Search Results (417)

Background: Regenerative endodontic treatment (RET) has emerged as a biologically based alternative to traditional apexification for managing immature permanent teeth with pulp necrosis. By promoting tissue ingrowth and continued root development, RET aims not only to eliminate infection but also to reinforce structurally compromised roots. Although its clinical use has expanded, evidence regarding the long-term predictability and durability of RET remains limited, as most published studies provide only short- or mid-term follow-up. Case presentation: This report describes two pediatric cases involving regenerative procedures performed on three immature permanent maxillary incisors, each followed for more than six years. The first case involved a 7-year-old girl who developed pulp necrosis in a maxillary lateral incisor after acute dental trauma. Management followed a regenerative protocol using triple antibiotic paste (ciprofloxacin, metronidazole, and minocycline) as intracanal medication and mineral trioxide aggregate as the coronal barrier. The second case concerned an 8-year-old girl presenting with chronic infection and sinus tracts affecting both maxillary central incisors. These teeth were treated using a regenerative approach with calcium hydroxide as the intracanal medicament and Biodentine as the sealing material. Clinical, radiographic, and cone beam computed tomography evaluations demonstrated complete symptom resolution and periapical healing but incomplete progressive apical closure. All treated teeth developed a calcified apical barrier, and outcomes remained stable throughout the extended follow-up period. Conclusions: While inherently limited by the nature of case reports, these findings support RET as a reliable and durable therapeutic option for necrotic immature permanent teeth, including cases in which conventional apexification has not been successful. Full article

Iatrogenic maxillary sinusitis accounts for a significant proportion of unilateral sinus infections. This report describes a 36-year-old HIV-positive patient with Serratia marcescens chronic left maxillary sinusitis and ethmoiditis caused by migration of a dental implant into the maxillary sinus. The implant was successfully removed endoscopically via functional endoscopic sinus surgery. Histopathological examination revealed polypoid mucosa with chronic inflammation, while microbiological culture grew Serratia marcescens, an uncommon and opportunistic pathogen. Targeted antibiotic therapy with trimethoprim/sulfamethoxazole was administered for 20 days. Six-month follow-up revealed complete remission without recurrence of sinusitis. Full article

Background: We aimed to determine paranasal sinus volumes using 3D volumetric measurements and to evaluate the effect of anatomical variations on these volumes, ensuring balanced age and sex distribution during childhood. Methods: Thirteen age groups (0–16 years), each including 10 males and 10 females, were formed. After excluding sinus pathologies, a total of 260 subjects were randomly selected from CT head examinations. Right and left frontal, maxillary, and sphenoid sinus volumes were calculated using 3D Slicer software (version 5.6.2) following manual segmentation of axial CT slices. Also, the presence of right and left Agger Nasi cells, Haller cells, Onodi cells, and concha bullosa were recorded. Results: No significant difference was found between males and females in sinus volumes (p > 0.05). Mean right and left maxillary sinus volumes were 6.23 cm³ and 6.27 cm³ (p = 0.551); frontal sinuses were 0.79 cm³ and 0.86 cm³ (p = 0.170); and sphenoid sinuses were 1.64 cm³ and 1.85 cm³ (p = 0.041). Sphenoid sinus pneumatization appeared in 30% of the 0–6-month group and in over 75% of older groups. Frontal pneumatization began at age 2–3 and exceeded 50% after age 4. Agger Nasi, Haller, Onodi cells, and concha bullosa were detected in 58.8%, 31.2%, 10%, and 22.3% of cases, respectively. Anatomical variations showed no significant effect on sinus volumes (p > 0.05). Conclusions: We developed a paranasal sinus volume chart applicable to routine practice, showing that anatomical variations had no significant impact on the development. This is the first study to investigate the impact of anatomical variations on sinus development and volume, along with the age at which variations emerge, with a balanced distribution of age and sex. Full article

