Age and gender variations in the cone-beam computed tomographic location of mandibular canal : implications for mandibular sagittal split osteotomy

Mandibular sagittal split osteotomy (MSSO) may incur unfavorable split and sensorineural injuries. Knowledge of the anatomic location of the mandibular canal (MC) and bone thickness in the region of interest for MSSO, and the possible variations by age and gender can assist in avoiding such complications. Purpose: To study the location of the MC and bone thickness in the region of MSSO by cone-beam computed tomography (CBCT) radiographs and to evaluate the possible variations by age and gender in a Jordanian population. This retrospective radio-anatomical study examined all CBCT radiographs for patients treated over three years at the University of Jordan Hospital, Amman, Jordan. Distances from the MC to the cortical external surfaces and MC diameter (MCD) were measured by a reliable observer at three predetermined regions for MSSO: region (A) [mandibular foramen area], region (B) [mandibular angle area] and region (C) [directly mesial to the second molar]. Gender and age differences in all measurements were then compared using non-parametric Mann-Whitney U test. The final study radiographs comprised a total of 202 CBCT belonged to a cohort of 202 subjects; 91 males (45.1%) and 111 (54.9%) females, with mean age (± SD) of 42.94 ± 18.54 years (range 18?90 years). Whereas only the bone thickness superior, buccal and inferior to MC in regions (B) and (C), and MCD in the three regions exhibited significant (p< 0.05) gender differences, all measured distances exhibited statistically significant (p< 0.05) differences between young and adult patients. The location of MC and bone thickness in the region of MSSO were significantly variable according to age, but exhibited sexual diamorphism only in regions (B) and (C). This fundamental knowledge should be considered during MSSO planning

Periodontal ligament injection versus routine local infiltration for nonsurgical single posterior maxillary permanent tooth extraction: comparative double-blinded randomized clinical study

Mohammad H Al-Shayyab Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, University of Jordan, Amman, Jordan Aim: The aim of this study was to evaluate the efficacy of, and patients&rsquo; subjective responses to, periodontal ligament (PDL) anesthetic injection compared to traditional local-anesthetic infiltration injection for the nonsurgical extraction of one posterior maxillary permanent tooth. Materials and methods: All patients scheduled for nonsurgical symmetrical maxillary posterior permanent tooth extraction in the Department of Oral and Maxillofacial Surgery at the University of Jordan Hospital, Amman, Jordan over a 7-month period were invited to participate in this prospective randomized double-blinded split-mouth study. Every patient received the recommended volume of 2% lidocaine with 1:100,000 epinephrine for PDL injection on the experimental side and for local infiltration on the control side. A visual analog scale (VAS) and verbal rating scale (VRS) were used to describe pain felt during injection and extraction, respectively. Statistical significance was based on probability values &lt;0.05 and measured using &Chi;2 and Student t-tests and nonparametric Mann&ndash;Whitney and Kruskal&ndash;Wallis tests. Results: Of the 73 patients eligible for this study, 55 met the inclusion criteria: 32 males and 23 females, with a mean age of 34.87&plusmn;14.93 years. Differences in VAS scores and VRS data between the two techniques were statistically significant (P&lt;0.001) and in favor of the infiltration injection. Conclusion: The PDL injection may not be the alternative anesthetic technique of choice to routine local infiltration for the nonsurgical extraction of one posterior maxillary permanent tooth. Keywords: PDL injection, infiltration, anesthesia, extractio

Efficacy of intraligamentary anesthesia in maxillary first molar extraction

Soukaina Tawfiq Ryalat,1 Mohammad H Al-Shayyab,1 Wala Amin,2 Saif Aldeen AlRyalat,3 Nosaiba Al-Ryalat,4 Faleh Sawair1 1Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan; 2Department of Prosthodontics, Faculty of Dentistry, University of Jordan, Amman, Jordan; 3Department of Ophthalmology, Faculty of Medicine, University of Jordan, Amman, Jordan; 4Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan Introduction: Infiltration anesthesia (IA) is the method to anaesthetize maxillary teeth successfully. In contrast, intraligamentary anesthesia (ILA) has been used as supplementary anesthesia during tooth extraction, particularly when regional block anesthesia has failed. In this study, we compare the efficacy of and patient satisfaction with ILA vs IA when extracting maxillary first molar teeth. Methods: Forty patients were enrolled in this study and 80 maxillary first molars extracted. All patients served as their own control, with ILA as the experimental side and IA as the control side. The two techniques were compared for efficacy using a visual analog scale (VAS) and patient satisfaction compared using a verbal rating scale (VRS). Results: The mean VAS pain score for extraction using ILA was lower than that for IA (20.30&plusmn;3.18 and 13.93&plusmn;1.95 mm, respectively; P&lt;0.001). For injection pain, the mean VAS pain score in the ILA side was higher than the IA side (42.28&plusmn;4.51 and 31.73&plusmn;3.1 mm, respectively; P&lt;0.001). VRS results showed a higher number of patients who felt that pain during ILA was greater than expected compared with IA. Conclusion: IA appears less painful during injection compared with ILA, and provides sufficient pain relief during extraction. However, ILA can be used when IA fails to achieve the desired pain suppression, as it provides higher extraction-pain relief. Keywords: infiltration anesthesia, maxillary first molars, intraligamentary anesthesia, periodontal intraligamentary anesthesi

Impaction of lower third molars and their association with age: radiological perspectives

Abstract Background Third molars are the most commonly impacted teeth, and their extraction is the most commonly performed procedure in oral and maxillofacial surgery. The aim of the present study is to describe the pattern of mandibular third molar impaction and to define the most appropriate age for prophylactic extraction of mandibular third molar teeth. Methods A total of 1198 orthopantomographs (OPGs) with 1810 impacted lower third molars were reviewed by two authors. The pattern of eruption in relation to patient’s age was examined using standard radiographic points and angles. Statistical analysis was performed using SPSS for Windows release 16.0 (SPSS Inc., Chicago, IL, USA). Results In patients older than 20 years, vertical pattern of impaction was the most common (21.4%); while in young patients; horizontal impaction was more common (21.3%). Furthermore, there was a constant pattern of increase in Pell-Gregory ramus class 1 with increasing age, as the prevalence of class 1 was 0% at age 18 years compared to 54.9% at the age of 26 years. Conclusion Frequency of vertical impaction of lower third molars was seen more at an older age (> 20 years) in this study, with an increase in the retromolar space. Late extraction of mandibular third molar teeth (i.e. after the age of 20) is therefore recommended when prophylactic extraction is considered

The clinical impacts of early using glutamine/arginine enriched high protein density formula at trophic dose in intolerant enteral nutrition cachectic hypoalbuminemic hospitalized patients

Background. We sought to evaluate the clinical impacts of the early administration of trophic doses of a glutamine/arginine enriched enteral nutrition formula (ENF) with a high protein density to cachectic hypoalbuminemic hospitalized patients intolerant to enteral nutrition