Reconstruction of extensive palatomaxillary defects with oronasal/antral communication represents a challenge to surgeons. Bone-containing microvascular flaps have been suggested as a promising option for rehabilitation of function and esthetics. These types of flaps, however, might be associated with high morbidity. A combination of less complicated treatments might also provide acceptable results while diminishing potential donor site complications. This clinical report presents a bilateral maxillary defect with oronasal communication due to resection of malignant melanoma of the palate. The lost alveolar bone was initially reconstructed with a nonvascularized fibula bone graft. After 6 months, the alveolar segment was subjected to vertical distraction osteogenesis to increase bone height. After a 3-month consolidation period, the patient received 10 dental implants and an implant-supported fixed prosthesis. To preclude graft harvesting morbidity for reconstructing the oronasal fistula, the frame of the prosthesis was designed to include 3 ball attachments on which a palatal obturator, merely covering the palate, could be stabilized. The removable implant-retained obturator restored function perfectly. During the 5-year follow-up, no complication regarding bone graft, the dental implants, and the obturator has been observed.

The mean age of the patients in our study was 39.54 ± 15 years. Thirty-five patients were male, and 25 were female. The serum blood glucose level was 111.6 ± 25.47 mg/dL before local anesthesia and 115.3 ± 24.39 mg/dL after tooth extraction (P = 0.418). Eleven female patients and four male patients had a reduction in the blood glucose levels after injection. There was a significant difference between these groups (P = 0.01). Conclusion: According to our findings and previous reports, using local anesthesia during tooth extraction does not induce hypoglycemia and could increase the serum blood glucose level in individuals.

Purpose: The inferior alveolar nerve block (IANB) is a necessary and frequent local anesthetic injection in dental practice in which the conventional technique is generally applied. However, multiple studies reported that the failure rate of IANB is high, whereupon our study aimed to assess the modified and conventional IANB techniques, concerning the success rate. Methods: A split-mouth single-blind randomized clinical trial study was conducted on 42 patients (84 cases) as paired analyzing, between 18 to 55 years-old, who needed bilateral IANB for posterior mandibular teeth extraction. To apply the modified technique, the barrel of the syringe was located in the corner of the mouth; while mouth is open wide and the needle-penetrated mucosa exactly lateral (anterior) to the pterygomandibular fold (PMF). The needlepoint was 5–15 mm above the occlusal plane (OP) according to the digital panoramic radiography and parallel to OP. The outcomes were analyzed using the Cochran-Mantel-Haenszel test. Results: The success rates were 97.6% in the modified IANB and 83.3% in the conventional technique, evaluating in the first 10 minutes.Conclusion: The clinician can operate IANB by modified technique with fewer anatomical landmarks, clear injection points and the higher success rate upon which the performance will be easy by the beginners. Trial registration IRCT20150924024167N2, on 07.03.2020, was retrospectively registered.

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