Objectives: This study aimed to comprehensively evaluate and compare the therapeutic effects of Right Angle Maxillary Protraction Appliance (RAMPA) therapy on nasal airway volume in pediatric patients, specifically differentiated by their baseline radiological paranasal sinus status. The objective was to quantify airway volume changes (absolute and percentage) in clear and opacified sinus groups, investigate the influence of age, sex, and treatment duration on these changes, and elucidate potential differences in the underlying mechanisms of airway expansion between groups. Study Design: A retrospective comparative cohort study design was employed. This study includes a “clear sinus group” of 26 patients (mean age: 6.6 years) with radiologically clear sinuses at baseline and an “opacified sinus group” of 20 patients (mean age: 6.8 years) diagnosed with rhinosinusitis and exhibiting significant sinus opacification on baseline CBCT scans. Upper airway volumetric measurements were performed using CBCT scans acquired pre- (T1) and post-treatment (T2), with data analyzed using Invivo 5 software. Results: RAMPA therapy significantly increased upper airway volume in both cohorts. The clear sinus group showed an approximate 18% mean increase (4886.9 mm³ absolute), while the opacified sinus group demonstrated a remarkably greater 61% mean increase (11,192.8 mm³ absolute). This difference was statistically significant. In the clear sinus group, airway volume gain positively correlated with treatment duration (p = 0.0303). Conversely, no significant correlation was found in the opacified sinus group (p = 0.288), suggesting rapid obstruction relief as a dominant mechanism. Sex did not significantly influence outcomes, and age was not a strong independent predictor of volume change magnitude. Conclusions: RAMPA therapy effectively increases upper airway volume in pediatric patients, with a substantially greater effect in those with baseline sinus opacification due to rapid obstruction resolution complementing skeletal changes. The mechanism of action differs by sinus status, with clear sinus patients showing gradual, duration-dependent skeletal adaptation and opacified sinus patients exhibiting immediate, duration-independent gains primarily from sinus clearance. These findings provide crucial insights for tailored clinical decision-making. Full article

Background: Primary intraosseous carcinoma (PIOC) is a rare and aggressive odontogenic malignancy that originates within the jaw bones without initial mucosal involvement. Its atypical and nonspecific symptoms frequently lead to diagnostic delays, especially in maxillary presentations. Methods: A 74-year-old male presented with persistent trigeminal-like neuralgic pain along the ophthalmic branch, initially misdiagnosed as secondary trigeminal neuralgia. MRI revealed a 45 × 46 × 34 mm mass occupying the right maxillary sinus with orbital wall destruction and dural invasion. Following histopathological confirmation of malignancy, a multidisciplinary team performed total maxillectomy with orbital exenteration and dural resection, followed by reconstruction using a temporoparietal flap. Adjuvant radiotherapy was administered. Results: Histopathology revealed invasive odontogenic carcinoma with atypical squamous features, dentinoid deposition, and perineural invasion. Postoperative recovery was uneventful, with complete pain resolution. MRI and PET surveillance over 2.5 years demonstrated no local recurrence. Conclusions: Maxillary PIOC may present exclusively with neuropathic pain, mimicking trigeminal neuralgia and leading to delayed diagnosis. In cases of unexplained facial pain with sinus or skull base involvement, odontogenic malignancies should be considered in the differential diagnosis. Early imaging and multidisciplinary management are key to achieving timely diagnosis, effective treatment, and improved quality of life. Full article

