Die chirurgische Entfernung eines Torus palatinus

The torus palatinus (TP) is a benign exostosis in the area of the sutura palatina media. It consists mainly of dense cortical bone with little trabecular bone and an overlying mucosa with little blood supply. Recent findings associate the occurrence of TP with bruxism, environmental factors and genetic factors. TP rarely causes symptoms, so treatment is only necessary in selected cases. Chronic trauma, impaired chewing function or compromise of the prosthetic restoration are the most common indications for surgical removal

Guided biopsy of osseous pathologies in the jaw bone using a 3D-printed, tooth-supported drilling template

Suspicious radiological findings in the jaw bone require histopathological examination for the confirmation of a diagnosis. As pathologies in this region are difficult to reach or are in close proximity to relevant anatomical structures, e.g. tooth roots or nerves, they often represent a challenge. Such factors may adversely affect the predictability of the surgical outcome of a biopsy of the osseous tissues. This technical note introduces a novel method for performing a digitally planned, guided biopsy. For this purpose, a cone beam computed tomography scan and an intraoral scan are superimposed using specific planning software. The resulting three-dimensionally printed, tooth-supported drilling template is designed for a trephine biopsy. It allows a precise, minimally invasive approach, with an exact three-dimensional determination of the biopsy location prior to surgery. The risk of devitalization of the neighbouring teeth or possible damage to the nerve structures can be minimized. Furthermore, a small access flap can be sufficient. In summary, the method of bone biopsy presented here allows high precision and greater predictability for biopsy sampling and is minimally invasive for the patient

Magnetic resonance imaging for preoperative diagnosis in third molar surgery: a systematic review

In recent years, magnetic resonance imaging (MRI) has made great strides through various technical improvements and new sequences, which have made it one of the most promising and leading imaging techniques in the head and neck region. As modern imaging techniques in dentistry aim to reduce radiation exposure, this systematic review evaluated the possibilities, advantages, and disadvantages of advanced imaging diagnostics using dental MRI and its evidence for clinical indications and limitations relevant to mandibular third molar (MTM) surgery. Two reviewers performed multiple database searches (PubMed MEDLINE, EMBASE, Biosis, and Cochrane databases) following the PICOS search strategy using medical subject headings (MeSH) terms, keywords, and their combinations. Ten studies were included in this systematic review. By providing high spatial resolution and excellent soft tissue contrast, black bone MRI sequences such as 3D Double Echo Steady State (DESS) and 3D Short Tau Inversion Recovery (STIR) imaging protocols have the potential to become a valuable alternative to cone-beam computed tomography (CBCT) in future dental clinical routines. Overall, radiation-free MRI represents another step toward personalized dentistry and improved decision-making that avoids ineffectiveness and minimizes risks in oral surgery by taking into account additional patient-side factors such as comorbidity, anatomical norm variations, and imaging biomarkers

Accuracy of guided biopsy of the jawbone in a clinical setting: A retrospective analysis

The aim of this study was to investigate the accuracy of a previously described technique for guided biopsy of osseous pathologies of the jawbone in a clinical setting. The data sets of patients who had undergone guided biopsy procedures were retrospectively examined for accuracy. Digital planning of the biopsies and manufacturing of the tooth-supported drilling template were performed with superimposed cone beam computed tomography and intraoral scans using implant planning software. After a trephine biopsy was taken using the template, the postoperative low-dose cone beam computed tomography was analyzed for accuracy using the planning software with the corresponding (digitally-planned) biopsy cylinder. The mean angular deviation was 4.35 ± 2.5°. The mean depth deviation was -1.40 ± 1.41 mm. Guided biopsy seems to be an alternative to a conventional approach for minimally invasive and highly accurate jawbone biopsy

Imaging in Third Molar Surgery: A Clinical Update

Third molar surgery is one of the most common surgical procedures performed in oral and maxillofacial surgery. Considering the patient's young age and the often-elective nature of the procedure, a comprehensive preoperative evaluation of the surgical site, relying heavily on preoperative imaging, is key to providing accurate diagnostic work-up, evidence-based clinical decision making, and, when appropriate, indication-specific surgical planning. Given the rapid developments of dental imaging in the field, the aim of this article is to provide a comprehensive, up-to-date clinical overview of various imaging techniques related to perioperative imaging in third molar surgery, ranging from panoramic radiography to emerging technologies, such as photon-counting computed tomography and magnetic resonance imaging. Each modality's advantages, limitations, and recent improvements are evaluated, highlighting their role in treatment planning, complication prevention, and postoperative follow-ups. The integration of recent technological advances, including artificial intelligence and machine learning in biomedical imaging, coupled with a thorough preoperative clinical evaluation, marks another step towards personalized dentistry in high-risk third molar surgery. This approach enables minimally invasive surgical approaches while reducing inefficiencies and risks by incorporating additional imaging modality- and patient-specific parameters, potentially facilitating and improving patient management

