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Cutaneous sinus tract of dental origin is the commonest of the many types of sinus tracts that are formed on the face and neck. Cutaneous sinus tracts may originate from local chronic osteomyelitis (Garre′s osteomyelitis). Although the etiological factor is usually periapical infection, they are seldom of periodontal origin. Conventional periapical and panoramic roentgenograms are generally insufficient for diagnosis and treatment planning of cutaneous sinus tracts of periodontal origin. In the present case, computed tomography was used for diagnosis, and osteomyelitis was managed by periodontal treatment.

Abstract Objective Distraction osteogenesis is an alternative treatment method for the correction of mandibular hypoplasia. In this case report, distraction with a multidirectional extraoral device was performed to gradually lengthen the corpus and ramus of a patient who had a severe hypoplastic mandible. Materials and methods The patient underwent bilateral extraoral ramus and corpus distraction osteogenesis. After seven days of latency period, distraction was performed 0.5 mm twice a day. Subsequent consolidation period was 12 weeks. Results The patient's mandible was elongated successfully. Cephalometric analysis revealed that ANB angle decreased from 13° to 6°, overjet of 15 mm decreased to 4 mm, corpus length increased from 49 mm to 67 mm, and ramus length increased from 41 mm to 43 mm. Posterior airway space (PAS) also increased due to advancement of the mandible. In stereolithographic model evaluation it was determined that the distances from condylion to gonion and from gonion to pogonion increased. Conclusion Satisfactory results from both aesthetic and functional standpoints were obtained by distraction osteogenesis of the ramus and corpus.

This study was undertaken to evaluate the relation between bone quality and alterations of implant stability quotient values measured during the initial phase of healing. Nineteen patients treated with 106 implants were included in the current study. The mean bone density of the implant recipient area was measured using Simplant 11 software incorporated in the computerized tomography (CT) machine. Mean bone density measurements were recorded in Hounsfield units. The implant recipient sites were subdivided into 5 groups according to bone quality. The numbers of the structures on the recipient site belonging to D1 and D5 types showed no statistical significance and were excluded. Standard 2-stage surgical technique was utilized to prepare the surgical sites. The implant stability quotient (ISQ) value at implant placement was recorded and did not influence the treatment procedure. The ISQ was measured by an Osstell instrument. The ISQ was further registered on the 21st and 60th days. SPSS statistical software was used for the statistical analysis. In comparison with the time of insertion, the mean values of the ISQ were decreasing for the first 21 days. However, on subsequent days, the ISQ values of all bone types have increased and on the 60th day reached the values recorded at the time of insertion. Analysis of the relation between changes in stability and bone type does not reveal statistical significance. With knowledge of the current clinical study, it can be concluded that bone quality in the recipient bone site does not effect changes in implant stability at the early stages of the osseointegration process.

