, 2.0 mm). Three patients reported a transient neurosensory deficit, 2 with the IAN and 1 with a lingual nerve. All 3 had a full resolution of symptoms within 3 months of the postoperative period. Conclusion The PO technique appears to be an additional viable alternative technique to extraction of MTMs in intimate proximity to the IAN.

Treatment of oral carcinomas often causes reduced speech intelligibility. It was the aim of this study to objectively evaluate the speech intelligibility of patients after multimodal therapy for oral squamous cell carcinoma (OSCC) with a computer-based, automatic speech recognition system.The speech intelligibility of 59 patients after multimodal tumor treatment for OSCC, located at the lateral tongue, floor of the mouth, or the alveolar crest of the lower jaw, was objectively analyzed by a computer-based speech recognition system that calculates the percentage of correct word recognition (WR).The patients' WR was significantly reduced compared with a healthy control group without speech impairment (P ≤ .001). Higher T-classification was associated with a reduced WR (P.01). Tumors located at the tongue showed a significantly higher WR than tumors at the floor of the mouth or the alveolar crest (P ≤ .001). Surgical resection and reconstruction of the lower jaw bone significantly reduced the WR (P ≤ .001) compared with cases without osseous tumor infiltration.Speech intelligibility after treatment for OSCC, objectively quantified by a standardized automatic speech recognition system, is reduced for increasing tumor size, increasing resection volume, and tumor localization near the lower jaw. Surgical reconstruction techniques seem to have an impact on speech intelligibility.

Purpose Ostectomies, performed by different methods, are often necessary in oral and maxillofacial surgery. Rotatory and reciprocating devices are most frequently used but have disadvantages, such as noise, vibration, and the potential for inducing thermal damage. Laser systems are interesting alternatives to these procedures. We analyzed bone healing in a rat model after mandibular ostectomy with a surgical bur or noncontact erbium:yttrium-aluminum-garnet laser using different energy levels. Materials and Methods Four groups of 5 rats each underwent ostectomy of the bone cortical of the mandibular body, with irrigation, using a surgical bur or erbium:yttrium-aluminum-garnet laser with different energy parameters. A metal plate was used for morphologic standardization of the cavities. The samples collected after 7, 14, 45, 60, and 90 days were analyzed by optical microscopy. Results The ostectomies performed with surgical burs resulted in bone healing from the cortical endosteum and remaining trabecular bone. The cortical endosteum was repaired after 45 days, followed by bone remodeling. After laser irradiation, healing involved bone neoformation from the external cortical surface and endosteum. Surface regions with thermal damage were observed after laser treatment in the 3 conditions used up to day 60, followed by bone remodeling. Conclusions Laser ostectomies resulted in a thin layer of thermal damage. Bone healing was faster when surgical burs were used, with similar results reached after 90 days.

Patients with impacted ectopic canines often present to Orthodontic and Oral and Maxillofacial units, with 85% being displaced palatally. Current orthodontic opinion suggests that the creation of adequate space ultimately allows the spontaneous eruption of most impacted canines, but we are often requested to operate to facilitate their eruption. There are several approaches, techniques that vary depending on whether orthodontically assisted or spontaneous eruption is expected. There are few publications that describe either the techniques or their merits. We have used a gingival-sparing technique for more than 10 years in this unit. To determine current practice, we carried out a national postal survey of consultant oral and maxillofacial surgeons and staff grade/associate specialists. A total of 564 questionnaires were sent, and 353 replies were received (63%). There was considerable variation in the design of mucosal flaps used for exposure of the canines. Only 9% of clinicians avoided the gingival margin of the adjacent erupted teeth during operation. We describe this unit's practice of sparing the gingival margins, and highlight the merits of this technique.