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Journal of Dental Education May 2024Interpretation of dental radiographs is a difficult process, particularly for inexperienced students. This study introduced concept mapping for dental students to help...
OBJECTIVES
Interpretation of dental radiographs is a difficult process, particularly for inexperienced students. This study introduced concept mapping for dental students to help in the radiographic interpretation of common jaw lesions. We aimed to analyze the efficacy of the concept map (CM) in radiographic interpretation, with a discussion of the diagnostic reasoning dilemma.
METHODS
This study included 39 dental students. After a 1-h class for CM guidance and based on three group discussions and one-on-one feedback, the students completed and submitted CMs for three jaw diseases (ameloblastoma, odontogenic keratocyst, and simple bone cyst). All participants underwent a pretest and posttest of knowledge and diagnosis; all students but one completed an open-ended questionnaire regarding the use of CMs.
RESULTS
Concept mapping effectively improved diagnostic accuracy. The participants' posttest scores were better than their pretest scores in both knowledge and diagnostic tests. Most of the students attempted radiographic interpretation through analytic reasoning. The time required for the students to draw a CM varied from student to student from 3-5 h to 1-3 days.
CONCLUSION
This study shows that CMs can improve the radiographic diagnostic ability of dental students by providing a framework for analytic reasoning. Continuous research is warranted to improve the effectiveness of CM in oral radiographic interpretation in the dental student's class.
PubMed: 38795325
DOI: 10.1002/jdd.13590 -
International Medical Case Reports... 2024Nasopalatine duct cyst (NDC) is the most prevalent non-odontogenic cyst emerging from the epithelial remnants in the maxillary incisive canal. A sublabial or...
INTRODUCTION
Nasopalatine duct cyst (NDC) is the most prevalent non-odontogenic cyst emerging from the epithelial remnants in the maxillary incisive canal. A sublabial or transpalatal approach is performed to enucleate NDC completely. More recently, transnasal endoscopic marsupialization has been used gradually.
CASE PRESENTATION
A 24-year-old male patient with a large nasopalatine duct cyst with a diameter of 51 mm was managed by transnasal endoscopic marsupialization under general anesthesia. The presentation involves painless swelling around the left side of the anterior maxilla and bulging of the hard palate. No postoperative complications were observed after a 3-month follow-up. Transnasal endoscopic marsupialization is a minimally invasive surgery for large NDC.
CLINICAL DISCUSSION
Approximately 1% of the population has a nasopalatine duct cyst. Surgical treatment was carried out under general anesthesia; the cyst was dissected and removed using a typically transnasal endoscopic marsupialization technique.
CONCLUSION
The cause of the NDC is unclear. Simple surgical resection and clinical and radiological control are recommended to ensure the case is resolved correctly.
PubMed: 38770520
DOI: 10.2147/IMCRJ.S443199 -
JPMA. the Journal of the Pakistan... Apr 2024We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical...
We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical signs, which is a relatively rare occurrence. However, the radiographic and histological presentation of this lesion was typical of a nasopalatine duct cyst. Therefore, this case report aims to highlight the variable presentations of the nasopalatine cyst, which is often misdiagnosed and treated as an endodontic infection.
Topics: Humans; Female; Adult; Nonodontogenic Cysts; Diagnosis, Differential; Nose Diseases; Cysts; Palate, Hard
PubMed: 38751287
DOI: 10.47391/JPMA.9934 -
Journal of Oral and Maxillofacial... Apr 2024One of the key features of orthognathic surgery is altering temporomandibular joint (TMJ) condylar positions.
Do Surgical Intervention Type and Baseline Condylar Position Affect Spatial Dimension Changes of the Temporomandibular Joint in the Surgical Correction of Skeletal Class II Deformities?
BACKGROUND
One of the key features of orthognathic surgery is altering temporomandibular joint (TMJ) condylar positions.
PURPOSE
This multivariate study aimed to identify surgical interventions and patient factors significantly associated with changes in TMJ spatial dimensions after the surgical correction of skeletal Class II deformities.
STUDY DESIGN, SETTING, SAMPLE
This is a retrospective cohort study including patients who had undergone an isolated bilateral sagittal split ramus osteotomy (BSSO) or a bimaxillary osteotomy (BMO) for mandibular advancement and a control sample of patients treated with the removal of odontogenic cysts in the mandibular posterior region. Excluded were those who presented with specific radiographic signs of TMJ osteoarthrosis, severe facial asymmetry, or deformity secondary to trauma.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE
The primary predictors were condylar position at baseline (anterior, concentric, and posterior), time points (T0, preoperatively; T1, immediately after surgery; and T2, 1-year follow-up), and surgical intervention type (BSSO, BMO, and control group).
