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PURPOSE: To investigate whether there were any significant differences in the mode of presentation, treatment, and outcome of patients presenting with a primary diagnosis of ameloblastoma in Glasgow, Scotland and San Francisco, CA. MATERIALS AND METHODS: All cases of ameloblastoma seen in both institutions between January 1, 1980 and December 31, 1999 were included in this study. Mode of presentation, radiographic appearance, histologic appearance, treatment, and follow-up were recorded. RESULTS: There were no significant differences in the clinical features on presentation (swelling, followed by pain, and altered sensation), the radiographic appearance (unilocular approximately 30% and multilocular 70%), or management with either local treatment (enucleation and/or curettage in just over 50% of cases) or radical treatment (a form of resection in under 50%) in the 50 cases included in this study. Primary care by conservative treatment led to a recurrence in approximately 80% of cases and this included cases of unicystic ameloblastoma. CONCLUSION: The mode of presentation, diagnosis, and management of the ameloblastoma was remarkably similar in Glasgow and San Francisco. The recurrence rate following local enucleation and curettage was unacceptably high, and this included the cases of unicystic ameloblastoma, which should be treated more aggressively than has been recommended in the past. Copyright © 2006 by the American Association of Oral and Maxillofacial Surgeons. [ABSTRACT FROM AUTHOR]

We present a case of an infection on a zygomaticus implant presenting on the skin, mimicking a cutaneous carcinoma, and presenting to a head and neck tumor board. The clinical findings were an intermittently discharging lesion over the zygomatic bone, which resolved upon removing the offending zygomaticus implant. It is essential to be aware that infections on a zygomaticus implant can occur well away from the normal tooth-bearing areas, and having a dentist with knowledge of these implants on a tumor board can prevent misdiagnosis and treatment.

Objective: This study attempted to understand the specific motivations of patients who undergo orthognathic surgery and determine their satisfaction with the surgery. The study also assessed the prevalence of complications and how they may impact patient satisfaction., Study Design: Patients who underwent orthognathic surgery at the University of California between 2016 and 2019 and had completed postoperative orthodontic treatment for ≥9 months were interviewed. They responded to an open-ended telephone interview regarding their motivations, satisfaction, and complications., Results: The patients showed a high level of satisfaction with the surgery, but there were persistent complications that affected satisfaction. The predominant complication was paresthesia over the distribution of the inferior alveolar nerve. The majority of patients who reported prior headaches and temporomandibular joint problems described improvement in those areas. Comparing the patients' motivations before and after surgery showed that before surgery, patients reported functional concerns, whereas postoperatively they were much more likely to recall aesthetic reasons for the surgery., Conclusion: This study showed that although patients are generally satisfied after orthognathic surgery, patients need to be realistically informed of their expectations and adequately informed of possible complications., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To determine why some implants can appear to be well osseointegrated with no signs of infection and yet can remain sensitive to percussion and painful and unable to tolerate the weight of a restoration., Study Design: Five patients were identified who between them had 7 implants that met the criteria of being persistently painful and sensitive to percussion while appearing to be well integrated and otherwise disease free. High-definition cone beam computed tomography scans were obtained for all patients. All patients had failed medical treatment., Results: The cone beam computed tomography scans showed radiolucent channels running from the nearest nerve trunk to the vicinity of the sensitive implants. These may represent neurovascular channels that originally supplied the teeth that were present at the site of the implants, and they may have terminal neuromas that neuromas may be irritated by the implant. In all cases removal of the offending implant caused either substantial or complete relief of discomfort., Conclusion: The presence of terminal neuromas within the jaws may be responsible for persistent pain and sensitivity in an otherwise well-integrated and disease-free implant. Removal of the offending implant appears to be the only treatment., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: To assess the long-term recovery of sensation in the lower lip after mandibular resection without reconstruction of the inferior alveolar nerve., Material and Methods: Thirty patients who had mandibular resection carried out without reconstruction of the inferior alveolar nerve were examined after an interval ranging from 6 to 33 years., Results: Only 1 patient, seen 10 years after resection, was totally numb over the distribution of the inferior alveolar nerve. The other 29 patients had some return of sensation and many had a significant return, though it may take several years to reach the final result. Utilizing the MRC scale 70% of patients achieved S3 (return of superficial cutaneous pain and tactile sensibility without over response) CONCLUSION: This study can serve as a baseline for comparison with patients who have had mandibular resection with reconstruction of the inferior alveolar nerve to assess if this procedure improves the outcomes., (Copyright © 2021 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Denosumab has been suggested as a medical treatment for central giant cell granuloma of the jaws. This study included eight patients, seven female and one male, aged between 19 and 32 years, with biopsy-proven central giant cell granuloma of the mandible. The patients were treated with subcutaneous injections of 120 mg of denosumab in a regime consisting of three injections at weekly intervals followed by five injections at monthly intervals over a 6-month period. They were followed up for between 60 and 71 months clinically and radiographically with panoramic radiographs and cone beam computed tomography scans. All of the lesions became calcified radiographically and asymptomatic clinically. They did not reduce in size, but to date only one patient has requested surgical remodeling. There has been no recurrence or regrowth in over 5 years., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Two cases are shown to demonstrate stress shielding in nonvascularized bone grafts to the mandible to reconstruct segmental defects, where rigid fixation is used. The effects are reversed on removal of the rigid fixation., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

