Preoperative imaging in third molar surgery - A prospective comparison of X-ray-based and radiation-free magnetic resonance orthopantomography.

This study aimed to compare preoperative data relevant to third molar surgery based on radiographic orthopantomography (OPG) and orthopantomogram-like MR images (MR-OPG), using five different MR protocols. X-ray-based OPG and OPG-like MRI reconstructions from DESS, SPACE-STIR, SPACE-SPAIR, T1-VIBE-Dixon, and UTE sequences were acquired in 11 patients undergoing third molar surgery, using a 15-channel mandibular coil. Qualitative (image quality, susceptibility to artifacts, positional relationship, contact/non-contact of the inferior alveolar nerve (IAN), relationship to maxillary sinus, IAN continuity, root morphology) and quantitative (tooth length, retromolar distance, distance to the IAN, and distance to the mandible margin) parameters of the maxillary and mandibular third molars were assessed regarding inter-reader agreement and quantitative discrepancies by three calibrated readers. Radiation-free MR-OPGs generated within clinically tolerable acquisition times, which exhibited high image quality and low susceptibility to artifacts, showed no significant differences compared with X-ray-based OPGs regarding the assessment of quantitative parameters. UTE MR-OPGs provided radiographic-like images and were best suited for assessing qualitative preoperative data (positional relationship, nerve contact/non-contact, and dental root morphology) relevant to third molar surgery. For continuous and focal nerve imaging, DESS MR-OPG was superior. MR-OPGs could represent a shift towards indication-specific and modality-oriented perioperative imaging in high-risk oral and maxillofacial surgery

Plasmazellgingivitis und plasmazellreiche Infiltrate der oralen Mukosa

Die Plasmazellgingivitis (PCG) ist eine durch ein dichtes Infiltrat polyklonaler Plasmazellen charakterisierte, gutartige, inflammatorische Erkrankung der Gingiva. Klinisch präsentiert sich die PCG als stark gerötete und auf Sondierung blutende Veränderung der befestigten Gingiva. Aus diesem Grund ist eine Verwechslung mit schweren Erkrankungen wie einer Leukämie oder einem Plattenepithelkarzinom möglich. Neben der PCG können weitere plasmazellreiche Infiltrate der oralen Mukosa auftreten. Therapeutisch kommen zur Behandlung der PCG neben der Etablierung einer suffizienten Mundhygiene topische Kortikosteroide sowie in schwer zu behandelnden Fällen Immunmodulatoren und Tumornekrosefaktor (TNF)-α-Hemmer zum Einsatz. Aufgrund der Häufigkeit von Rezidiven ist im Verlauf eine engmaschige Nachkontrolle der betroffenen Patienten notwendig. Ziel dieser Arbeit ist es, eine Übersicht zur Ätiologie, zur Differenzialdiagnostik mit Blick auf plasmazellreiche Infiltrate und zu Therapieoptionen der PCG zu geben

Parodontale Rehabilitation bei einer gehörlosen Patientin mit symptomatischer Epilepsie bei Sturge­Weber­Krabbe­ Syndrom

When a syndrome forms the background of a systemic involvement of periodontal disease, it is necessary to fully exploit the resources outside, which soon reaches its limits in private practice. In the patient's environment, it must be checked whether support for the patient can be guaranteed. Without support, as in this presented case, the patient's oral hygiene could hardly be maintained. This article reports on a female patient who was referred to the Center for Dental Medicine at the University of Zurich. In addition to various secondary carious lesions, an apical whitening, two carious wisdom teeth and two extremely mobile molars in the third quadrant, the patient had chronic, localized advanced (stage III, grade B) periodontitis associated with systemic disease (deafness and Sturge-Weber syndrome). For two years, the patient was treated at the Department of Periodontology. Due to the strong bleeding tendency on the left side, facial localization of the naevus flammeus, the patient was partially referred to the Polyclinic of Oral Surgery and treated there. Numerous oral hygiene sessions, scaling and root planing, restoration with composite fillings, a root filling, removal of wisdom teeth and finally removal of hypermobile molars 36 and 37 during corona lockdown were performed. In the meantime, the patient has been orally rehabilitated. Home oral hygiene was reorganized with the patient's family and the patient was discharged to a close supportive periodontal recall for the time being