MAIN OUTCOME VARIABLES
The primary outcomes were changes in posterior spatial dimension (PSD), superior spatial dimension, and medial spatial dimension assessed by cone-beam computed tomography preoperatively, immediately after surgery, and at 1-year follow-up.
COVARIATES
Covariates included sex, age, and amount of mandibular advancement.
ANALYSES
Estimations of independent effects of primary predictors on outcome variables were made by applying generalized estimation equation models. The value of statistical significance was P < .05.
RESULTS
The study sample included 88 participants. The BSSO samples included 39 patients, and the BMO group included 22 patients; the control group comprised 27 subjects. The average age was 31.2 years; the majority were female (61.4%). Adjusted generalized estimation equation models yielded a significant time interaction between BSSO and spatial dimensions over time (PSD, P < .001). Key predictors of spatial dimension changes were the baseline posterior (PSD, P < .001) and the central condylar position (PSD, P < .001).
CONCLUSION AND RELEVANCE
This controlled study, for the first time, provides scientific evidence on the effects of surgical intervention type and baseline condylar position on spatial dimension changes in the TMJ. It shows a more favorable outcome in long-term spatial dimension changes for patients treated by a BMO procedure.
PubMed: 38750659
DOI: 10.1016/j.joms.2024.04.016 -
European Journal of Medical Research May 2024Odontogenic keratocysts exhibit frequent recurrence, distinctive histopathological traits, a tendency towards aggressive clinical behavior, and a potential linkage to...
OBJECTIVES
Odontogenic keratocysts exhibit frequent recurrence, distinctive histopathological traits, a tendency towards aggressive clinical behavior, and a potential linkage to the nevoid basal cell carcinoma syndrome. The aim of this systematic review is to compile insights concerning the control of this condition and assess the effectiveness of various treatment approaches in reducing the likelihood of recurrence.
MATERIALS AND METHODS
The following systematic review adhered to the PRISMA guidelines. The systematic revision was registered on PROSPERO and structured around the questions related to the population, intervention, control, outcome and study design (PICOS).
RESULTS
After conducting a search on the PubMed database, we initially identified 944 records. After using end-note software to remove duplicate entries, results totally with 462 distinct records. A thorough review of the titles and abstracts of these articles led to the selection of 50 papers for in-depth examination. Ultimately, following the application of our eligibility criteria, we incorporated 11 articles into our primary outcome analysis.
CONCLUSION
Among the studies examined, the most common location for these lesions was found to be in the area of the mandibular ramus and the posterior region of the mandible. In cases where the exact location wasn't specified, the mandible emerged as the predominant site. When we considered the characteristics of these lesions in studies that mentioned locularity, most were described as unilocular in two studies, while in two other studies, the prevalence of multilocular lesions was observed. Risk factors associated with keratocyst recurrence include younger patient age, the presence of multilocular lesions, larger lesion size, and a longer anteroposterior dimension. Certain treatment methods have demonstrated a lack of relapses. These include the use of 5-fluorouracil, marsupialization, enucleation with peripheral ostectomy or resection, enucleation and curettage, as well as resection without creating continuity defects. However, it is important to note that further research is essential. Prospective studies and randomized trials are needed to collect more comprehensive evidence regarding the effectiveness of various treatment approaches and follow-up protocols for managing odontogenic keratocysts.
CLINICAL RELEVANCE
Odontogenic keratocysts still enter into differential diagnoses with other lesions that affect the jaw bones such as ameloblastama and other tumor forms, furthermore it is not free from recurrence, therefore the therapeutic approach to the lesion aimed at its elimination can influence both the possible recurrence and complications, knowledge of the surgical methods that offer the most predictable and clinically relevant result for the management of follow-up and recurrences.
Topics: Humans; Odontogenic Cysts
PubMed: 38750607
DOI: 10.1186/s40001-024-01854-z -
BMC Oral Health May 2024Solitary Bone Cyst (SBC), also known as a simple bone cyst, hemorrhagic cyst, or traumatic cyst is classified by the WHO among non-odontogenic benign lesions of the jaw....
BACKGROUND
Solitary Bone Cyst (SBC), also known as a simple bone cyst, hemorrhagic cyst, or traumatic cyst is classified by the WHO among non-odontogenic benign lesions of the jaw. The article explores the use of a static 3D-printed surgical guide to treat mandibular SBC, emphasizing a minimally surgical approach for this lesion.