Background/objective: Maxillofacial fractures continue to represent a significant public health issue, with incidence patterns shaped by regional and demographic variables. This study aimed to deliver a comprehensive 15-year epidemiological analysis of maxillofacial trauma cases in southern Hungary. Methods: The study included patients who received treatment for maxillofacial trauma at the University of Pécs from 2009 to 2023. Data collected encompassed demographic characteristics, injury etiology, fracture location and complexity, date of injury, presence of alcohol involvement, therapeutic interventions, postoperative complications and reasons, and number of fixation plates removed. Descriptive statistics and odds ratios were calculated, with statistical significance defined as p < 0.05. Results: Among 1948 patients (69.9% male), a total of 2826 fractures were reported, averaging 1.45 fractures per patient. The most frequently affected age group was 21–30 years; however, a notable increase in cases among the elderly was observed for recent years. Falls accounted for the highest proportion of injuries (44.4%), followed by assaults (28.3%) and traffic accidents (16.8%). Injuries predominantly occurred on weekends, with Saturdays being particularly common. Alcohol consumption was documented in 14.7% of cases. The condyle (27.9%), body (25.7%), and angle (25.0%) were the most common sites of mandibular fracture. The maxillary sinus and zygomatic body were the leading sites of maxillofacial fractures. Conservative treatment was implemented in 54.6% of all cases, whereas surgical intervention was more frequently required for mandibular injuries (76.7%). Plate removal was performed in 15.3% of patients. Conclusions: During the study period, the incidence of maxillofacial trauma demonstrated a consistent increase, accompanied by demographic changes indicative of an aging population and a reduction in assault-related cases. Falls—especially among older adults—became the leading cause of injury. These results emphasize the necessity for targeted prevention efforts, geriatric-specific trauma management, and the implementation of health policies tailored to regional needs. Full article

Background: Impaired mucus drainage from the paranasal sinuses is often associated with nasal obstruction and reduced airway function in growing patients. Orthopedic maxillary protraction and expansion techniques can enhance airway dynamics, but their underlying fluid–structure mechanisms remain insufficiently understood. Objective: To validate that the Right Angle Maxillary Protraction Appliance (RAMPA), combined with a semi-rapid maxillary expansion (sRME) intraoral device gHu-1, improves mucus drainage by enhancing nasal airflow through nasal cavity expansion. Methods: The effects of RAMPA therapy were analyzed using computational fluid dynamics (CFD) for single-phase (air) and two-phase (air–mucus) flows within the nasal cavity, employing the unsteady RANS turbulence model. Finite element method (FEM) results from prior studies were synthesized to assess changes in the center and radius of maxillary rotation induced by RAMPA-assisted sRME. A male patient (aged 8 years 7 months to 11 years 7 months) treated with extraoral RAMPA and the intraoral appliance (gHu-1) underwent pre- and post-treatment cone-beam computed tomography (CBCT) and ear, nose, and throat (ENT) evaluation. Results: FEM analysis revealed an increased radius and elevated center of maxillary rotation, producing expansion that was more parallel to the palatal plane. CFD simulations showed that nasal cavity expansion increased airflow velocity and pressure drop, enhancing the suction effect that promotes mucus clearance from the frontal sinus. Clinically, nasal passages widened, paranasal opacities resolved, and occlusal and intermolar widths improved. Conclusions: RAMPA combined with sRME improves nasal airflow and maxillary skeletal expansion, facilitating paranasal mucus clearance and offering a promising adjunctive approach for enhancing upper airway function in growing patients. Full article

Objectives: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of vasculitides sharing a common pathophysiology, which affects small and medium blood vessels. Sinonasal involvement is one of the most common manifestations of AAV. The goal of this study was to find the most suitable method to assess paranasal sinus changes in a group of patients with ANCA-associated vasculitis and renal involvement. Subjective scales like Lund–Mackay and Zinreich were compared with a three-dimensional (3D) volumetric method. Pre- and post-treatment computer tomography were compared. Methods: Computer tomography, nasal symptoms, and endoscopy of 28 patients hospitalized at the Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute were assessed retrospectively. Paranasal sinus tomography was performed during treatment induction and after achieving disease remission (BVAS = 0) to assess treatment effectiveness. Radiological analysis was performed with the Lund–Mackay scoring system, Zinreich scoring system, and 3D volumetric scoring system with the usage of Slicer 3D analysis. The radiologic scoring systems were compared. Results: The statistically significant differences in treatment effectiveness were observed for the Zinreich scale on both the right and left side. Similar to the 3D volumetric scoring system, the right and left maxillary sinuses demonstrated statistically significant differences. On the other hand, no statistically significant differences were found between the first and second visits for the Lund–Mackay or total Global Osteitis scores on either side. The strongest correlation was achieved between the Zinreich scoring system and 3D volumetric scale. Conclusions: The three-dimensional CT volumetric analysis demonstrated higher SRM (standardized response mean) values than the Zinreich score on both sides, but the differences were not statistically significant. The Zinreich scoring system should be used instead of the Lund–Mackay scale in everyday clinical practice. Full article

