Javad Yazdani

Mandibular Angle Fractures: Comparison of One Miniplate vs. Two Miniplates

Background Monocortical miniplate fixation is an accepted and reliable method for internal fixation of mandibular angle fractures. Although placement of a second miniplate may theoretically provide more stability; however, the clinical importance of this issue remains controversial. Objectives The present study assessed the postoperative complications and outcomes associated with the fixation of mandibular angle fractures using 1 and 2 miniplates in patients with favorable mandibular angle fractures. Patients and Methods A prospective study of 87 patients (73 males, 14 females) with favorable mandibular angle fractures was done. In the first group, a 4-hole miniplate was placed at the superior border through an intraoral approach. In group 2, patients were treated with 2 miniplates, one placed at the superior border (similar to group 1) and the other on the lateral aspect of the angle at the inferior border through an intraoral and transcutaneous approach using a trocar. Postoperative complications including malocclusion, malunion and sensory disturbances associated with surgery, additional maxillomandibular fixation (MMF) by means of an arch bar and wires for a longer period (for delayed union) and infection were assessed in patients of both groups up to 12 months postoperatively. The data were analyzed using the chi-square test. Results In the single miniplate group, 25 patients showed lip numbness associated with surgery (55.6%), 22 patients required additional use of MMF (48.9%) and 3 patients developed infections (6.7%). In the double miniplate group 20 patients showed lip numbness associated with surgery (47.6%), 18 patients required additional use of MMF (42.9%) and 1 patient developed infection (2.4%). None of the patients in either group showed malocclusion or malunion. No significant difference was observed between the groups regarding overall complication rate. Conclusions In this study, use of one miniplate or two miniplates for treatment of favorable mandibular angle fractures was associated with a similar incidence of complications. Thus, it seems that the use of two miniplates in this setting may not be warranted, nor cost-efficient.

Comparison of the Effect of Mouthwashes with and without Zinc and Fluocinolone on the Healing Process of Erosive Oral Lichen Planus

Background and aims Lichen planus is a chronic inflammatory disorder with unspecified etiology, appearing as a result of stress, genetic predisposition and immunologic factors. Erosive type of the disease is more important because of its clinical symptoms of pain, irritation and malignancy risk. Despite various medications used, a definite cure for lichen planus is un-known. Regarding the effect of zinc on healing of ulcers, the aim of this study was to compare the effect of a mouthwash with and without zinc and fluocinolone on healing of erosive oral lichen planus. Materials and methods Twenty randomly-selected patients with erosive oral lichen planus were divided into two groups of 10. One group received zinc mouthwash with fluocinolone ointment and the other group received placebo with ointment. The largest dimension of the ulcers was measured by digital calipers and the intensity of pain was determined by visual ana-logue scale. Data was analyzed with Mann-Whitney U test. Results Pain, irritation and lesion surface area decreased in both groups. Decrease in pain severity was identical in both groups (P = 0.11). However, decrease in surface area with zinc mouthwash plus fluocinolone was more than that with only fluocinolone (P = 0.037). Conclusion 0.2% zinc mouthwash plus fluocinolone and only fluocinolone were both effective in decreasing pain, irrita-tion, and surface area of OLP. However, decrease in surface area with zinc mouthwash plus fluocinolone was more than that with fluocinolone alone.

Comparing the effect of 3 orthognathic surgical methods on the mandibular range of movement.

Background: Mandibular setback for the treatment of mandibular prognathism is a common orthogenetic surgical procedure carried out using various intraoral and extraoral methods. Reduced mandibular movement range (MMR) is one of the common complications of this surgery. Objectives: The aim of this study was to compare the reduction of MMR after 3 surgical procedures including sagittal split osteotomy (SSO), intraoral vertical ramus osteotomy (IVRO), extraoral vertical ramus osteotomy (EVRO). Methods: In this clinical trial, 150 patients with mandibular prognathism were divided into 3 groups of 50 patients. In the first group, mandibular setback was performed using SSO; in the second group, we used IVRO, and EVRO was the method used in the third group. In each group, before and 3 months after the surgery, maximum interincisal opening and the range of right and left lateral and protrusive movements were measured and compared. Results: Although the mean amount of MMR reduced in all the groups, it was not equal in all the groups. Sagittal split osteotomy and the EVRO resulted in the most and least reduction of MMR, respectively. Conclusions: Reduced MMR is one of the complications of SSO, IVRO, and EVRO; however, SSO resulted in the most and EVRO in the least effect on limitation of movement after surgery.

Central giant cell granuloma of the posterior maxilla: a case report

Central giant cell granuloma (CGCG), formerly called giant cell reparative granuloma, is a non-neoplastic proliferative lesion of unknown etiol-ogy. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as CGCG. We describe a case of CGCG arising from the poste-rior maxilla to highlight the importance of histo-pathology in the diagnosis of this enigmatic le-sion.