CASE PRESENTATION
A 20-year-old woman was referred for a persistent mandibular SBC lacuna, without specific complaints. Her medical history included a previous bone trepanation for a SBC in the same area, radiologically and surgically confirmed. X-ray assessment showed a well-defined unilocular radiolucency surrounding the root of the first left lower molar (tooth #36), measuring 10 × 10 mm. Pulp sensitivity was normal. CBCT data and STL files of dental cast were obtained preoperatively and registered. A 3D-printed surgical guide was used for minimally invasive trepanation of the buccal cortical. The simulation used a targeted endodontic microsurgery approach in order to determine axis and diameter of the trephine. Surgery was performed under local anesthesia. The guide was tooth supported integrating tubes and a fork for guiding precise trepanation. A 3.5 mm round bone window was created, leaving an empty cavity confirming SBC diagnosis and permitting bone curettage. A blood clot was obtained to promote bone healing. Complete reossification was observed after 6 months. The follow-up at 2 years confirmed a complete bone healing with normal pulp sensitivity.
DISCUSSION
The 3D-printed windowed surgical guide with dental support offers big advantages, including improved visibility and reduced errors. Compared to traditional guides, it eliminates visual hindrance and allows easier and quick access to confined areas as well as an improved irrigation during drilling process. The article also highlights the importance of preoperative planning while acknowledging potential limitations and errors and surgical complications.
CONCLUSION
The use of the 3D-printed surgical guide could be used in routine for minimally invasive intervention of SBC. This case also demonstrates the potential utility of this approach in various procedures in oral and maxillofacial surgery. The technique provides precise localization, reducing complications and enhances operative efficiency.
Topics: Humans; Female; Minimally Invasive Surgical Procedures; Printing, Three-Dimensional; Young Adult; Cone-Beam Computed Tomography; Mandibular Diseases; Jaw Cysts
PubMed: 38745168
DOI: 10.1186/s12903-024-04308-4 -
Indian Journal of Dental Research :... Oct 2023Although numerous syndromic and non-syndromic odontogenic lesions of the jaws have been documented in the literature, there are very few cases of simultaneous benign and...
INTRODUCTION
Although numerous syndromic and non-syndromic odontogenic lesions of the jaws have been documented in the literature, there are very few cases of simultaneous benign and malignant jaw lesions.
PATIENT CONCERNS
We present a case of right maxillary squamous cell carcinoma along with several benign odontogenic cystic lesions of the jaws and skeletal abnormalities that meet the criteria for Gorlin-Goltz syndrome.
TAKEAWAY LESSONS
With a review of the literature, the specifics of management and follow-up are discussed.
Topics: Humans; Basal Cell Nevus Syndrome; Odontogenic Cysts; Maxillary Neoplasms; Carcinoma, Squamous Cell; Male; Neoplasms, Multiple Primary; Radiography, Panoramic; Female
PubMed: 38739831
DOI: 10.4103/ijdr.ijdr_9_23 -
International Journal of Surgery Case... Jun 2024Odontogenic keratocysts (OKC) are benign intraosseous cysts with expansive growth. They account for approximately 7.8 % of all jaw cysts and have a high recurrence...
Clinical and radiological documentation of complete remodeling of the mandibular bone after the enucleation of a large odontogenic keratocyst: 15 years follow-up of a unique case - A case report.
INTRODUCTION AND IMPORTANCE
Odontogenic keratocysts (OKC) are benign intraosseous cysts with expansive growth. They account for approximately 7.8 % of all jaw cysts and have a high recurrence rate. Herein, we present a minimally invasive approach for the surgical treatment of a remarkable variation of OKC with a 15-year radiological and clinical follow-up.
PRESENTATION OF THE CASE
We present the case of a 42-year-old female patient with a large cyst in the mandible between teeth 35 and 45, who reported spontaneous swelling and paresthesia of the lower lip. Radiological imaging is crucial for treatment planning. The cyst was surgically treated with a single enucleation combined with adjuvant therapy to minimise recurrence. A titanium plate was inserted because of the size of the defect. Recurrence was observed one year later and treated with single enucleation and adjuvant therapy. After 15 years, complete healing, no signs of recurrence, and complete remodeling of the mandible were observed.
CLINICAL DISCUSSION
The treatment of OKC remains the subject of varying approaches in the literature due to the lack of established general guidelines. One treatment option is single enucleation combined with adjuvant therapy to minimise recurrence, which can result in complete clinical and radiological remodeling of the bone.
CONCLUSION
Direct enucleation combined with adjuvant therapy is a practical approach for treating large OKCs. It is associated with less morbidity and burden on the patient than enucleation with prior decompression or radical resection. Additionally, it shows no deficits in bone defect healing.