Introduction: Odontogenic infections may influence distant structures, including the eye. Their extension into the paranasal sinuses and orbital region can contribute to inflammatory and glaucomatous conditions. Case Report: A 46-year-old man was examined for a possible odontogenic source of chronic eye disease. The patient had an 18-year history of progressive vision loss in his left eye associated with Posner–Schlossmann syndrome, chronic uveitis, and episodic elevation of intraocular pressure (IOP). Imaging studies revealed the presence of a foreign body in the alveolar recess of the left maxillary sinus, as detected on panoramic radiography, cone-beam computed tomography (CBCT), and infrared thermography (IRT). Preliminary IRT examination showed marked thermal asymmetry (ΔT = 1.1 °C) between the left and right sides of the maxilla. Worsening of ocular symptoms and increased IOP despite steroid treatment prompted surgical treatment. The foreign body, identified as a root canal filling, was removed, and the chronically inflamed sinus mucosa was excised. During a follow-up visit two weeks later, the IRT examination showed a reduction in temperature difference (ΔT = 0.2 °C) and routine postoperative healing. After two months, no thermal asymmetry was found (ΔT = 0 °C), and an ophthalmological examination showed no active inflammation. Six months after the procedure, the patient remained asymptomatic, and the IRT examination revealed only minimal residual variability within the measurement tolerance (ΔT = 0.1 °C), consistent with the resolution of the sinus inflammation. Conclusions: This case highlights the value of interdisciplinary diagnostics in identifying odontogenic contributors to chronic ocular disease. Infrared thermography proved to be a helpful non-invasive adjunct for detecting and monitoring subclinical maxillary sinus inflammation. Full article

Background: Anatomical variations of the maxillary sinus, including the septa, can affect surgical outcomes. This study aimed to present the characteristics of maxillary sinus septa in an Asir-region cohort using cone-beam computed tomography (CBCT). Methods: Archival adult CBCT scans of patients at the King Khalid University College of Dentistry were reviewed in this retrospective cross-sectional study. Septa were measured in axial, coronal, and sagittal planes and classified as vertical, oblique, or horizontal. Correlations between the characteristics of the septa and both age and sex were analyzed. Results: Of the 400 CBCTs randomly selected between May–August 2025, 350 were suitable for analysis; among them, only 26 patients (53.8% male; age, <30 years) presented with sinus septa. The septa were unilateral in 16 (61.5%) and bilateral in 10 (38.5%) patients, without any significant differences based on sex (χ² = 0.248; p = 0.619) or age (χ² = 5.491; p = 0.139). Oblique and horizontal orientations were most common on the right (n = 10) and left (n = 11) sides, respectively; no associations were observed with sex (p > 0.05). The mean mediolateral length and septal height ranged from 7.8 to 10.3 mm and ~8.2 to 8.5 mm, with no sex- or age-related differences. Septal thickness did not vary by age (p > 0.05). Pathologic mucosal findings were infrequent and showed no association with septal location or side. Conclusions: These findings provide region-specific data on maxillary sinus septa in the Asir-region cohort, contributing to the understanding of anatomical variations before planning surgical interventions. Full article

