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Impacted mandibular third molar extraction is one of the most frequent procedures performed in the field of oral surgery. Oral surgeons sometimes face cases that cannot be extracted using the conventional procedure because of atypical tooth structure or irregular tooth position in the mandible. Here, we report an unusual impacted third mandibular molar with atypical root form, which was extracted by buccal cortex osteotomy of the mandibular ramus. A 42-year-old Japanese female presented with a complaint of discomfort in the left molar region. Radiographical examination showed an impacted third molar with a mushroom-like root overlapping the mandibular canal. This lesion was radiographically diagnosed as cemental hyperplasia. The tooth could not be extracted using the conventional procedure, and buccal cortex osteotomy was applied. Briefly, bones necessary for extraction were removed once from the mandibular ramus. After extraction, the bony fragment was repositioned in the original position. The patient experienced no postoperative complications such as nerve paralysis, mandibular angle fracture, and infections. Buccal cortex osteotomy is a simple and easy technique to extract impacted mandibular third molars that cannot be extracted by conventional methods.

Objective Plasma rich in growth factors (PRGF) and platelet-rich plasma (PRP) can be rapidly obtained from patient blood. They are a new and potentially useful adjunct in oral and maxillofacial bone repair or regenerative surgery. The aim of this study was to compare the possibility of new bone formation using PRGF and PRP. Methods The osteogenic potential with transplantation of PRGF or PRP onto rat calvaria was evaluated by histologic examination and microCT. PRGF or PRP was prepared by centrifugation of rat whole blood (WB). First, the cells in the blood product were counted; there were no leukocytes in PRGF, and PRP included leukocytes. PRGF contained higher levels of TGF-β1 and PDGF-BB than PRP. Furthermore, PRGF or PRP was transplanted onto calvarial bone of rats. Results MicroCT showed that PRGF promoted an increase in bone volume when compared to PRP. Histological observation demonstrated that the PRGF group showed newly formed bone in a wide range. In addition, the PRP group showed numerous inflammatory cells compared to the PRGF group in HE-stained specimens. This suggests that PRP might delay bone regeneration due to the inflammatory response. Conclusions PRGF has more availability for bone regeneration than PRP, and PRGF may be useful in bone regeneration treatment.

Osteomas are uncommon, benign, slow-growing osteogenic tumors, arising from the bones, can be classified as central, peripheral, or extra-skeletal. Peripheral osteomas develop as masses attached to the cortical bone, and are mushroom-shaped masses protruding from the periphery of the jaw bones. Here we report an unusual solitary compact osteoma arising from the inferior border of the mandible but predominantly in the anterior belly of the digastric muscle. A 58-year-old Japanese woman had a hard mass in the submental region. Computed tomography showed a hyperdense, well circumscribed mushroom-like lesion measuring 2.1 × 1.2 cm in size, and the lesion was located from the inferior border of the mandible in the left anterior belly of the digastric muscle. The clinical and radiological diagnosis was peripheral osteoma. The patient underwent resection of the osteoma through the submental skin incision under general anesthesia. Intraoperatively, the mass was present in the anterior belly of digastric muscle, and the tendinous origin of the muscle adhered to not to the mass but to the mandible. Histopathological examination showed a compact osteoma. The postoperative course was uneventful and there was no recurrence 5 years after surgery.