Inferior alveolar and lingual nerve injuries: An overview of diagnosis and management

Oral and maxillofacial surgery operations are susceptible to cause injury to terminal branches of the trigeminal nerve. The mandibular division is more prone to injury than ophthalmic and maxillary nerves. Inferior alveolar branch of the trigeminal nerve is the most commonly injured branch, followed by the lingual nerve. These nerves may be subjected to neurosensorial disturbance during third molar surgery, followed by sagittal split ramus osteotomy, endodontic therapy and dental implant placement. Local anesthetic injections, pre-prosthetic surgery, various other types of orthognathic surgery, ablative tumor surgery involving mandibular resections, osteoradionecrosis, osteomyelitis or maxillofacial trauma are among other potential etiologic factors. If an inferior alveolar or lingual nerve injury occurs, a timely diagnosis and a proper management are key factors to avoid further or permanent damage. A wide range of therapeutic modalities are available in managing nerve injuries, ranging from simple observation to complex grafting, depending on various factors. Data regarding nerve injuries may not always be reliable since most are based upon personal experience and in a retrospective nature. It is also challenging to draw proper conclusions from studies on nerve injuries due to the differences in outcome criteria and assessment methods. Still, an accurate knowledge of anatomy should be combined with both clinical and radiological data to avoid any nerve-related complications. Thus, this article will present a narrative review of the current literature on the inferior alveolar and lingual nerve injuries, focusing on the functional assessment methods, factors influencing recovery, the contemporary management protocols as well as future trends in nerve repairs

Plasmablastic Lymphoma in a Previously Undiagnosed Human Immunodeficiency Virus-Positive Patient: A Case Report

Plasmablastic lymphoma (PBL) is a rare and aggressive non-Hodgkin lymphoma subtype associated with human immunodeficiency virus (HIV) infection. PBL is extremely aggressive and has a poor response to treatment. Clinically PBL resembles a periodontal disease, Kaposi sarcoma, or melanoma. Delayed diagnosis adversely affects the treatment and life expectancy. A 52-year-old male presented with a firm intraoral mass causing a slight elevation noticeable extraorally. Radiologically, loss of lamina dura around the first premolar and loss of both vertical and horizontal bone height around the dental implant replacing the second premolar were present. The biopsy confirmed a diagnosis of PBL. Further evaluation revealed that the patient was positive for HIV. The chemotherapy regimen included etoposide, vincristine, hydroxydaunorubicin, cyclophosphamide, and prednisolone, followed by an autologous hematopoietic stem cell bone marrow transplant. This article attempts to describe the clinical presentation and histopathological evaluation of PBL, and emphasize the paramount role of biopsy, early clinical suspicion, and correct diagnosis

Evaluation of the Short-Term Efficacy of Transdermal Ozone Therapy in Turkish Patients with Internal Derangement of the Temporomandibular Joint

Objective:To investigate the efficacy of transdermal high-frequency ozone therapy in the management of pain and pain-related restricted jaw movements in patients with internal derangement of the temporomandibular joint (TMJ). Material and Methods:This retrospective study included 40 patients who had received transdermal high-frequency ozone therapy for the management of disc displacement with reduction of the TMJ. Subjects were treated 3 times for one week with a bio-oxidative high-frequency ozone generator with an intensity of 80% for ten minutes bilaterally.  Pain scores and maximal interincisal opening (MIO) values of the patients were evaluated before and after the treatment. Results:An increase in the mean MIO value was achieved following the ozone therapy, however, the difference was not statistically significant (p=0.350). A statistically significant decrease in the mean pain score (48.13 ± 27.75) was observed following the ozone therapy. Conclusion:Transdermal application of high frequency ozone may be a good alternative for management of pain and pain-related restricted jaw movements in patients with internal derangement of the TMJ

Esthetic evaluation of implant-supported single crowns: a comparison of objective and patient-reported outcomes

Abstract Background This study investigated objective and patient-reported esthetic outcomes and their correlation for single-tooth implant restorations in the maxillary anterior region. Methods Nineteen patients were included. Gingival biotypes and smile lines were evaluated. Esthetic evaluation was performed according to the pink and white esthetic scores (PES and WES). Patients rated their satisfaction regarding the implant treatment using a subjective outcome questionnaire and a 10-cm visual analogue scale (VAS). Results The mean PES and WES were 10.7 (range 5–13, SD ± 2.24) and 8.6 (range 8–10, SD ± 0.60), respectively. The overall mean VAS was 8.54 ± 0.36 (range 3.8–9.8). No significant correlation was found between VAS and PES or WES (p = 0.475, p = 0.984, respectively). PES and WES scores for gingival biotypes failed to show any statistically significant difference (p = 0.701, p = 0.831). There was a significant negative correlation between the smile line and VAS; indicating that patients with lower smile lines expressed higher patient satisfaction (p = .001). Conclusions Professionally reported esthetic outcomes (PES and WES results) may not correlate with patient-reported outcomes. Smile line is a significant factor in patient satisfaction, which should be evaluated thoroughly prior to implant placement in the anterior maxilla

Comparative assessment of 3D reconstruction technique and Cavalieri’s principle in predicting the mandibular bone defect volumes

Purpose The objective of this study was to compare the accuracy of the Cavalieri’s principle and 3D reconstruction in predicting the volume of a bony defect. Materials and Methods Defects of the same approximate size were created on nine artificial mandibles. The actual volume of the defect on each mandible was measured by water displacement, and served as the control. Each mandible was then scanned using a CBCT and volume measurements were made for each defect using two techniques: Cavalieri’s principle and 3D reconstruction. For each defect, the volume obtained by each of the two techniques was compared to the control volume using the analysis of variances (ANOVA) with p<0.05. Results ANOVA between the control, 3D reconstruction and Cavalieri’s principle groups showed no statistically significant differences (p=.058). When the control group was further analyzed by Dunnett’s post-hoc test, the results from Cavalieri’s principle were found to be statistically different than the control group (p=.035), whereas the results of 3D reconstruction technique did not reach the level of significance (p=.523). Conclusion Cavalieri’s principle significantly underestimates the actual control volume, and is less accurate than the 3D reconstruction technique. The 3D reconstruction method is a reliable technique in measuring volume of bony defects