Jackie E. Brown

Modern management of salivary calculi.

The aim was to investigate the results of a minimally invasive approach to the management of salivary calculi.

Outcome of Minimally Invasive Management of Salivary Calculi in 4,691 Patients

To evaluate the application of minimally invasive techniques in the management of salivary stones.

The anterior loop of the inferior alveolar nerve: prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging

OBJECTIVES Interforaminal implant surgery requires anatomical knowledge of the area and adequate information on the location of the various landmarks of significance such as the mental foramen, the anterior loop of the inferior alveolar nerve and the mandibular incisive canal. Cone beam computed tomography (CBCT) is a relatively new imaging modality that provides a multi-dimensional view of the facial skeleton with, in most instances, lower radiation dose to the patient compared to medical CT. The present study aims to use CBCT to identify and measure variation in the presence and extent of the anterior loop of the inferior alveolar nerve. This information may be used to provide recommendations to the surgeon without access to a 3D scan of the dento-alveolar region. MATERIAL AND METHODS Ninety-three patients scanned with a Newtom VG device for a variety of clinical indications were included in this retrospective study. Using the multiplanar capabilities of the devices software the prevalence and length of the anterior loop was assessed. RESULTS The results show that an anterior loop could be identified in 48% of the cases with a mean length (range) of 0.89 mm (0-5.7). CONCLUSIONS In almost half of the surveyed cases an anterior loop was present. Even though in 95% of the study cases the loop was <3 mm, a 100% safety margin in the placement of anterior mandibular implants, in the absence of a CBCT scan, would only be achieved with a distance of 6 mm between the anterior border of the mental foramen and the most distal interforaminal implant fixture.

Extracorporeal shockwave lithotripsy in the management of salivary calculi

The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor.

Clinical and Radiographic Assessment of the Efficacy of Calcium Silicate Indirect Pulp Capping A Randomized Controlled Clinical Trial

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).

Clinical and Radiographic Assessment of the Efficacy of Calcium Silicate Indirect Pulp Capping

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).

Balloon dilatation of salivary duct strictures: Report on 36 treated glands

Purpose: This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 affected glands. Methods: Thirty-four patients (36 glands) had balloon dilatation of their salivary duct strictures performed under fluoroscopic control. They were evaluated immediately afterwards and at review by sialography. Results: In 36 cases attempted, 33 (92%) strictures were dilated. The immediate post-treatment sialogram was available in 28 cases, of which 23 (82%) demonstrated complete and four (14%) partial elimination of stricture. In one case the appearance was unchanged (4%). Review data (mean 6.8 months) were available on 25 glands: 12 were asymptomatic (48%), 12 (48%) had reduced symptoms and one (4%) failed to improve. Sialographic data were available on 21 glands: in 10 (48%) the duct remained patent, in one (5%) the stricture was partially eliminated, in seven (33%) the strictures had returned and in the remaining three (14%) cases there was complete obstruction. Conclusions: Balloon dilatation is an effective treatment of salivary duct stenosis. In half the cases the stricture recurred but symptomatic improvement was achieved and maintained in the majority of cases.

Factors influencing the outcome of extracorporeal shock wave lithotripsy in the management of salivary calculi

To identify the factors that affect outcome (stone clearance, partial clearance without symptoms, and residual stone with symptoms unchanged) of extracorporeal shock wave lithotripsy (ESWL). To develop and validate a predictive model for outcome of treatment.

Minimally invasive radiologically guided intervention for the treatment of salivary calculi

Purpose: To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction. Methods: Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire. Results: Of 86 cases of sialolithiasis treated, in 55 (64%) it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1–49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed. Conclusions: Stone removal from the salivary duct system by radiologically guided, minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.

Minimally Invasive Techniques for the Treatment of Benign Salivary Gland Obstruction: A Review

This paper reviews the literature published on minimally invasive techniques developed to treat benign salivary gland obstruction. Techniques reported include extracorporeal and intracorporeal salivary gland lithotripsy, endoscopy and radiologically guided techniques for the extraction of calculi and dilatation of duct strictures. These techniques are described, their advantages and disadvantages discussed and their success rates compared. Recommendations are made on the most appropriate application of each technique.