Background Langerhans cell histiocytosis (LCH) is a rare disorder of the reticuloendothelial system with unknown etiology. This report aims to present a case of LCH with diffuse involvement of the oral cavity and to raise awareness of the distinguishing features of this diagnostically challenging entity. Case ReportA 26-year-old male patient presented with complaints of teeth mobility, intense pain, and difficulty in chewing. Intraoral and radiological examinations revealed generalized gingival hyperplasia and severe teeth mobility with widespread alveolar bone loss. Periodontal therapy was performed with no significant improvement. An incisional biopsy revealed Langerhans cells and positive reaction to S-100 and CD1, and the patient was diagnosed with LCH. The patient underwent systemic chemotherapy with vinca alkaloids and corticosteroids. Regression of gingival lesions, as well as significant decrease in mobility of the remaining teeth and severity of pain, was achieved during 12 months of follow-up. ConclusionThe rarity and variable system involvement of LCH necessitate a multidisciplinary approach be carried out for accurate diagnosis, effective treatment, and an uneventful follow-up. Awareness of oral manifestations of LCH may aid clinicians greatly in reducing morbidity and mortality associated with this debilitating condition.

Objectives This study sought to investigate the association between the systemic intake of proton pump inhibitors (PPI) and the early failure of dental implants. Materials and Methods A retrospective cohort study involving 1,918 dental implants in 592 patients (69 implants in 24 PPI users and 1,849 implants in 568 nonusers, respectively) was conducted. The effect of PPI intake on the osseointegration of dental implants was evaluated using patient- and implant-level models. Results Among 24 PPI users, two patients experienced implant failure, one of whom had three and the other of whom had one failed implant, respectively. Thus, the rate of failure for this population was 8.3%. Separately, 11 nonusers each experienced one implant failure, and the failure rate for these patients was 1.9%. Fisher's exact test revealed statistically significant differences between PPI users and nonusers at the implant level ( P =0.002) but failed to show any significance at the patient level ( P =0.094). The odds of implant failure were 4.60 times greater among PPI users versus nonusers. Dental implants that were placed in patients using PPIs were found to be 4.30 times more likely to fail prior to loading. Conclusion The findings of this study suggest that PPI intake may be associated with an increased risk of early dental implant failure.

PurposeThe aim of this study was to evaluate the correlations between measurements made using panoramic radiography and cone-beam computed tomography (CBCT) based on certain anatomical landmarks of the jaws, with the goal of preventing complications due to inaccurate measurements in the pre-surgical planning phase of dental implant placement.Materials and MethodsA total of 56 individuals who underwent panoramic radiography and a CBCT evaluation before dental implant surgery were enrolled in the study. Measurements were performed to identify the shortest vertical distance between the alveolar crest and neighboring anatomical structures, including the maxillary sinus, nasal floor, mandibular canal, and foramen mentale. The differences between the measurements on panoramic radiography and CBCT images were statistically analyzed.ResultsStatistically significant differences were observed between the measurements on panoramic radiography and CBCT for all anatomical structures (P<.05). The correlation coefficients (r) between the paired samples obtained from panoramic radiography and CBCT were closely correlated (P<.05), with r values varying from 0.921 and 0.979 for different anatomical regions.ConclusionThe results of this study support the idea that panoramic radiography might provide sufficient information on bone height for preoperative implant planning in routine cases or when CBCT is unavailable. However, an additional CBCT evaluation might be helpful in cases where a safety margin cannot be respected due to insufficient bone height.

Background Complications arising from sinus floor elevation (SFE) with lateral approach surgery can be avoided by means of maxillary sinus examination in the preoperative period. Purpose To investigate anatomical variations in the maxillary sinus by making use of cone beam computed tomography (CBCT) in terms of SFE with a lateral approach. Materials and Methods Two hundred twenty eight maxillary sinuses in 114 patients were included. Parameters such as the position and diameter of the posterior superior alveolar artery (PSAA) canal, the frequency and localization of the septa or accessory maxillary ostium (AMO), and lateral wall thickness values were subjected to statistical analysis. Results Septa were observed in 35.1% of sinuses. The majority of septa were determined in the middle region (48.8%). Additionally, 71.1% of PSAA canals were intraosseous, generally exceeding 1 mm in diameter (68.9%). The shortest mean perpendicular distance between the sinus floor and the PSAA canal was determined in the first molar region (9.22 ± 5.66 mm). Similarly, the highest mean sinus lateral wall thickness was determined in the first molar region, in the area 3 mm distant from the sinus floor (2.42 mm ± 0.88 mm). AMO was detected in 40.8% of sinuses. Conclusion CBCT‐guided treatment planning may be beneficial prior to SFE procedures in order to avoid surgical complications.

