Bone regeneration at the distal aspect of the adjacent second molar after lower third molar coronectomy: a long-term analysis

Abstract. A residual bone defect at the distal aspect of the adjacent second molar may occur after total removal of the lower third molar. Lower third molar coronectomy has been proved to be a safe alternative to total removal, but the extent of bone regeneration at the adjacent tooth after coronectomy is not well reported. The aim of this prospective study was to investigate the long-term bone regeneration at the distal aspect of the adjacent second molar after lower third molar coronectomy. Preoperative and postoperative cone beam computed tomography scans were measured to assess bone regeneration at the distobuccal (DB), mid-distal (MD), and distolingual (DL) aspects of the lower second molar. Forty-eight coronectomies in 37 patients (23 female) with a mean �(standard deviation) age of 29.1 (7.2) years were assessed. The mean follow-up was 93.2 (8.7) months. The mean bone level increase at DB, MD, and DL aspects was 3.2 (1.6) mm, 3.5 (1.5) mm, and 3.2 (1.6) mm, respectively; the bone levels were significantly higher than the preoperative measurements (P < 0.001). Age and impaction patterns were not factors affecting bone regeneration. Based on this study, it appears that coronectomy of the lower third molar brings favourable bone regeneration at the distal aspect of the adjacent second molar

Early Management of Dental Trauma in the Era of COVID-19

Traumatic dental injuries are emergencies that must be treated promptly and properly to reduce the suffering, costs, and time for patients and parents. However, since the coronavirus disease 2019 (COVID-19) outbreak was declared a pandemic on March 11, 2020, most dental care facilities in the affected countries have been completely closed or have been only providing emergency treatment. This can partly be a result of the lack of universal protocol or guidelines regulating the dental care provision during such a pandemic, especially in the management of dental trauma. This lack of guidelines has the potential to both promote the spread of nosocomial COVID-19 through oral health care facilities and deny people in need of immediate treatment. Moreover, ceasing dental care provision during such a period will incense the burden on hospitals’ emergency departments that are already struggling with the pandemic. Therefore, this chapter elaborates on the importance of early management of dental trauma by sharing local guidelines and experience with a proposed algorithm for the early management of dental trauma during the emergence of COVID-19

MOS principles - revisited

This lecture is directed to young oral surgeons and dental officers in which it gives an overview of the prevalence & the public health aspects of minor oral surgery in Malaysia. It then revisits and discuss the principles in minor oral surgery including the indications and decision making, surgical principles, presurgical assessment, the clinical and radiological assessment, the risk assessment, grading the difficulty index of the surgery, the medications used, alternative procedures available as well as the complications. At the end of the lecture, participants are expected to grab the basic principles in doing minor oral surgery

Multidisciplinary management of obstructive sleep apnea: challenges and current perspective

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete airway obstruction during sleep associated with a decrease in oxyhemoglobin saturation leading to sleep disruption. This chronic interrupted sleep condition will eventually produce a collection of physiologic derangements. If it is left untreated, OSA can negatively affect the neurocognition leading to impaired concentration and memory, excessive daytime somnolence, and ultimately, increase the risk of cardiovascular morbidity (Kenderska et al., 2014). The global prevalence of OSA in adults is estimated to be around 14% (Benjafield et al., 2019). Similarly in Malaysia, about 15% to 20% adults presented with OSA features including obesity, snoring, hypersomnolence and interrupted breathing during sleep (Kamil et al., 2007

Anterior open bite correction by Le Fort I osteotomy with or without anterior segmentation: which is more stable?

A retrospective cohort study was conducted to analyze the relapse rate of anterior open bite (AOB) correction comparing Le Fort I osteotomy with and without anterior segmentation. The risk factors that might contribute to relapse were also assessed. Lateral cephalograms obtained at six different times were analyzed. A total of 81 patients with AOB were recruited. Thirty-five patients underwent Le Fort I osteotomy without anterior segmentation and 46 patients underwent anterior segmentation. Le Fort I osteotomy with anterior segmentation resulted in significantly more AOB relapse when compared to that without anterior segmentation at 7 weeks postoperative (15.2% vs. 0%, P = 0.016). During the early postoperative period, factors that contributed to AOB relapse in Le Fort I osteotomy with anterior segmentation were AOB closure 4 mm and inferior positioning of the anterior segment >2 mm. Over the long term, AOB closure �4 mm and intraoral vertical ramus osteotomy as the only mandibular procedure were factors identified as causing more AOB relapse in those treated by Le Fort I osteotomy with anterior segmentation. In conclusion, Le Fort I osteotomy without anterior segmentation was found to be more stable in the surgical correction of AOB in the early and late postoperative periods

Age estimation based on pulpal changes in 14 – 25 years old.

Secondary dentin formation is a slow continuous process that occurs following completion of dental development which leads to a continuous decrease in the size of pulp cavity. Changes in the pulp size of young permanent teeth with completed root formation provide an alternative and additional biomarker for age estimation. This study was conducted to explore the association between pulp size and chronological age in Malay young adults with respect to different sides and sex. Orthopantomograms of 165 healthy Malay males and females each with an age ranging from 14 to 24 years old were used. Pulpal changes were evaluated by calculating the ratios of measured length and width of tooth and root of mandibular canines: the pulp/root width at three levels i.e. root and pulp width at CEJ level (A), root and pulp width midway between measurements A and C (B); and root and pulp width midway between apex and CEJ(C). The ratios were measured using Vixwin Pro 2000 version 1.5. Pulp changes between the right and left canines were tested using paired t-test and showed bilateralism trend. A multiple regression analysis indicated that sex and tooth ratios did not make significant contribution to the prediction of age. This study illustrates the symmetrical trend and lack of sexual dimorphism of pulp changes with weak correlation between pulpal size and chronological age in Malay young adults

Comparing topical anaesthesia, local cooling and vibration technique as pain control during palatal local anaesthetic injection

Introduction: It is ironic that local anaesthesia (LA) is essential in providing painless dentistry when LA injection itself is often considered as being a most painful experience. Numerous techniques have been proposed to reduce pain on injection such as topically applied anaesthetic, vibration, buffered local anaesthesia and local cooling. Aims and Objectives: This study aims to determine whether local cooling and vibration onto the injection site are superior techniques in relieving pain of injection compared to topical anaesthesia application. Methodology: 20 adults received three methods of pain control namely topical anaesthesia, local cooling and vibration prior to palatal LA injection. Subjects recorded their responses via the Visual Analogue Scale(VAS), Numerical Rating Scale(NRS) for pain score and State Trait Anxiety Inventory-6(STAI-6) for anxiety score before and after injection following each application method. Results: Local cooling and vibration method yielded less actual pain during palatal injection based on NRS and VAS compared to its anticipated pain though statistically non-significant (p>0.05). Similarly, ANOVA comparison revealed that mean pain score for NRS and VAS is non-significantly lowest for local cooling method followed by vibration and topical anaesthesia. Additionally, subjects aged 31-45 years old had experienced the least pain during injection with local cooling and vibration application. Interestingly, patients felt less anxious during injection after receiving topical anaesthesia compared to local cooling and vibration. Conclusion: During palatal local anaesthetic injection, vibration and local cooling had proven to be much effective in reducing pain compared to application of topical anaesthesia. (244 words) Keywords : Vibration, Local Cooling, Topical anaesthesia, Palatal injectio