A Rare Case: Multiple Mandibular Arteriovenous Malformation with High Output: May a Tooth Extraction Alone Turn to a Catastrophic Condition?

Background: Arteriovenous malformations (AVM) in mandible and neck are potentially life-threatening conditions because of possible massive hemorrhage. They are often first diagnosed by dentists as bleeding. In this case, we report how a tooth extraction turned to a catastrophic condition in a patient with multiple AVMs in the mandibular, submandibular and hyoid region. Case: A 19-year-old male patient diagnosed with AVMs in the mandibular and submandibular regions was admitted to our hospital with the complaint of leaky hemorrhage around the lower left 3rd molar tooth. Tooth extraction was planned after embolization procedure. The patient was intubated uneventfully using video laryngoscope. However, an acute bleeding of more than 1600 ml occurred in one minute just after the mouth opener was inserted. The patient was transferred to the Interventional Radiology and other branches of the high-flow AVM were embolized. The patient was taken back to the operating room and the tooth was extracted uneventfully. Conclusion: In AVM cases, trauma should be minimized during induction of general anesthesia and intubation should be performed gently with fiberoptic bronchoscopy or video laryngoscopy. We conclude that a multidisciplinary approach as applied to our patient would be valuable in such cases.

The Effect of Simvastatin on mRNA Expression of Transforming Growth Factor-β1,Bone Morphogenetic Protein-2 and Vascular Endothelial Growth Factor in Tooth Extraction Socket

Aim To determine the effect of local simvastatin application on the mRNA expression level of transforming growth factor-β1 （TGF-β1）, bone morphogenetic protein-2 （BMP-2） and vascular endothelial growth factor （VEGF） in the tooth sockets of rat. Methodology Forty-eight male Wistar rats were randomly divided into experimental and control groups （n=24）. Polylactic acid/polyglycolic acid copolymer carriers, with or without simvastatin, were implanted into extraction sockets of right mandibular incisors. The expression of TGF-β1, BMP-2 and VEGF mRNA was determined by in situ hybridization in the tooth extraction socket at five days, one week, two weeks and four weeks after implantation. Results The fusiform stroma cells in the tooth extraction socket began to express TGF-β1, BMP-2 and VEGF mRNA in both experimental and control groups from one week after tooth extraction until the end of experiment. The expression of TGF-131 and BMP-2 mRNA in the experimental group was significantly up-regulated after one, two and four weeks, and expression of VEGF mRNA was significantly increased after one and two weeks compared with that in the control group. Conclusion The findings indicate that local administration of simvastatin can influence alveolar bone remodeling by regulating the expression of a school of growth factors which are crucial to osteogenesis in the tooth extraction socket.

Fate of root shell after pontic/socket shield techniques,is it better to extract the whole tooth?

A series of changes occur in the remaining alveolar process after whole tooth extraction.The basic question is,why do the bony walls(especially the labial/buccal)get resorbed immediately after the tooth is removed?This could be because,with cementum of the concerned tooth and its periodontal ligament,the supporting bundle bone is dependent on the presence of the tooth.This loss can be compensated using numerous techniques,such as socket grafting using various biomaterials to preserve the alveolar bone and buccal grafting with guided tissue regeneration to increase the thickness of buccal bone or placement of implant immediately.However,none of these techniques prevent the modelling of the alveolar bone post-extraction.Few studies have demonstrated that preservation of the roots in the alveolar process maintains the bone volume and facilitates vertical bone growth.A histological study in animals and humans has shown that the retained root shell does not pose any interference in the osseointegration of the implant(if placed simultaneously).Although various names have been proposed to describe the concept of retaining full or part of the root to prevent the resorption of the ridge,socket-shield and pontic-shield are the two most commonly used terms worldwide.The extraction of the whole tooth might be the choice of therapy when socket-shield or pontic-shield is not possible due to anatomical variations,infections,or lack of clinical expertise.Irrespective of the size,when a whole root or a root fragment(is left in situ),it is the dentist’s ethical duty to advise/inform the patient and ensure repeated clinical and radiographic follow-up.The present study aimed to highlight the current status of these techniques,their benefits,and possible complications and address whether the paradigm of the teeth extraction methods should be altered.