Background Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. L-PRF is suggested as a viable adjunctive method to surgical interventions due to its advantages on tissue healing. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients. Methods Between January 2012 and December 2020, patients with AAOMS stage II and III MRONJ lesions, who were treated surgically with adjunctive use of L-PRF in the authors’ institution were enrolled. Surgical interventions consisted of either marginal resection or sequestrectomy with peripheral ostectomy (SPO) or curettage and L-PRF application. Medical records of these patients were retrospectively reviewed and healing was assessed according to certain parameters including mucosal closure and presence of infection, exposed bone, fistula or radiologic markers of disease progression for a minimum of 12 months. Results Thirteen patients (7 women and 6 men) with an average age of 72.4 years (± 10.61, range 54–84) were included in the study, nine of whom had AAOMS stage III and four stage II MRONJ. Three patients had a marginal resection, nine patients had sequestrectomy with peripheral ostectomy (SPO) and one patient underwent a curettage procedure. All marginal resection and six SPO patients showed complete healing while four patients, who had SPO or curettage experienced incomplete healing. Mean follow up was 20.1 ± 18.29 months. Conclusion The use of L-PRF may be a favorable adjunctive option in the treatment of MRONJ owing to its favorable effects on tissue repair, ease of application, minimally invasive and cost-effective character and autogenous nature. Trial registration Retrospectively registered.

Evaluation of temperature rise following the application of diode and ErCr:Ysgg lasers: an ex vivo study Purpose Erbium, chromium: yttrium, scandium, gallium, garnet (ErCr:Ysgg) lasers have been frequently used in oral surgical procedures and are almost seen as alternatives to diode lasers. The aim of this comparative study was to analyze in an animal model the thermal elevation induced by ErCr:Ysgg and diode lasers in soft tissue and bone. Materials and methodsThirty freshly dissected sheep mandibles containing bone and soft tissue were divided into 120 equal parts. Gallium-aluminum-arsenide (Ga-Al-As) diode laser (λ=940 nm) with 1, 2 and 5 W output powers and ErCr:Ysgg laser (λ=2780 nm) with 2.75, 4.5 and 6 W output powers were used on soft and bone tissues separately for 3 seconds with point application. Mean temperature values before and after application of the lasers were compared in soft tissue and bone. ResultsThe minimum mean temperature value was observed with 2.75 W ErCr:Ysgg laser while irradiation with 5 W diode laser created the maximum values (p<0.05). ConclusionErCr:Ysgg laser (λ=2780 nm) with 2.75 W power generates low levels of heat compared to diode lasers and may provide safer surgery in soft and bone tissues without destructive effects of temperature increase.

Evaluation of temperature rise following the application of diode and ErCr:Ysgg lasers: an ex vivo study Purpose Erbium, chromium: yttrium, scandium, gallium, garnet (ErCr:Ysgg) lasers have been frequently used in oral surgical procedures and are almost seen as alternatives to diode lasers. The aim of this comparative study was to analyze in an animal model the thermal elevation induced by ErCr:Ysgg and diode lasers in soft tissue and bone. Materials and methodsThirty freshly dissected sheep mandibles containing bone and soft tissue were divided into 120 equal parts. Gallium-aluminum-arsenide (Ga-Al-As) diode laser (λ=940 nm) with 1, 2 and 5 W output powers and ErCr:Ysgg laser (λ=2780 nm) with 2.75, 4.5 and 6 W output powers were used on soft and bone tissues separately for 3 seconds with point application. Mean temperature values before and after application of the lasers were compared in soft tissue and bone. ResultsThe minimum mean temperature value was observed with 2.75 W ErCr:Ysgg laser while irradiation with 5 W diode laser created the maximum values (p<0.05). ConclusionErCr:Ysgg laser (λ=2780 nm) with 2.75 W power generates low levels of heat compared to diode lasers and may provide safer surgery in soft and bone tissues without destructive effects of temperature increase.

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