Clinical, Radiological, and Pathological Diagnosis of Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A Retrospective Study

BACKGROUND: Fibro-osseous lesions (FOL) of the jaw represent a rare, benign group of lesions that share similar clinical, radiological, and histopathological features and are characterized by progressive, variable replacement of healthy bone tissue by fibrous connective tissue. METHODS: This retrospective study aimed to evaluate the incidence of fibro-osseous lesions and to reassess the efficacy of case-specific treatment management from a clinical, radiological, and histopathological perspective based on 14 years of data. RESULTS: Forty-four patients with a radiological and/or histopathological diagnosis of benign FOLs were identified and re-evaluated. Cemento-osseous dysplasia was the most common group of FOLs present in our patient cohort (45%), followed by ossifying fibroma (39%) and fibrous dysplasia (16%). The diagnostic imaging technique of choice was CBCT (68%), followed by PAN (18%), with most patients (95 %) additionally undergoing biopsy. The mean age of the patients at the time of diagnosis was 40.54 ± 13.7 years, with most lesions being located in the mandible (86%), with females being predominantly affected (73%). CONCLUSION: An interdisciplinary approach that analyzes all case-specific factors, including demographic data, medical history, intraoperative findings, and, most importantly, histopathological and radiological features, is essential for an accurate diagnosis and key to avoiding inappropriate treatment

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention

Value of FDG-PET/MR in Oral Focus Assessment in Head and Neck Cancer Patients-A Feasibility Study

FDG-PET/MR is a hybrid imaging modality used for the staging and restaging of advanced head & neck cancer (HNC) patients. Their treatment typically involves radiation therapy, which requires previous dental focus assessment. The aim of this study was to analyze if staging FDG-PET/MR is a valuable tool for oral focus assessment. For this purpose, FDG-PET/MR findings, such as metabolic activity of periapical radiolucencies and marginal periodontitis, were retrospectively compared with conventional standardized dental focus assessment, including dental radiographs and clinical assessment of 124 teeth in seven patients. Increased FDG uptake of periapical lesions was found in one out of 23 lesions. Increased FDG uptake of the marginal periodontium was recorded in one out of 34 lesions. In summary, standardized dental focus assessment by panoramic radiography and periapical radiographs may be enriched by information from FDG-PET/MR, showing active inflammation in dental foci. However, many dental foci have no correlate in FDG-PET/MR. The treatment decision for oral foci may benefit from the visualized presence or absence of metabolic activity on FDG-PET/MR

Development and application of a 3D periodontal in vitro model for the evaluation of fibrillar biomaterials

Background: Periodontitis is a chronic inflammation of the tooth supporting structures that finally can lead to tooth loss. As chronic periodontitis is associated with systemic diseases multiple approaches have been followed to support regeneration of the destructed tissue. But very few materials are actually used in the clinic. A new and promising group of biomaterials with advantageous biomechanical properties that have the ability to support periodontal regeneration are self-assembling peptides (SAP). However, there is still a lack of 3D periodontal models that can evaluate the migration potential of such novel materials. Methods: All experiments were performed with primary human periodontal ligament fibroblasts (HPLF). Migration capacity was assessed in a three-dimensional model of the human periodontal ligament by measuring the migration distance of viable cells on coated (Enamel Matrix Protein (EMP), P11–4, collagen I) or uncoated human dentin. Cellular metabolic activity on P11–4 hydrogels was assessed by a metabolic activity assay. Deposition of ECM molecules in a P11–4 hydrogel was visualized by immunostaining of collagen I and III and fibrillin I. Results: The 3D periodontal model was feasible to show the positive effect of EMP for periodontal regeneration. Subsequently, self-assembling peptide P11–4 was used to evaluate its capacity to support regenerative processes in the 3D periodontal model. HPLF coverage of the dentin surface coated with P11–4 increased significantly over time, even though delayed compared to EMP. Cell viability increased and inclusion of ECM proteins into the biomaterial was shown. Conclusion: The presented results indicate that the 3D periodontal model is feasible to assess periodontal defect coverage and that P11–4 serves as an efficient supporter of regenerative processes in the periodontal ligament. Clinical relevance: The establishment of building-block synthetic polymers offers new opportunities for clinical application in dentistry. Self-assembling peptides represent a new generation of biomaterials as they are able to respond dynamically to the changing environment of the biological surrounding. Especially in the context of peri-implant disease prevention and treatment they enable the implementation of new concepts