Anatomical characteristics and visibility of mental foramen and accessory mental foramen: panoramic radiography vs. cone beam CT

Background: The mental foramen (MF) is a small foramen located in the anterolateral region of the mandible through which the mental nerve and vessels emerge. The knowledge on the anatomic characteristics and variations of MF is very important in surgical procedures involving that area. The aim of this study was two-fold: firstly, to analyze the anatomic characteristics of MF and the presence of accessory mental foramen (AMF) using CBCT and, secondly, to compare the capability of CBCT and PAN in terms of MF and AMF visualization, as well as influencing factors. Material and Methods: A sample of 344 CBCT scans was analyzed for presence and characteristics (i.e. diameter, area, shape, exit angle) of MF and AMF. Subsequently, corresponding PANs were analyzed to ascertain whether MF and AMF were visible. Results: Out of the 344 patients, 344 (100%) MFs and 45 (13%) AMFs were observed on CBCT. Regarding gender, MF diameter and area, MF-MIB and MF-MSB distances, and exit angle were all significantly higher in males. Also, statistically significant differences were found in terms of age and dental status. Statistically significant differences in MF long and short diameters and MF area were found with respect to AMF presence ( p =.021, p =.008, p =.021). Only 83.87% of the MFs and 45.83% of the AMFs identified on CBCT were also visible on PANs. MF diameter, shape, exit angle, and age had a significant influence on MF visualization on PAN (B=.43, p =.005; B=-.55, p =.020; B=.20, p =.008; B=.61, p =.005). Conclusions: PAN is not an adequate technique to properly identify MF and AMF. Diameter, shape, exit angle, and age are all factors influencing MF visualization on PAN images. For surgery involving the MF anatomical region, a preoperative radiological study with CBCT is of crucial importance to avoid complications

Clinical anatomy of cervical spondylosis

The aim of this study is to describe the anatomical alterations in complementary tests (MRI and EMG) in patients with cervicobrachialgia according to sex and age. Retrospective study of 184 patients with cervicobrachialgia who underwent cervical MRI and EMG. The variables analyzed were gender, age, elements of spondylosis (osteophytes, arthropathy, spondylolisthesis and canal stenosis), the type of disc disease (protrusion and herniated disc) and curvature in the sagittal plane. The EMG was used to evaluate the neurogenic findings in the muscles dependent on the spinal roots of C4 to C8-T1. Average age was 53.65±11.96 years. The patients were evaluated for the presence of osteophytes (n = 111), arthropathy (n = 76), spondylolisthesis (n = 15) and stenosis of the spinal canal (n = 35). The highest incidences were osteophytes in C5-C6 (n=108), protrusions in C5-C6 (n=58), herniated disc in C5-C6 (n=18) and neurogenic findings in C7 (n=130). The rectification of cervical lordosis appeared in 124 patients. Spondylosis increases with age. Disc herniations, disc protrusions and motor radiculopathy are more frequent in the 5th to 6th years of life. In patients with cervicobrachialgia, the sagittal rectification is more common than the normal lordosis

Ex vivo vs. in vivo antibacterial activity of two antiseptics on oral biofilm

Aim: To compare the immediate antibacterial effect of two application methods (passive immersion and active mouthwash) of two antiseptic solutions on the in situ oral biofilm. Material and Methods: A randomized observer-masked crossover study was conducted. Fifteen healthy volunteers wore a specific intraoral device for 48 h to form a biofilm in three glass disks. One of these disks was used as a baseline; another one was immersed in a solution of 0.2% Chlorhexidine (0.2% CHX), remaining the third in the device, placed in the oral cavity, during the 0.2% CHX mouthwash application. After a 2-weeks washout period, the protocol was repeated using a solution of Essential Oils (EO). Samples were analyzed for bacterial viability with the confocal laser scanning microscope after previous staining with LIVE/DEAD® BacLight™. Results: The EO showed a better antibacterial effect compared to the 0.2% CHX after the mouthwash application (% of bacterial viability = 1.16 ± 1.00% vs. 5.08 ± 5.79%, respectively), and was more effective in all layers (p < 0.05). In the immersion, both antiseptics were significantly less effective (% of bacterial viability = 26.93 ± 13.11%, EO vs. 15.17 ± 6.14%, 0.2% CHX); in the case of EO immersion, there were no significant changes in the bacterial viability of the deepest layer in comparison with the baseline. Conclusions: The method of application conditioned the antibacterial activity of the 0.2% CHX and EO solutions on the in situ oral biofilm. The in vivo active mouthwash was more effective than the ex vivo passive immersion in both antiseptic solutions. There was more penetration of the antiseptic inside the biofilm with an active mouthwash, especially with the EO. Trial registered in clinicaltrials.gov with the number NCT02267239. URL: https://clinicaltrials.gov/ct2/show/NCT02267239.This work was supported by project PI11/01383 from Carlos III Institute of Health (General Division of Evaluation and Research Promotion, Madrid, Spain), which is integrated in National Plan of Research, Development and Innovation (PN I+D+I 2008-2011). This project was cofinanced by European Regional Development Fund (ERDF 2007-2013)S