Objectives: The aim of this study was to evaluate the effects of latency period on the bone formation after periosteal distraction. For this purpose, a rabbit model was developed and histologic and histomorphometric analyses were conducted., Study Design: Periosteal distractors were custom designed and built from stainless steel. Rabbits were divided into 2 groups of 18 each according to the duration of latency period. In group 1, the latency period was 7 days, and in group 2 it was 1 day. Distraction was performed by activating the distractor 0.25 mm twice per day. A periosteal distraction of 7.0 mm was achieved after a distraction period of 10 days. Both groups were divided to 3 subgroups according to the rabbits being killed on the 15th, 30th, or 60th day of the consolidation period. Histologic and histomorphometric analyses were performed to evaluate the bone formation., Results: In the histologic evaluation, new bone formation was observed on the lateral side of the mandible of all the rabbits. Histomorphometric measurements revealed that the mean area of newly formed bone formation was 2.62 cm(2) in group 1 and 3.26 cm(2) in group 2., Conclusions: Periosteal distraction osteogenesis is a viable method in acquired and congenital alveolar ridge defects, resulting in new bone formation. Newly formed bone can be obtained by periosteal distraction osteogenesis applying different latency periods., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objective: The aim of this paper is to present the outcome of iliac bone block grafts used for paranasal augmentation during bimaxillary orthognathic surgery for the patient with deep concavity of canine fosse., Study Design: Preoperative evaluation of the patient, done with 3-dimensional (3D) surgical simulation software, revealed deep bony concavity of paranasal area and insufficient soft tissue improvement when Le Fort I level maxillary advancement was accomplished. The deficient sites were grafted and better profile was achieved with 3D simulation. After the leveling phase, Le Fort I advancement and mandibular setback with sagital split osteotomies were performed. Bony deficiency of paranasal regions were corrected simultaneously with autogenous iliac block grafts to obtain maximum improvement in the profile., Results: More satisfactory esthetic results were obtained with paranasal augmentation, and acceptable profile was provided for the patient., Conclusions: Bimaxillary orthognathic surgery combined with augmentation of paranasal area is an efficient method to obtain better aesthetic outcome for patients with severe concave profile. Paranasal augmentation with iliac bone block grafting is a novel technique to ensure favorable soft tissue support and esthetic appearance of the patient., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Juvenile hyaline fibromatosis (JHF) is a rare autosomal-recessive hereditary disease, characterized by gingival hypertrophy, flexion contractures of joints, bone lesions, hyaline deposition in the extracellular spaces of the dermis and soft tissues, stunted growth, and skin lesions such as multiple nodules, tumors and pink, pearly papules. No case of JHF with a mandibular bone involvement, exists in the literature. Bone involvement in JHF is an uncommon finding and distinct solitary lesions in the calvarial bones has been reported by some authors. A 21-year-old male patient was referred to Diyarbakir Military Hospital, Department of Dental Service. Clinical findings were consistent with a solid alveolar mass in the right mandibular premolar-molar region and displaced right mandibular molar teeth. Orthopantomographic examination showed impaction of all lower right molars in a mixed radioopaque/radiolucent area. Microscopically, increased nodular connective tissue was seen under the lobulated mucosal surfaces of the resected area. The case presented here had a localized fibrous proliferation that infiltrated bone trabeculae and caused displacement of teeth. Juvenile hyaline fibromatosis should be considered in the differential diagnosis with the other intraosseous radiolucent-patchy opaque lesions of jaw bones. Based on the clinical and histopathological findings, a diagnosis of JHF was made.

This report presents a case of osseous choristoma in the submandibular region of a 33-year-old female. Her chief complaint was painless swelling in the submandibular region. Panoramic radiography showed a well-defined, round, radiopaque lesion near the inferior border of the right mandibular angle. Coronal and sagittal tomographic images indicated a high-density area in the right submandibular region with no bony connection. The lesion was diagnosed as an osseous choristoma based on histopathological examination of the surgical specimen. A 1-year follow-up period was uneventful.

Mucopolysaccharidosis type I (Hurler syndrome, MPS I-H) is an autosomal recessive inborn error of metabolism due to deficient alpha-L-iduronidase enzyme activity and is characterized by accumulation of incompletely degraded glycosaminoglycans that generally lead to impairment of organ and body functions. This report presents oral, dental, and radiographic findings in a boy who presented with MPS I-H. Nine of the patient's primary teeth were extracted and investigated using scanning electron microscopy, x-ray diffraction analysis, and Fourier transform infrared spectroscopy. Compared with the teeth of otherwise healthy patients, MPS I-H-affected dentin was characterized by extremely narrow dentinal tubules, whose direction followed an irregular wave-like pattern. The enamel-dentin junction was defective, as evidenced by microgaps, and the enamel displayed irregular arrangement of prisms. The additional novel observation was made that the protein structure of enamel and dentin changed in MPS I-H-affected teeth. Also, an increase was observed in the relative mineral/matrix ratio of MPS I-H-affected dentin, indicating that its protein content had decreased in comparison with normal dentin.

A possible cause for dental implant failure is the periapical implant lesion (PIL). In this case report we describe an apical periodontitis on a tooth adjacent to a dental implant that may have communicated with the apical region of the dental implant, and causing retrograde peri-implantitis. To our knowledge this is the first report demonstrating the concomitant successful treatment of the periapical implant pathology and the adjacent natural tooth without the removal of the implant. The presence of large bony defect at the apical region of the natural tooth and the implant, resulting in a sinus tract and a deep periodontal pocket, was also confirmed with computerized tomography. The treatment procedure included root canal treatment followed by the debridement of the apical bone lesion, and guided bone regeneration. An uneventful healing with acceptable esthetic was observed.