The main role of panoramic radiography lies in its rapid screening capability and its ability to detect and identify bone lesions, pathologies, and tooth-bearing structures. Since panoramic radiographs are widely used, they provide a good view of the jaw bones, maxillary sinus, and temporomandibular area. However, their major limitation is the reduced ability to accurately assess bone conditions, particularly in evaluating cortical integrity or identifying subtle, nondisplaced, or greenstick-type fracture lines. Other limitations include the presence of artifacts, image distortion, magnification variability, and high sensitivity to patient and film positioning, all of which can compromise image quality and diagnostic confidence. This 2D imaging method is still used worldwide, especially by dentists; however, this type of radiograph can be unpredictable due to structural superimposition and reduced ability to clearly establish, measure, and verify the precise dimensions, boundaries, and areas occupied by selected lesions. Many patients undergo panoramic imaging to assess possible mandibular fractures after trauma or following the removal of cysts, tumors, or impacted teeth. In most cases, the occurrence of a fracture without displacement can be misjudged, omitted, or underestimated. In such cases, either cone-beam computed tomography is performed or a detailed clinical examination before or during surgery, followed by intraoperative assessment, helps identify a possible fracture line, bone bending, mandibular instability, or the potential need for simultaneous prophylactic plating during dental procedures or the use of maxillomandibular fixation. This paper presents the author’s own experience regarding the limitations of panoramic radiographs in estimating bone condition and detecting fracture lines. Therefore, it is essential to highlight the role of prophylactic (preventive) mandibular plating (PMP) or fixation and to clarify when it should be considered. Full article

Background: Chronic maxillary sinusitis is most often linked to dental, allergic, or anatomical etiologies, with foreign body-induced forms remaining rare. This case report describes a unique occurrence of chronic maxillary sinusitis resulting from misplaced hyaluronic filler due to a facial esthetic procedure. Case presentation: A 60-year-old woman experienced right-sided maxillary sinusitis symptoms for three years after hyaluronic filler injections. Multi-slice computed tomography showed total sinus opacification, a vermicular foreign body, and a small anterior wall perforation. The patient underwent Caldwell-Luc surgery for foreign body removal and mucosal excision, followed by histopathological analysis. Results: The procedure was successful, with complete extraction of the foreign body compatible with hyaluronic filler. Postoperative recovery was uneventful, and symptoms resolved. This rare complication likely resulted from accidental filler penetration into the maxillary sinus during the injection. Conclusions: To the best of our knowledge, after a detailed search of the available literature, this is the first reported case of chronic maxillary sinusitis caused by material that is compatible with misplaced hyaluronic filler. It stresses the critical need to minimize serious complications in the facial esthetic procedures through detailed anatomical knowledge, technical skill, and a strict credentialing protocol of practitioners. Further awareness and regulations could improve patient safety. Full article

Background and Objectives: Odontogenic sinusitis (ODS) is a particular type of sinus infection induced by dental infections or iatrogenic causes. Although not rare, it is often underrated and sometimes confused with other forms of chronic rhinosinusitis. The aim of this review was to summarize the main diagnostic aspects, microbiological profile, and current options in the therapeutic management of ODS. Materials and Methods: Recent studies and consensus statements from both dental and ENT fields were reviewed. The focus was on the ODS diagnostic criteria, the types and the timing of dental and endoscopic treatment approaches, and treatment combinations inducing the best outcomes in ODS. Results: ODS usually involves anaerobic bacteria such as Fusobacterium and Peptostreptococcus. Empirical antibiotics like amoxicillin or amoxicillin–clavulanate are most often used, but antibiotic therapy alone rarely cures the disease. Dental treatment is essential in ODS cases with oroantral fistulas, infected maxillary sinus bone grafts, or implants. However, in these clinical situations, concurrent one-stage dental and endoscopic sinus surgery (ESS) treatment seems to offer the highest success rate, close to 97%. Combined surgery significantly improved ODS treatment outcomes in terms of reduced reintervention rates and recurrence. There is still debate on how wide ESS should be in uncomplicated ODS, but many reports show that maxillary antrostomy alone can be sufficient. In apical periodontitis-related ODS, recurrence after primary ESS is uncommon in the short term. Conclusions: ODS management needs cooperation between ENT and dental specialists. Treating the dental underlying infection remains critical to prevent oral or systemic complications. Future research should better define diagnostic criteria, antibiotic use guidelines, and the best timing for combined surgery. New studies on microbiology, immunity, and artificial intelligence could help improve diagnosis and medical care of ODS patients. Full article