Critical anatomic region of nasopalatine canal based on tridimensional analysis: cone beam computed tomography

The study aim of this was to define the critical anatomic region of the premaxilla by evaluating dimensions of nasopalatine canal, buccal bone plate (BBP) and palatal bone plate (PBP). 230 CBCTs were selected with both, one or no upper central incisors present (+/+, −/+, −/−) and periodontal condition was evaluated. T-student test, ANOVA, Pearson´s correlation and a multivariant-linear regression model (MLRM) were used. Regarding gender, significant differences at level 1 (lower NC) were found for: buccal-palatal, transversal and sagittal NC diameters and NC length (NCL). Regarding dental status, significant differences were found for: total BBP length (tBL) and PBP width (PW2) at level 2 (NCL midpoint). NCL was correlated with PW2, tBL and PBP length at level 3 (foramina of Stenson level). An MLRM had a high prediction value for NCL (69.3%). Gender is related to NC dimensions. Dental status has an influence on BBP dimensions, but does not influence on NC and PBP. Periodontal condition should be evaluated for precise premaxillae analysis NC diameters at the three anatomical planes are related to each other, while NCL is related to BBP and PBP lengths. A third of premaxilla is taken up by NC, thus, establishing the critical anatomic region.S

Selective Serotonin Reuptake Inhibitors as a risk factor for dental implant fail- ure: A retrospective clinical study

Introduction: The trend in recent decades in Europe and the United States points to an exponential increase in the consumption of antidepressant drugs and, in particular, selective serotonin reuptake inhibitors (SSRIs). This retrospective study aims to investigate whether there is an association between SSRI intake and dental implant (DI) failure and, secondarily, the influence of other systemic and local factors. Material and Methods: This cohort retrospective study is in concordance with the STROBE guidelines for observational studies. One-hundred seventy patients received 573 DIs between 2014 and 2020. Results: The reported DI failure rate was 6.11%. Of these, 18.31% failed in patients treated with SSRIs while 4.38% failed in healthy patients (p<0.001). Specifically, the use of these drugs was associated with a 4.53 times higher rate of DI failure, and, in the multivariate analysis, 3.70 times higher adjusted risk was found. A lower survival rate at 90 months follow-up was also observed in these patients compared to those not taking these drugs (84.30% vs. 96%; p=0.00014). Conclusions: With the limitations of the present study, it can be affirmed that there is a relationship between the intake of SSRIs and DI failure, as well as a lower survival rate in these patients

Nestin expression is associated with relapses in head and neck lesions

Background: The aim was to investigate the clinical significance of nestin immunohistochemical expression in head and neck area lesions and to study its role in patient survival and recurrence. Methods: 39 (44.3%) nasosinus, 37 (42%) major salivary gland (6 submandibular and 31 parotid) and 12 (13.6%) oral cavity lesions of paraffin-embedded samples were retrospectively included. Results: The expression was categorized into grades, negative for 55 (62.5%) cases, grade 1 in 10 cases (11.4%), grade 2 in 12 cases (13.6%), and grade 3 in 11 cases (12.5%); 100% of pleomorphic adenomas were positive for nestin with grade 3 intensity, 100% of polyps and inverted papillomas were negative (p p = 0.002). ROC (receiver operating characteristic) curves revealed that the positivity for nestin (+/−) in relation to malignancy, presented a sensitivity of 50.98%, a specificity of 81.08%, with an area under the curve of 0.667 (p = 0.009). Conclusions: Nestin could be a useful marker to detect the presence of stem cells in head and neck tumors that have a role in tumor initiation and progression

Assessment of the Economic and Health-Care Impact of COVID-19 (SARS-CoV-2) on Public and Private Dental Surgeries in Spain: A Pilot Study

Objectives: The COVID-19 (SARS-CoV-2) pandemic is an ongoing public health challenge, also for the dentistry community. The main objective of this paper was to determine the economic and health-care impact of COVID-19 on dentists in the Autonomous Region of Galicia (Spain). Methods: This was a descriptive observational study in which the data was collected by means of a self-administered survey (from 1 April 2020 to 30 April 2020). Results: A total of 400 dentists from Galicia responded to the survey. Only 12.3% of the participants could obtain personal protective equipment (PPE) including FFP2 masks. Of the male respondents, 33.1% suffered losses >€15,000 compared to 19.4% of female respondents (OR = 3.121, p < 0.001). Economic losses seem to have contributed to the applications for economic help as 29.5% of the respondents who applied for this measure recorded losses in excess of €15,000 (p = 0.03). Patients complained more about the fact that only emergency care was available during the State of Alarm, in dental surgeries that do not work with insurance companies or franchises. Only 4 professionals tested positive, 50% of whom worked exclusively in private practice and the other 50% who practised in both private and public surgeries. Dentists who practise in the public sector saw more urgent patients per week than those practising in private surgeries (p = 0.013). Conclusions: The COVID-19 pandemic has had economic repercussions in dentistry as only urgent treatment was available during the State of Alarm. These repercussions seem to be higher in male participants, as the majority of the participants have revealed higher economic losses than females. The level of assistance has also been affected, reducing the number of treated patients, although this quantity has been different in private and public surgeries. By presenting these findings we look to highlight the role that dentists play in society in treating dental emergencies in our surgeries, and this must be recognised and addressed by the relevant authorities, who must provide PPEs as a priority to this group as well as providing special economic aid in accordance with the losses incurred by the sectorS