PubMed: 38735217
DOI: 10.1016/j.ijscr.2024.109752 -
Head and Neck Pathology May 2024Odontogenic lesions constitute a heterogeneous group of lesions. CLIC4 protein regulates different cellular processes, including epithelial-mesenchymal transition and...
BACKGROUND
Odontogenic lesions constitute a heterogeneous group of lesions. CLIC4 protein regulates different cellular processes, including epithelial-mesenchymal transition and fibroblast-myofibroblast transdifferentiation. This study analyzed CLIC4, E-cadherin, Vimentin, and α-SMA immunoexpression in epithelial odontogenic lesions that exhibit different biological behavior.
METHODS
It analyzed the immunoexpression of CLIC4, E-cadherin, and Vimentin in the epithelial cells, as well as CLIC4 and α-SMA in the mesenchymal cells, of ameloblastoma (AM) (n = 16), odontogenic keratocyst (OKC) (n = 20), and adenomatoid odontogenic tumor (AOT) (n = 8). Immunoexpressions were categorized as score 0 (0% positive cells), 1 (< 25%), 2 (≥ 25% - < 50%), 3 (≥ 50% - < 75%), or 4 (≥ 75%).
RESULTS
Cytoplasmic CLIC4 immunoexpression was higher in AM and AOT (p < 0.001) epithelial cells. Nuclear-cytoplasmic CLIC4 was higher in OKC's epithelial lining (p < 0.001). Membrane (p = 0.012) and membrane-cytoplasmic (p < 0.001) E-cadherin immunoexpression were higher in OKC, while cytoplasmic E-cadherin expression was higher in AM and AOT (p < 0.001). Vimentin immunoexpression was higher in AM and AOT (p < 0.001). Stromal CLIC4 was higher in AM and OKC (p = 0.008). Similarly, α-SMA immunoexpression was higher in AM and OKC (p = 0.037). Correlations in these proteins' immunoexpression were observed in AM and OKC (p < 0.05).
CONCLUSIONS
CLIC4 seems to regulate the epithelial-mesenchymal transition, modifying E-cadherin and Vimentin expression. In mesenchymal cells, CLIC4 may play a role in fibroblast-myofibroblast transdifferentiation. CLIC4 may be associated with epithelial odontogenic lesions with aggressive biological behavior.
Topics: Humans; Epithelial-Mesenchymal Transition; Chloride Channels; Cadherins; Odontogenic Tumors; Ameloblastoma; Vimentin; Adult; Female; Odontogenic Cysts; Male; Actins; Young Adult; Middle Aged; Antigens, CD; Adolescent
PubMed: 38727794
DOI: 10.1007/s12105-024-01646-1 -
Journal of Stomatology, Oral and... May 2024This study aimed to assess the diagnostic performance of a machine learning approach that utilized radiomic features extracted from Cone Beam Computer Tomography (CBCT)...
This study aimed to assess the diagnostic performance of a machine learning approach that utilized radiomic features extracted from Cone Beam Computer Tomography (CBCT) images and inflammatory biomarkers for distinguishing between Dentigerous Cysts (DCs), Odontogenic Keratocysts (OKCs), and Unicystic Ameloblastomas (UAs). This retrospective study involves 103 patients who underwent jaw lesion surgery in the Maxillofacial Surgery Unit of Federico II University Of Naples between January 2018 and January 2023. Nonparametric Wilcoxon-Mann-Whitney and Kruskal Wallis tests were used for continuous variables. Linear and non-logistic regression models (LRM and NLRM) were employed, along with machine learning techniques such as decision tree (DT), k-nearest neighbor (KNN), and support vector machine (SVM), to predict the outcomes. When individual inflammatory biomarkers were considered alone, their ability to differentiate between OKCs, UAs, and DCs was below 50 % accuracy. However, a linear regression model combining four inflammatory biomarkers achieved an accuracy of 95 % and an AUC of 0.96. The accuracy of single radiomics predictors was lower than that of inflammatory biomarkers, with an AUC of 0.83. The Fine Tree model, utilizing NLR, SII, and one radiomic feature, achieved an accuracy of 94.3 % (AUC = 0.95) on the training and testing sets, and a validation set accuracy of 100 %. The Fine Tree model demonstrated the capability to discriminate between OKCs, UAs, and DCs. However, the LRM utilizing four inflammatory biomarkers proved to be the most effective algorithm for distinguishing between OKCs, UAs, and DCs.
PubMed: 38719192
DOI: 10.1016/j.jormas.2024.101912