Background: Maxillary sinus floor augmentation is widely used to enable implant placement in the atrophic posterior maxilla, yet comparative data for porcine-derived xenografts remain limited. Objective: To evaluate long-term bone regeneration and implant outcomes following sinus augmentation using a collagenated porcine xenograft. Methods: This paper reports a retrospective case series of three partially edentulous patients (aged 46–56 years) who underwent lateral sinus augmentation with a small-particle collagenated porcine xenograft (THE Graft™, Purgo Biologics, Gyeonggi-do, Republic of Korea) and staged implant placement. In one case, a controlled perforation of the Schneiderian membrane was performed to access and remove a sinus mucocele, followed by repair using a resorbable collagen membrane. Core biopsies were harvested at implant placement for histology (hematoxylin-eosin, Masson–Goldner) and tartrate-resistant acid phosphatase (TRAP) staining. Clinical outcomes included surgical events, vertical bone gain, marginal bone levels, and implant survival at long-term follow-up. Results: Healing was uneventful in all cases. Mean vertical bone gain was 12.0 mm (baseline 1.33 mm to 13.33 mm final). At a mean 46.8-month follow-up (range 38.3–52.2 months), 100% of implants were functional without failure; marginal bone loss remained < 1 mm during the first year and was stable thereafter. Histology at 3.7, 4.7, and 7.5 months showed vascularized new trabecular bone intimately contacting residual xenograft particles (new bone 20–30%, residual biomaterial 30–40%, connective tissue 30–50%). TRAP-positive multinucleated giant cells at 7.5 months indicated ongoing biomaterial degradation without severe inflammatory reactions. Conclusions: Within the limits of a small case series, collagenated porcine xenograft supported predictable bone regeneration and stable long-term implant function after sinus floor elevation, with favorable histologic integration and gradual resorption. Full article

Background/Objective: To outline strategies for the safe clinical use of orthodontic temporary anchorage devices (TADs) by analyzing papers that examine associated risks, complications, and approaches for their prevention and resolution. Methods: The research protocol used PubMed, Medline, and Scopus up to May 2024, focusing on controlled and randomized clinical trials aligned with the review objective. Fourteen studies were included; bias risk was assessed, key data extracted, and a descriptive analysis performed. Study quality and evidence strength were also evaluated. Results: TADs optimize anchorage control without relying on patient compliance. However, they carry risks and complications. TAD contact with the periodontal ligament or root without pulp involvement requires removal for spontaneous healing. If pulp is involved, the TAD should be removed and endodontic therapy performed. If anatomical structures are violated, TAD should be removed. If transient, spontaneous recovery occurs, but sometimes pharmacological treatment may be needed. A 2 mm gap between the TAD and surrounding structures can prevent damage. In the maxillary sinus, a less than 2 mm perforation of the Schneiderian membrane recovers spontaneously; wider perforations require TAD removal. Good oral hygiene and TAD abutments prevent soft tissue inflammation, which resolves with 0.2% chlorhexidine for 14 days. Unwanted forces can cause TAD fractures, requiring removal. Minor TAD mobility due to loss of primary stability can be maintained; significant instability requires repositioning. Conclusions: The use of TADs requires meticulous planning, radiological guidance, and monitoring to minimize risks and manage complications. With proper care, TADs improve orthodontic outcomes and patient satisfaction. Full article