Orbital apex syndrome after tooth extraction in an immunocompromised patient

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

Oral Health Determinants and Demographic Factors of Permanent Tooth Extraction in Iranian Adults

Preservation of teeth until old ages indicates oral health status. Improving life expectancy in developing countries makes teeth care an important topic. This study assessed reasons of tooth extraction (TE), oral health determinants and demographic factors of permanent TE in Iranian adults. Adult people who referred to dental clinic of Mashhad Medical University in 2012 for dental extraction and lived in Mashhad city, participated in this study by convenient sampling method after obtaining informed consent. Demographic characteristics, oral health status, health habit and reasons of TE of participants were assessed. Data were analyzed by SPSS11.5 by Chi-Square, T-Test, ANOVA, Mann-Whitney and Kruskall-Wallis tests. Totally 254 people participated (383 extracted teeth) that 55% were female. Mean age of participants was 39.3 years;females were 6.1 years younger than males. The main reason of TE was dental caries (55.1%), following by impaction. There was significant difference between average times of tooth brushing in both sexes, but difference was not shown in sugar intake. Except in people with college degrees that dental caries is the main cause of TE. With increase in life expectancy to more than 70 years old in Iranian, the age of TE especially in women is younger than expected. The most common cause of TE is dental caries that seem in spite of improving health indexes in Iran, poor oral hygiene remains as a problem. There is no significant difference between frequency of sugar intake and level of education that indicates unhealthy dietary habits related to tooth decay.

Design of Collagen-Based Sponge Device for Use in Oral Surgery

This study aims to develop various types of collagen devices for use in oral surgery. The targets are the sheet-shaped sponges to cover mucosal defect wounds (product-1) and gingival defect wounds (product-2) and the cylindrical sponge to fill tooth extraction sockets (product-3). The sheet-shaped sponges were manufactured by freeze-vacuum drying the aqueous solution of collagen (Col) and heat-denatured collagen (Col’) at a composition ratio of 2/1, 1/1 or 1/2. Both surfaces of the sheet-shaped sponge were treated by ultraviolet (UV) irradiation for 5, 10 or 15 minutes to introduce intermolecular crosslinks between collagen molecules. The elution behavior of each collagen sponge was investigated by immersing the sponge in water for a predetermined time and then by measuring the weight change. The collagen sponge composed of Col and Col’ with a composition ratio of 2/1 that was treated by UV irradiation for 15 minutes showed very slow elution properties. This sheet-shaped sponge is the top candidate for product-1. The collagen sponge composed of Col and Col’ with a composition ratio of 2/1 that was treated by UV irradiation for 5 minutes showed slightly fast elution properties. This sheet-shaped sponge is the top candidate for product-2. Next, the cylindrical sponge was manufactured by freeze-vacuum drying the aqueous solution of Col and Col’ at a composition ratio of 2/1. Both sides of the cylindrical sponge were treated by UV irradiation for 15 minutes. This sponge showed initially fast elution properties and subsequent very slow elution properties. This cylindrical sponge is a good candidate for product-3. As a basic design, the sheet-shaped sponge and the cylindrical sponge should be biodegraded and absorbed by the time new tissue formation is completed.

Evaluation of success rates of immediate and delayed implants after tooth extraction

Objective To evaluate the success rates of immediate and delayed placement of implants with respect to the causes of tooth extraction and implant positions.Methods A total of 310 dental implants (immediate implants∶delayed implants=76∶234) were inserted into 80 patients. The types,sizes and positions of the implants and the causes of tooth extraction were recorded. We then investigated the relationship of implant loss with the causes of tooth extraction and placement methods. Results A higher failure rate was found for the implants in the posterior region of the maxilla,and when periodontitis was cited as a reason for tooth extraction. The overall success rates were 93.4% and 95.7% in the immediate and delayed implant placement groups,respectively,after a 2-year follow-up. No obvious relationship of success rate was observed with the implant placement method,cause of tooth extaction,and implants’ position. Conclusion The immediate placement of implants into fresh extraction sockets could offer advantages over the delayed implant placement. It seems to be a safe and predictable method for patients.

The Application of Xenograft Materials in Patients with Minimally Invasive Tooth Extraction and Implant Restoration

Objective:The application effect of xenograft materials in patients with implant restoration after minimally invasive tooth extraction is explored.Methods:From February 2016 to December 2019,80 patients with minimally invasive dental implants were treated in our hospital and selected as the research object.They were divided into the observation group and the control group based on to the random number table methods,and 40 patients in each group.The patients in the control group were sutured directly after minimally invasive tooth extraction.After the minimally invasive tooth extraction in the observation group,Bio-Oss Collagen was implanted into the alveolar fossa,which was covered with Bio-Gide absorbable biofilm.Changes in the height of the mastoid,the width and height of the crest crest,and the width of the lip between the two groups of patients immediately and 6 months after the tooth extraction were compared.Results:Changes of the alveolar ridge height and width in the observation group were less than those in the control group,and the difference was statistically significant(t=5.816,3.997,and P=0.000);the width of lip and tongue and the height of the interdental mastoid in the observation group.The amount of change was less than that in the control group,and the difference was statistically significant(t=7.384,10.686,and P=0.000).Conclusion:Bio-Oss Collagen and Bio-Gide absorbable biofilms have significant clinical effects on patients with minimally invasive tooth extraction and implant restoration,helping to maintain the stability of the alveolar ridge height and width,which is conducive to the creation of later dental implants in good conditions.