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Comparative Analysis of Ameloblastoma in Jamaican Children and Adults Utilizing the St. Augustine Radiological Classification
OOOOE Volume 108, Number 4 grafting. Although immediate grafting of the socket has been shown to be effective versus not grafting, it is not without its limitations. Firstly, even with grafting there is still predictably some loss of alveolar height in the months following extraction. Secondly, grafting will only preserve the alveolar bone that remains immediately after the extraction. It stands to reason that atraumatic extraction techniques aimed at preserving crestal alveolar bone would provide a better platform for grafting and for preserving maximum alveolar bone. Hand operated periotomes have been utilized by some practitioners to this end however length of time involved and decreased effectiveness with multi-rooted teeth have limited its use. In our clinical study we used a new device called the Powertome Periotome. The Powertome is an automated periotome which allows for the atraumatic extraction of single rooted and multirooted teeth, predictably, in a controlled fashion, without patient discomfort and within an acceptable amount of time. It is proposed that using the Powertome to atraumatically extract teeth will allow for immediate alveolus preservation without compromising on time and patient comfort. Purpose: To demonstrate that use of the Powertome Periotome allows for preservation of alveolar bone without compromising on time and patient comfort. Method: 14 were treated using the Powertome Periotome. Each event was graded based on location of tooth, preoperative stability of the tooth, power setting of the device, length of time used, patient comfort, and surgeon satisfaction. Results: 14 total teeth were extracted, 8 posterior and 6 anterior. The machine has 10 power settings (1-10) and an average power level of 6.9 (range 1-10) was used. The extractions took an average of 4.8 minutes (range 0.2-15). Patient satisfaction was graded on a scale of 1-5 (most comfortable to least comfortable) with an average of score of 2.6 (range 2-5). Alveolar bone was fully preserved in all cases except for one (7%) where a bur was used to help facilitate the extraction. Conclusion: This data in this ongoing study support the thesis that patient comfort is maintained and alveolar bone is preserved while using the Powertome Periotome for tooth extraction.
REVIEW AND DISCUSSION OF LIFE-THREATENING HEMATOMA OF THE FLOOR OF THE MOUTH RESULTING FROM DENTAL IMPLANT PLACEMENT Authors: Kasey L. Call, DMD; Brian M. Smith, DMD, MD Presenter: Kasey L. Call, DMD Purpose: To increase cognizance of the risks of implant placement in the anterior mandible, and provide preoperative and perioperative suggestions to decrease the incidence of hematoma in the floor of the mouth. Introduction: The placement of dental implants has become standard of care for restoring edentulous spaces, and is commonplace in most oral surgery practices. Easy access and dense cortical bone in the mandible makes placing an implant in that area of the mouth favorable for the patient and surgeon; however, reports have shown that placement of implants in the anterior mandible and premolar region can result in hematomas of the floor of the mouth leading to airway compromise. Method: A case is reviewed of a 55 year-old-man who had an implant placed in the anterior mandible which lead to an expansile hematoma of the floor of mouth. Surgical decision making was complicated by an incidental finding of a large temporo-parietal AVM, and severe hypertension. His two-week
Abstracts 525 hospital course involved 12 days of intubation and evacuation of sublingual hematoma. A literature search was conducted using key words “floor of mouth hematoma” and “blood supply to mandible” revealing multiple case reports of hematoma in the floor of the mouth, as well as cadaveric and radiographic anatomic studies to locate the vessels supplying blood to the lingual mandible. Results: Preoperative CT analysis of the mandible can reveal arteries that perforate the lingual cortex of the mandible that are not visible on conventional radiography. Surgical stent usage will help prevent perforation of the lingual cortex of the mandible while preparing the implant site. Also reviewed is a report of size and location of the blood vessels that supply the lingual mandible. Conclusion: While operative risks and complications cannot be completely eliminated, an increased level of cognizance of the vascular supply to the mandible and proper surgical planning and technique can reduce the incidence of life-threatening bleeding in the floor of the mouth.
COMPARATIVE ANALYSIS OF AMELOBLASTOMA IN JAMAICAN CHILDREN AND ADULTS UTILIZING THE ST. AUGUSTINE RADIOLOGICAL CLASSIFICATION Author: Christopher Ogunsalu, MBBS, BDS, FRACDS, MSc.Med, FICS, FWACS Presenter: Christopher Ogunsalu, MBBS, BDS, FRACDS, MSc.Med, FICS, FWACS Objective: To compare ameloblastoma occurring in the young (less than 20 years old) with that occurring in the adult (20 years old and over) in Jamaica utilizing the St. Augustine radiological classification for ameloblastoma. Methods: A total of 49 cases of ameloblastoma were analyzed, separating ameloblastoma occurring in the young (Group A) from that occurring in the adult age group (Group B). All these cases were from two major hospitals (Kingston Public Hospital and Cornwall Regional Hospital) in Jamaica, and had both radiological and histological confirmation of ameloblastoma. The two groups were analyzed using the St. Augustine radiological classification and were then further subjected to comparative analysis. Results: Ameloblastoma in the young Jamaican seems to have no predilection for any sex; however, there is a slight predilection for the female sex in ameloblastoma in the adult Jamaican. In this series only 1 case (5.26%) of ameloblastoma occurred in the maxilla in the young compared with 4 cases (13.33%) which occurred in the adults. In both age groups, according to the St. Augustine classification, most cases were of the IIb2 radiological group. Of these, 37.50% of the IIb2 ameloblastomas in the young patients had associated root resorption, while 53.85% of the IIb2 ameloblastomas in the adult group had root resorption. Conclusions: It is significant to note that the most predominant radiological group for ameloblastoma in both young and adult Jamaicans, according to the St. Augustine classification, was IIb2. This suggests that the majority of ameloblastomas occurring in both age groups would be better managed utilizing resection with cryosurgery together with re-entry cryosurgery in six months for prevention of recurrence. It is important that further studies be done to correlate the radiological type of ameloblastoma with the histological type. By so doing, one will be able to determine if ameloblastomas in the IIb2 radiological group occurring in young and adult Jamaicans are of the same histological type.
