The location of the mental foramen in a selected Malay population

Knowledge of the position of the mental foramen is important both when administering regional anesthesia and performing periapical surgery in the mental region of the mandible. This study determines the position of the mental foramen in a selected Malay population. One hundred and sixty nine panoramic radiographs of Malay patients retrieved from a minor oral surgery waiting list were selected to identify the normal range for the position of the mental foramen. The foramen was not included in the study if there was any mandibular tooth missing between the lower left and right first molars (36-46). The findings indicated the most common position for the mental foramen was in line with the longitudinal axis of the second premolar (69.2) followed by a location between the first and second premolar (19.6). The right and left foramina were bilaterally symmetrical in three of six recorded positions in 67.7 patients. The mental foramen was most often in line with the second premolar

Is there a "safety zone" in the mandibular premolar region where damage to the mental nerve can be avoided if periapical extrusion occurs?

The mandibular premolars are located close to the mental foramina (Fig. 1). As such, various events affecting these teeth, such as odontogenic infection1 and orthodontic, endodontic, periodontal or surgical misadventure, may result in neurosensory disturbance of the mental nerves.2-4 In one retrospective study, the incidence of mental paresthesia resulting from periapical infection or pathology was 0.96. In another 0.24 of cases in the same study, mental paresthesia was a complication of root canal treatment (caused by severe overfill in one case and iatrogenic perforation of mechanical instrumentation through the root and into the mental nerve in the second case).1 The incidence of mental paresthesia resulting from orthodontic, periodontal and surgical misadventure cannot be determined but is presumably low, as most such cases have been reported as individual case reports. In endodontology, elimination of infection from the pulp and dentin followed by adequate intracanal preparation and proper sealing constitute the basic principles of root canal treatment. Ideally, mechanical preparation and filling should be limited to the root canal, as overinstrumentation or extrusion of chemical fillings beyond the apical foramen to the adjacent nerve may give rise to neurosensory disturbances such as anesthesia, paresthesia or dysesthesia.5 Unfortunately, cases of endodontic extrusion of various filling or irrigation agents continue to be reported, despite recent advances in endodontology

Decompression of inferior alveolar nerve: case report comment

Paresthesia as a result of mechanical trauma is one of the most frequent sensory disturbances of the inferior alveolar nerve. This case report describes surgical treatment for paresthesia caused by a compressive phenomenon within the mandibular canal. The cause of the compression, a broken instrument left in the patient's mouth during previous endodontic therapy, was identified during routine radiography and computed tomography. Once the foreign object was removed by surgery, the paresthesia resolved quickly. This case highlights the potential for an iatrogenic mechanical cause of paresthesia. Comment : The article by Marques and Gomes (J Can Dent Assoc 2011;77:b34) caught my attention. For your information, there is almost an almost similar case reported recently, but with dysesthesia.1 It is fortunate that the patient in the current case has less severe symptoms (occasional numbness of her left lip and a small part of her chin, and a tingling sensation in the vestibular gingival). What I can deduce from the radiographs shown is that the file was actually lodged onto the wall of the periapical defect and the mandibular canal, and because of this the inferior alveolar nerve (IAN) was spared direct injury. Ikeda et al.2 had shown that there is room between the IAN and the canal. However, as reported by the Marques and Gomes, her symptoms were more aggravated in the morning and during stressful situations. This may be a result of fluid accumulation in the morning, or during any sympathetic (stressful) event, that may result in vasodilatation, and hence compression within the narrow mandibular canal that usually average 3.4 + 0.5 mm in diameter. 2,3 I hope this opinion is of help. Thank you

Familial cases of missing mandibular incisor: three case presentations

Hypodontia is the congenital absence of one or more teeth because of agenesis. The most commonly missing teeth are the third molars, the maxillary lateral incisors and the second premolars. Cases are presented of three patients with a missing mandibular incisor

Orthognathic surgery in the University of Malaya

This is the first review on orthognathic surgery in Malaysia. The records of a total of 84 patients seen between 1977 and 1999 in the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, University of Malaya were analysed. Skeletal III deformity formed 85 of the sample with a female dominance of 2 to 1. The patients' age ranged from 17 to 36 years, with a mean of 25.3 years. The common surgical techniques used were combined bilateral sagittal split and Le Fort I osteotomy. The predominant ethnic group was Chinese (n=58, 69); followed by Malay (n=14, 17) and Indian (n=12, 14)

Malignancy in oral lichen planus: a review of a group from the Malaysian population

The objective of this study was to determine the socio-demography (age, race and gender) of a group of Malaysian patients who were diagnosed as suffering from oral lichen planus (OLP). The occurrence of malignancy was also investigated. A total of 77 clinical and biopsy records of patients with OLP were studied. Females were affected more than males, with the female to male ratio being 2:1. Middle-aged Indian and Chinese females tend to be affected by OLP when compared with the rest of the population. Only 19 patients returned for further follow-up. One adult Indian female with a six-year history of lichenoid reaction showed the presence of malignancy

Making your own retrograde carrier

One of the problems faced by manufacturers is the difficulty in constructing a robust and reliable, angled applicator tip. This can be overcome by handmaking your own retrograde carrier. The applicator tip may be bent to about 50 degrees and, if a kink occurs while bending the tip, it can be replaced easily by a new modified needle. Because the wire used is flexible, it can adapt to the bend without a problem. Narrower carriers can also be made using a 20-G needle, perhaps more suitable for retrograde fillings of molar apices. Because the carrier is designed to be used once only, the problems of it being difficult to load and liable to blockages should not arise

Disposable carrier for retrograde fillings

Commercially available retrograde filling carriers are delicate and easily damaged by pressure. In addition, they are difficult to clean and keep free from blockage. This report describes a simple and easy technique for transforming a standard disposable hypodermic syringe and needle into a disposable carrier for retrograde fillings. {\^A}{\copyright} 2006 Asian Association of Oral and Maxillofacial Surgeons

Management of the fractured maxillary tuberosity: an alternative method

The maxillary tuberosity can fracture during extraction of a molar tooth. If a small bony fragment is affected, the extraction of the tooth and tuberosity continues; however, a conservative approach is advised if the bony fragment is large. In a modified blind surgical technique, the tooth is removed without the fractured bone

Lower lip numbness due to peri-radicular dental infection

Lower lip numbness has always been a sinister symptom. Much has been written about it being the sole symptom of pathological lesions and metastatic tumours in the mandible. It may also be a symptom of manifestations of certain systemic disorders. A case of lower lip numbness resulting from the compression of the mental nerve by a peri-radicular abscess is presented because of the unusual nature of this spread of infection