- ItemOpen AccessPrevalence of neurovascular structures in the anterior mandible and differences based on dentition, age and sex; a retrospective cone-beam computed tomography study(2023-07-13) Demers, Xavier; Huen, Galvin; Sunil, Mutalik (Dentistry); Kelekis-Cholakis, Anastasia (Dentistry); Hryniuk, Alexa (Human Anatomy and Cell Science); Bhuller, Raj (Dentistry); Stavropoulou, ChrysiObjective: To assess the prevalence of lingual and incisive vascular structures in the anterior aspect of the mandible and to see the effect sex, age and dentition status may have. Methods: A total of 191 anonymized cone-beam computed tomography (CBCT) scans were assessed by a single calibrated operator. Incisive canals and lingual canals present between the mental foramina were counted, with location, size, dentition status in the lower anterior mandibular sextant, as well as the distance between the alveolar crest for the most coronal centered lingual canal being noted. Results: Lingual canals were present in the midline area in 96% and in the lateral areas in about 25% of cases. Incisive canals had a prevalence under 10% for a given area in the mandible. Most canals observed were below 1 mm in diameter. The most coronal lingual canal in the center was 2 mm closer to the alveolar crest in females and in patients showing a degree of edentulism in the anterior mandible, with dentate patients also showing an increased number of lingual canals below 1 mm in size at the midline. Furthermore, aging appeared to impact the presence of lateral lingual canals. Although unclear, the dentition status could also affect the presence of larger incisive canals. Conclusions: The anterior mandible features several structures visible on CBCT scans. The present findings suggest that sex, age and dentition status could have an effect on their presence. As such, the previous variables should be considered when planning surgical interventions in the area.
- ItemOpen AccessA prospective evaluation of peri-operative glucocorticoid use in the management of cervicofacial infections of odontogenic origin(2023-07-12) McCoy, Ryan; Shah, Adnan (Dentistry); Elgazzar, Reda (Dentistry); Mutalik, Sunil (Dentistry); Bhullar, Raj (Dentistry); Shah, Adnan; Elgazzar, RedaOdontogenic cervicofacial infections requiring inpatient management are treated in a routine manner by oral and maxillofacial surgeons in Manitoba. After a standardized pre-operative workup, patients undergo surgical intervention including extraction of necessary teeth and incision and drainage of associated abscess(es). Patients are treated post-operatively with antibiotics, steroids, and medications for supportive care until appropriate for discharge. Benefits of intravenous corticosteroids in patients undergoing dentoalveolar and maxillofacial surgery include improved comfort, reduced post-operative edema, and shortened time to recovery. Corticosteroids also aid in reducing the risk of morbidity by limiting mass effect from edema and associated airway obstruction. In addition, their anti-inflammatory effect limits further swelling from manipulation of soft tissues during surgical procedures. Current literature supports the use of corticosteroids in the management of primary and deep space neck infections. However, corticosteroid dosing regimens are currently determined by the clinical judgment of the attending surgeon and are not standardized. The purpose of this study was to provide guidance for optimal dosing of methylprednisolone in the management of odontogenic cervicofacial infections. This prospective study followed the inpatient course of 28 patients with various cervicofacial infections of odontogenic origin. All patients were treated with a standardized surgical protocol, antibiotics, and steroids. Patients were randomized to receive one of two methylprednisolone dosing regimens. 14 patients were assigned to receive one dose of methylprednisolone 125mg IV at the time of surgery. The remaining 14 patients received one dose of methylprednisolone 125mg IV at the time of surgery and three consecutive doses of methylprednisolone 125mg IV every six hours post-operatively. Patients were evaluated at the time of hospital presentation and daily throughout admission. Outcomes evaluated included C-reactive protein (CRP) levels, white blood cell (WBC) count, length of hospital admission, and trismus. By examining differences in outcome success variables, the goal of this study was to support future evidence-based dosing decisions in the peri-operative treatment of inpatients in Manitoba. Data analysis showed a greater reduction in CRP throughout admission in the four-dose methylprednisolone group that was statistically significant. No significant difference in daily WBC count or trismus was found.