This article reports a type of localized osteonecrosis that can occur in patients who have had successful osseointegrated implants for many years and then commence anti-resorptive therapy. Eleven female patients were identified who had successful implant insertion, but who were placed on anti-resorptive therapy (bisphosphonates or denosumab) several years later and developed osteonecrosis around the implants. In each case, the osteonecrosis occurred only around the implants and not around the patient's remaining teeth. The implants of eight patients were removed with a sequestrum of bone tightly adherent to the implant. This is different from the normal pattern of implant failure. Implant failure can occur when patients with successfully integrated implants are later placed on anti-resorptive therapy, and the osteonecrosis takes a particular form where a sequestrum forms that remains adherent to the implant. Why the adjacent remaining teeth are not affected is unclear., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The concept of socket preservation by placing a particulate bone allograft or xenograft into a tooth socket or on the alveolar ridge after tooth removal remains a somewhat controversial topic. The concept is that it will preserve the ridge from resorption and such that subsequent implant insertion will be easier, with fewer complications. However, one particular issue is that these materials, although not directly neurotoxic, appear to be an irritant to the nerves if they come in contact with them. We present a case series demonstrating this complication., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Many forms of dental treatment have the potential to cause injury to the oral branches of the trigeminal nerve, including local anesthetic injections, root canal therapy, implant insertion, bone grafting, and dentoalveolar surgery. Based on the records of a referral center with more than 30 years' experience in managing 3200 of these injuries, this article reviews etiology and prevention; suggests criteria for referral of patients; and discusses treatment for the various types of injury and the results of such treatment.