Alveolar bone loss, platelet and glycosylated haemoglobin levels in 239 patients. A clinical study

The relation between periodontal disease and systemic pathologies is still not widespread among general practitioners. The aim of our study is to evaluate whether or not periodontal radiological diagnosis can aid the detection of blood alterations associated with acquired systemic diseases. This is a cross sectional study. All of the participants underwent a panoramic radiograph and a complete blood test. Morphological bone loss was considered as positive in those patients who showed radiographically more than 1 tooth with bone loss greater than or equal to the middle third of the root. The statistical analysis was performed by comparing the variables using the ANOVA or U-Mann-Whitney tests for independent samples with normal conditions. The correlation coefficient was analysed using the Pearson test. 239 patients were included in our study (96 men and 143 women) with an average age of 64.40 years. 59.04% of the patients were determined as morphological bone loss positive and had on average 4 teeth less than negative patients (p <0.0001). Also the average platelet levels in positive patients were lower (p = 0.024) and mean levels of HBA1c (p = 0.009) were higher. Morphological bone loss parameter can be useful both for dentists and general practitioners to refer, subsequently, to periodontal specialist

Histological and histomorphometric study of human palatal mucosa: implications for connective tissue graft harvesting

Aims To analyse the histological structure and histomorphometric characteristics of human hard palatal mucosa in order to determine the donor site of choice for connective tissue grafts from a histological point of view. Materials and Methods Palatal mucosa samples from six cadaver heads were harvested at four sites: incisal, premolar, molar and tuberosity. Histological and immunohistochemical techniques were performed, as was histomorphometric analysis. Results In the current study, we found that the density and size of cells were higher in the superficial papillary layer, whereas the thickness of the collagen bundles increased in the reticular layer. Excluding the epithelium, the mean percentage of lamina propria (LP) and submucosa (SM) was 37% and 63%, respectively (p < .001). LP thickness showed similar values in the incisal, premolar and molar regions, and a significantly greater thickness in tuberosity (p < .001). The thickness of SM increased from incisal to premolar and molar, disappearing in the tuberosity (p < .001). Conclusions As dense connective tissue of LP is the tissue of choice for connective tissue grafts, the best donor site from a histological point of view is tuberosity because it is composed only of a thick LP without the presence of a loose submucosal layerS

In vitro histological evaluation of the surgical margins made by different laser wavelengths in tongue tissues

Background: Lasers have become standard tools for the surgical treatment of oral lesions. The purpose of this study is to determine the surgical margins and histologically evaluate the tissue thermal effects induced by different types of surgical instruments. Material and Methods: Cuts were made in pork tonguesâ mucosa with different lasers (Er:YAG at 2W with and without air / water spray and at 4W with and without air / water spray; CO2 at 3.5W and 7W in pulsed mode and at 7W in continuous mode; the diode laser at 3.5W and boost 3.5W in pulsed mode; Nd:YAG at 6W, 40Hz and electroscalpel at 5W and conventional scalpel as control. Macroscopic and microscopic morphological changes were evaluated. Results: The results of this study showed that the surgical instruments that caused greater tissue damage extension were: the Nd:YAG laser (670.68μm), the diode 3.5W and boost PW (626.82μm), the CO2 7W CW (571.18μm), the CO2 at 7W PW (485.45μm), the diode 3.5W PW (456.15μm), the electroscalpel (409.57μm) and lastly the CO2 laser 3.5W PW (306.19μm) and Er:YAG (74.66μm) laser, regardless of power, mode or air / water spray used. An association between the Tissue Damage Extension and the Degree of Carbonization (r = 0.789; P = 0.01), and an association between the Tissue Damage Extension and Regularity of the Incision were found (r = -, 299; P = 0.01). Conclusions: The results of this study suggest that lasers can be used in soft tissues biopsies of the oral cavity, enabling a correct histopathological analysis, as long as the biological effects of each laser type are considered. The Er:YAG laser revealed its potential for biopsies of the oral mucosa ensuring a successful histological evaluation and the CO2 laser at 3,5W in pulsed mode presented itself as the best choice for surgeries with hemostasis