- ItemOpen AccessEfficacy of maxillary tuberosity connective tissue grafts in periodontal and peri-implant soft tissue procedures: a systematic review(2023-03-21) Chung, Katie; Shah, Adnan (Dentistry); Soloman, Charlene (Dentistry); Cholakis, Anastasia (Dentistry); Stavropoulou, ChrysiThe objective of this systematic review was to assess the efficacy of maxillary tuberosity connective tissue grafts (MT-CTGs) in periodontal plastic surgeries at tooth and implant sites. An electronic search of literature in OVID, Embase, Cochrane and Scopus databases and a manual search up to August 2022 were performed to identify clinical studies at all levels of evidence with a minimum 3 month follow-up. Out of 880 potential publications, 10 studies were included, which included randomized controlled trials (RCTs), cohort studies and case reports. Due to study heterogeneity, a meta-analysis was not performed. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool, the Newcastle-Ottawa Scale and the JBI Critical Appraisal checklist. MT- CTGs were more commonly utilized for peri-implant soft tissue augmentation, with keratinized mucosa thickness gain of 3-4 mm. Favourable gingival recession and mucosal dehiscence coverage outcomes, and satisfactory aesthetic ratings were reported though untoward hyperplastic tissue reactions at treated sites have also been documented. The limited evidence suggests MT-CTGs to be a sound soft tissue graft choice which may perform as well as lateral palate CTGs in periodontal soft tissue surgeries. Their true effect is yet to be determined with more well-designed long-term RCTs.
- ItemOpen AccessA Prospective Quality Control Study on Methods Used for the Treatment of Non-Complicated Mandibular Angle Fractures by Open Reduction and Internal Fixation in Manitoba(2022-07-14) Howard, Ryan; Shah, Adnan (Dentistry); Elgazzar, Reda (Dentistry); Franca, Rodrigo (Dentistry); Shah, AdnanMandibular fracture is a common diagnosis that the Oral and Maxillofacial Surgeon is presented with, and its management is a critical skill for a competent trauma surgeon. One of the most commonly fractured regions of the mandible is that of the mandibular angle, found where the tooth-bearing corpus of the mandible meets the ascending ramus. While the mandibular angle fracture is a particularly common injury, there remains some openness in the interpretation of the best manner in which to establish fixation in these cases. The Oral and Maxillofacial Surgery Department at the University of Manitoba treats mandibular angle fractures by open reduction internal fixation using one of two typical plating orientations. The first method positions a miniplate angled along the superolateral aspect of the external oblique ridge spanning the fracture site, while the second method positions a miniplate strictly on the lateral aspect of the mandible across the fracture site. The purpose of this study was to compare the post-operative outcomes of these two plating methods. The study consisted of eighteen patients with mandibular angle fractures eligible for treatment by open reduction internal fixation that were randomly assigned to two treatment groups: Group A (N=8) with the miniplate oriented at the superolateral aspect of the mandible, and Group B (N=10) with the miniplate oriented on the lateral aspect of the mandible. Patients in each group were followed prospectively at 1-week, 4-week and 6-month post- operative time intervals for outcomes that included post-operative malocclusion, maximal interincisal opening, paresthesia, pain, swelling, development of infection, and surgical site dehiscence. There was no statistically significant difference found between the two plating orientation methods in each of the aforementioned outcomes.
- ItemOpen AccessVideoscope-assisted lateral maxillary sinus floor elevation: evaluation of the Schneiderian membrane for micro-perforations(2022-06-30) Ohnander, Sarah; Stavropoulou, Chrysi (Dentistry); Kelekis-Cholakis, Anastasia (Dentistry); Harrel, Stephen (Texas A&M University); Stavropoulou, ChrysiIntroduction: Sinus floor elevation procedures are of a moderate to high complexity, entailing a significant risk of complications. The most frequent and common intra-operative complication is perforation of the sinus membrane. For the lateral window technique, perforation rates of 10% to 20% have been documented. Several studies have reported a correlation between perforation of the membrane and failure of the graft, as well as post-operative infection. In order to help identify perforations early, the authors evaluated the Schneiderian membrane for micro-perforations. The purpose of this case series was to identify the incidence of micro- perforations during lateral maxillary sinus elevation surgery. Case Series: Lateral maxillary sinus floor elevation was performed on 8 patients. A surfactant solution was applied topically to the exposed Schneiderian membrane. The presence of micro- perforations was assessed by observing for a bubbling effect after slight positive pressure. Evaluations were recorded using a videoscope, which provided magnification and additional lighting at the surgical site. Data was collected after evaluation of the membrane intra- operatively; post-operatively, the recordings of the procedure were randomised and evaluated by three periodontists. Conclusion: Use of a surfactant solution and videoscope evaluation did not reveal any incidence of micro-perforations on the Schneiderian membrane during lateral sinus lift.