Desmoplastic fibromas are rare, benign, but aggressive lesions, affecting predominantly young people, with an affinity for the mandible. Four patients with desmoplastic fibromas of the mandible, seen between 1995 and 2015 with long-term follow-up, were identified. Three were treated by wide mandibular resection and immediate reconstruction with rib grafts, and one was treated with chemotherapy. In the three resected cases, there has been no recurrence and all rib grafts were successfully incorporated. The case treated by chemotherapy has persistence of the tumour, but it is not progressing. Desmoplastic fibromas in young children respond well to wide mandibular resection and immediate reconstruction with rib grafts. Chemotherapy may halt progression., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to identify whether there is scientific evidence to support excision of the overlying mucosa (EOM) in conjunction with cyst enucleation to decrease the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs)., Materials and Methods: A systematic review with meta-analysis conforming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of 3 major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date or language restrictions from inception to December 2015. Eligible articles were selected based on the following inclusion criteria: randomized, prospective, or retrospective studies comparing enucleation with EOM to enucleation without EOM for patients with KOTs. The predictor variable was treatment group (enucleation with EOM vs enucleation without EOM). The outcome variables were RR of KOTs, presence of epithelial islands and microcysts in the excised overlying mucosa, and correlation between recurrent cortically perforated KOTs. A weighted RR and odds ratio (OR; using a random- or fixed-effect model) and the Mantel-Haenszel test with 95% confidence interval (CI) were performed using comprehensive meta-analysis software., Results: Eleven studies were included in this review. There was no significant difference between enucleation with and without EOM (random; OR = 3.259; 95%, 0.975-10.901, P = 0.055). The weighted event rates for enucleation with Carnoy's solution plus EOM and enucleation without EOM in cortically perforated lesions were 6.2% (random; 95% CI, 2.6-14) and 9.1% (random; 95% CI, 1.6-38.2), respectively. The weighted event rate for the presence of epithelial islands and microcysts in overlying mucosa of KOTs was 68.8% (random; 95% CI, 27.2-92.9)., Conclusion: The results of this study suggest that enucleation of KOTs plus the use of Carnoy's solution or liquid nitrogen (when indicated) should be combined with EOM to obtain the lowest RR, specifically for retromandibular trigone, posterior maxillary, and cortically perforated lesions. However, the results from this study do not provide sufficient scientific evidence for EOM in combination with enucleation of KOTs., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the specific inclusion criteria. A weighted RR and odds ratio (OR) using a Mantel-Haenszel (M-H) test and random effect model with 95% confidence interval (CI) were performed. Meta-regression analysis was conducted to further identify the influence of the duration of follow-up periods on the overall OR. A total of 997 KOTs enrolled in 14 studies were included in this analysis. There was a significant advantage for the enucleation ± adjuvant therapy group in preventing recurrence for patients with KOTs (M-H, OR, 0.514; 95% CI, 0.302-0.875; p = 0.014). The overall pooled weighted RR for enucleation ± adjuvant therapy and decompression ± secondary cystectomy were 18.2% and 27.1%, respectively. The meta-regression analysis showed that duration of follow-up time did not significantly influence the OR of KOT recurrence (Q = 0.506, p = 0.646). In conclusion, initial cystectomy ± adjuvant therapy was associated with fewer recurrences than decompression ± secondary cystectomy., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The most appropriate management for the lesion now known as the keratocystic odontogenic tumour (previously known as the odontogenic keratocyst) remains controversial. This article reviews the different management protocols adopted by one surgical unit over the last 30 years and the results obtained from the different treatment modalities. A current treatment protocol consisting of initial decompression followed by aggressive curettage and peripheral ostectomy with methylene blue staining appears to be successful, but our longest follow-up is only 6 years., (Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Coronectomy is considered in patients older than 25, where there is an intimate relationship between the roots of a retained lower third molar (occasionally second or first molars) and the inferior alveolar nerve, in noncontraindicated circumstances. It may be used on younger patients with a medium to high risk of inferior alveolar nerve damage. The decision to use this technique is made with the aid of cone-beam computed tomography scans. Short- to medium-term success rate is excellent, but long-term studies are not yet available. The technique is gaining wider acceptance, although there are differences in the indications and actual technique used within and between countries., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The Patient Protection and Affordable Care Act, or Obamacare, is now providing medical and dental insurance for millions of Americans who never had it before and will bring real benefits to the American healthcare system over the next few years. This article discusses its provisions and shows how dentistry fits in.

Dental education in the United States has changed considerably over the last 30 years and it could be argued that not all the changes are positive. The number of dental schools has increased and the number of graduates has increased, but the level of dental care in the country as a whole has not increased. The majority of US dental schools are now private and profit making and even the state schools need to generate income. The curriculum has also changed at the expense of the basic sciences.