REVIEW AND DISCUSSION OF LIFE-THREATENING HEMATOMA OF THE FLOOR OF THE MOUTH RESULTING FROM DENTAL IMPLANT PLACEMENT Authors: Kasey L. Call, DMD; Brian M. Smith, DMD, MD Presenter: Kasey L. Call, DMD Purpose: To increase cognizance of the risks of implant placement in the anterior mandible, and provide preoperative and perioperative suggestions to decrease the incidence of hematoma in the floor of the mouth. Introduction: The placement of dental implants has become standard of care for restoring edentulous spaces, and is commonplace in most oral surgery practices. Easy access and dense cortical bone in the mandible makes placing an implant in that area of the mouth favorable for the patient and surgeon; however, reports have shown that placement of implants in the anterior mandible and premolar region can result in hematomas of the floor of the mouth leading to airway compromise. Method: A case is reviewed of a 55 year-old-man who had an implant placed in the anterior mandible which lead to an expansile hematoma of the floor of mouth. Surgical decision making was complicated by an incidental finding of a large temporo-parietal AVM, and severe hypertension. His two-week
Abstracts 525 hospital course involved 12 days of intubation and evacuation of sublingual hematoma. A literature search was conducted using key words “floor of mouth hematoma” and “blood supply to mandible” revealing multiple case reports of hematoma in the floor of the mouth, as well as cadaveric and radiographic anatomic studies to locate the vessels supplying blood to the lingual mandible. Results: Preoperative CT analysis of the mandible can reveal arteries that perforate the lingual cortex of the mandible that are not visible on conventional radiography. Surgical stent usage will help prevent perforation of the lingual cortex of the mandible while preparing the implant site. Also reviewed is a report of size and location of the blood vessels that supply the lingual mandible. Conclusion: While operative risks and complications cannot be completely eliminated, an increased level of cognizance of the vascular supply to the mandible and proper surgical planning and technique can reduce the incidence of life-threatening bleeding in the floor of the mouth.
COMPARATIVE ANALYSIS OF AMELOBLASTOMA IN JAMAICAN CHILDREN AND ADULTS UTILIZING THE ST. AUGUSTINE RADIOLOGICAL CLASSIFICATION Author: Christopher Ogunsalu, MBBS, BDS, FRACDS, MSc.Med, FICS, FWACS Presenter: Christopher Ogunsalu, MBBS, BDS, FRACDS, MSc.Med, FICS, FWACS Objective: To compare ameloblastoma occurring in the young (less than 20 years old) with that occurring in the adult (20 years old and over) in Jamaica utilizing the St. Augustine radiological classification for ameloblastoma. Methods: A total of 49 cases of ameloblastoma were analyzed, separating ameloblastoma occurring in the young (Group A) from that occurring in the adult age group (Group B). All these cases were from two major hospitals (Kingston Public Hospital and Cornwall Regional Hospital) in Jamaica, and had both radiological and histological confirmation of ameloblastoma. The two groups were analyzed using the St. Augustine radiological classification and were then further subjected to comparative analysis. Results: Ameloblastoma in the young Jamaican seems to have no predilection for any sex; however, there is a slight predilection for the female sex in ameloblastoma in the adult Jamaican. In this series only 1 case (5.26%) of ameloblastoma occurred in the maxilla in the young compared with 4 cases (13.33%) which occurred in the adults. In both age groups, according to the St. Augustine classification, most cases were of the IIb2 radiological group. Of these, 37.50% of the IIb2 ameloblastomas in the young patients had associated root resorption, while 53.85% of the IIb2 ameloblastomas in the adult group had root resorption. Conclusions: It is significant to note that the most predominant radiological group for ameloblastoma in both young and adult Jamaicans, according to the St. Augustine classification, was IIb2. This suggests that the majority of ameloblastomas occurring in both age groups would be better managed utilizing resection with cryosurgery together with re-entry cryosurgery in six months for prevention of recurrence. It is important that further studies be done to correlate the radiological type of ameloblastoma with the histological type. By so doing, one will be able to determine if ameloblastomas in the IIb2 radiological group occurring in young and adult Jamaicans are of the same histological type.