Developmental Odontogenic Cysts of Jaws: A Clinical Study of 245 Cases

Background and aims The aim of this study was to investigate the relative frequency of developmental odontogenic cysts in an Iranian population. Materials and methods In this study 245 cysts from both jaws, treated in the Faculty of Dentistry at Tabriz University of Medical Sciences during a 10-year period from 1998 to 2008, were analyzed in order to evaluate the incidence of such cysts. We had permission from all the patients. Case histories of 65% of male and 35% of female patients were analyzed. The age of the patients varied from 14 to 64 years, with an average of 33.21 ± 10.89. Results In this 10-year study of odontogenic cysts, 97 cases were developmental odontogenic cysts with the following inci-dence: dentigerous cyst, 44%; odontogenic keratocyst, 36%; primordial cyst, 9%; Gorlin cyst, 2%; lateral periodontal cyst, 3%; eruption cyst, 3%; and gingival cyst, 3% (adults 2%, infants 1%). A total of 60% of the cysts were found in the mandible and 40% in the maxilla. Regarding the mandible, the molar region was involved in 47% of the cases, premolar region in 33% and anterior region in 20% (total = 100%). Regarding the maxilla, the canine-to-canine region was involved in 52% of the cases, premolar region in 20% and molar region in 28% (total = 100%). Conclusion An important finding in this study was the fact that 39% of the jaw cysts were developmental odontogenic cysts and the most common developmental odontogenic cysts were dentigerous cyst and OKC (odontogenic keratocyst).

Comparison of the Inclination of Unerupted Mandibular Third Molars on Panoramic Radiography and Casts Made after Surgical Incision

Background and aims Panoramic radiographs are used for surgical planning of unerupted third molars. The major prob-lems associated with panoramic radiography include unequal magnification and geometric distortion of the image. The purpose of this study was the clinical evaluation of the effect of radiographic distortion on the position and classification of unerpted mandibular third molars. Materials and methods Panoramic radiographs of 20 patients with indication for extraction of lower third molars were included in this study. On the day of surgery, a silicon impression was taken from the second and third molar region and poured with type IV gypsum to provide a study cast. The inclination of the lower third molar to the second molar on panoramic radiog-raphy was compared with this angulation on the study casts. Results There was a mean difference of 5.75° ± 1.65 between the position of the lower third molar on panoramic radiographs and on study casts. Student’s t-test indicated a statistically significant difference (P < 0.05). Conclusion Panoramic radiography tends to exhibit a more mesial position of the third molars; however, panoramic radiog-raphy can still be used as the main tool for surgical planning of lower third molars.

Efficacy of radiographic density values ofthe first and second cervical vertebrae recorded by CBCT technique toidentify patients with osteoporosis and osteopenia

Background. Osteoporosis is a systemic skeletal disease characterized by a decrease in bone strength with an increase in the risk of fractures. This study aimed at evaluating the ability to predict osteoporosis and osteopenia based on radiographic density values obtained from CBCT imaging technique. Methods. CBCT images of 108 patients were prepared by using NewTom VGI (QR, Verona, Italy). Then the patients were assigned to osteoporosis, osteopenia and healthy group, using the T-score derived from the DEXA technique. Finally, RD of the lateral mass of C1 on the left and right sides and body and dens of the C2 were measured. RD values were compared between the three groups by one-way ANOVA, followed by an appropriate post hoc test. Results. The results of the comparisons of RD values at the first and second cervical vertebrae in the three groups showed that all the values had statistically significant differences (P<0.05). The most precise diagnosis of osteoporosis was related to the RD values of the body of C2 and left lateral mass of C1 that was equal to 99% and their cut-off points were 375 and 386, respectively. Conclusion. Based on the findings of this study, it is possible to predict the osteoporosis status of the patient through the RD related to the body of C2 and the left lateral mass of C1 more accurately than the other areas.,

Evaluation of Glove Damage during Dental Procedures among Dental Specialists in Tabriz

Background and aims Dental practitioners are prone to occupational risk of infection. This can be prevented in part by wearing gloves. However, for this to be effective, gloves should be intact during the entire course of dental procedure. Leaky surgical latex gloves have been seen in 0.9% of cases before use. As much as 1.9% of latex gloves have been reported to be damaged during dental procedures. In this study, we decided to assess glove damage during dental procedures among dental specialists in Tabriz. Materials and methods Thirty-six dental specialists were selected for this study. Each practitioner received 40 pairs of intact powdered latex gloves. Upon the completion of dental procedures, the gloves were retrieved and any tears were evaluated separately for right and left hands. Data was analyzed using chi-square test. Results 159 punctures were detected in 144 gloves (5%) out of 2880 unpaired gloves used by practitioners. They noticed the tear(s) in 60 cases (2%), however, 99 cases (3%) of tear(s) were not noted during the procedure. The highest rate of glove damage was observed in the prosthodontists’ group (12.3%), which was statistically significant comparing to other groups (p=0.048). The lowest rate of the damage was observed in the oral surgeons’ group (2%) which showed no significant difference (p=0.134). The highest rate of punctures in the gloves was observed in the first and second fingers of the non-dominant hand. Conclusion The damage to 5% of the gloves is highly significant, with a potential role in occupational hazards. The higher rate of leaks in the prosthodontists’ group compared to other groups demands for greater prudence in this field. The high rate of leaks in the first and second fingers of the non-dominant hand requires more attention to this area during daily practice.