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References 1. Robert RC, Bachetti P, Pogrel MA. Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg, 2005; 63:732-735. 2. Kraut RA, Chahal O. Management of patients with trigeminal nerve injuries after mandibular implant placement. J Am Dent Assoc, 2002; 133:1351-1354. 3. Grotz KA, Al-Nawas B, De Aguiar EG, Schulz A, Wagner W. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig, 1998; 2:73-76. 4. Chaushu G, Taicher S, Halamish-Shani T, Givel N. Medicolegal aspects of altered

Summary

Aim: To stress the importance of surgical planning when treating large dentigerous cysts.

Case Report: In a routine radiographic examination, a dentigerous cyst was revealed in a 20 years old male. A surgical approach that ensured the integrity of the inferior alveolar nerve (IAN) was applied. The incision was exceeded to the mesial surface of the first molar in order to create adequate surgical field and visibility. The final result was that the exposed nerve was protected successfully.

Conclusion: This case shows the necessity of a meticulous preparation, even in routine operations.

- Interpretation Basics of Cone Beam Computed Tomography, Wiley Blackwell, Iowa, 2014, 16-22. 9. de Melo Albert DG, Gomes AC, do Egito Vasconcelos BC, de Oliveira e Silva ED, Holanda GZ. Comparison of orthopantomographs and conventional tomography images for assessing the relationship between impacted lower third molars and the mandibular canal. J Oral Maxillofac Surg. 2006;64:1030-37. 10. Atieh MA. Diagnostic accuracy of panoramic radiography in determining relationship between inferior alveolar nerve and mandibular third molar. J Oral Maxillofac Surg. 2010;68:74-82. 11. Koong

: Anatomy, healing process, and influencing factors. Compendium , 2007; 28:206-213. 8. Wadu SG, Penhall B, Townsend GC . Morphological variability of the human inferior alveolar nerve. Clin Anat , 1997; 10:82-87. 9. Krasny A, Krasny N, Prescher A . Study of inferior dental canal and its contents using high-resolution magnetic resonance imaging. Surg Radiol Anat , 2012; 34:687-693. 10. Krasny A, Krasny N, Prescher A . Anatomic variations of neural canal structures of the mandible observed by 3-Tesla magnetic resonance imaging. J Comput Assist Tomogr , 2012; 36

Summary

Background/Aim: The aim of the present study was to assess prevalence and morphologic mandibular canal variations in dry skulls.

Material and Methods: Panoramic radiographs were obtained of 57 skulls among the academic collection at the University of Pittsburgh. Orthodontic wire was inserted through the mandibular canal as a reference point at panoramic images for localization of the course of the mandibular canal.

Results: Double mandibular canals were present in 2 out of 57 skulls (3,5%); one of them was unilateral the other one was bilateral. Additionally, bifurcation of the mandibular canal and different types of configurations were assessed. In five of the specimens (8,8%) bifid canals were identified. Among them, one case (1,7%) was identified as a forward type. In one case additional canal (1,7%), was detected in the retromolar region, which joined the main canal. Three of the specimens (5,3%) showed accessory canal types. These were the canals that detached from the main canal and proceeded towards the molar teeth roots (dental type). All of these bifid canal types were unilateral.

Conclusions: Our results depicted the anatomical variations of the mandibular canal. Dental practitioners should be aware of this underestimated but not a rare occurrence of mandibular canal variations in order to avoid complication during surgical procedures.

Abstract

The objective of this study was to perform a comprehensive evaluation of major indices of pain syndrome in patients with mandibular fractures accompanied by damage of inferior alveolar nerve using conventional therapeutic regimen supplemented by the administration of drug product Nucleo CMP Forte. Operative and postoperative treatment of 50 patients with angular fractures of the mandible, accompanied by clinical manifestations of inferior alveolar nerve damage, was performed. The severity of pain syndrome and neuropathy symptoms was evaluated using the LANSS pain scale, DN4 questionnaire, the Visual Analogue Scale (VAS) and Neuropathy Total Symptom Scores (NTSS-9). Decrease of pain syndrome was revealed in both groups but with different dynamic pattern. In the treatment group pain syndrome manifestations and neuropathy symptoms decreased quicker than in the comparison group. As LANSS, DN4, VAS and NTSS-9 scales characterize pain syndrome from various perspectives, the results were different but similar tendency was shown. At the beginning of the study LANSS scale indices were nearly identical in both groups, while on the 7th and 14th day they were 1.35 and 2.03 times lower, respectively, in the treatment group compared to the control group. On the first day NTSS-9 scale values did not practically differ in between the studied patients, being somewhat higher in the treatment group. On the 7th and 14th day the values increased 1.24 and 3.82 times, in the treatment group and in the group of comparison, respectively. Thus, the patients in the treatment group showed significantly greater pain relief than those in the comparison group. The analysis of dynamic pattern of complaints as well as the objective findings in angular fractures of the mandible, accompanied by the damage of inferior alveolar nerve, demonstrated that the administration of drug product Nucleo CMP Forte led to a more pronounced improvement of pain syndrome in the course of treatment. Because of the fact that neuropathic pain can develop in orthodontic treatment, as well as when partial and complete removable dentures are used, the administration of drug product Nucleo CMP Forte is warranted in combined therapy of both mandibular fractures followed by the clinical manifestations of inferior alveolar nerve damage, and neuropathic pain management in orthodontics and orthopedic stomatology.

References 1 . Boteva , E. Endodontics. Arbilis OOD, 2014. Anesthesia for the purposes of endodontics. P 43-48 [Book in Bulgarian]. 2 . Al - Hashimi, K. et I. Waleed. A Comparison of Inferior Alveolar Nerve Block and Periodontal Ligament Injection During Endodontic Treatment of Human Mandibular First Molars. - J Bagh Coll Dentistry, 18, 2006,9-14. 3 . Edwards, R. W. A Clinical Trial of Intraligamentary Anesthesia. - JDR, 68, 1989, 1210-1213. 4 . Fisher, J. Local Anesthesia in Dentistry, 4th ed, Philadelphia, Lea &Febiger, 1993, Walten Re, Abbott Bj

References 1. Koseoglou BG, Tanrikulu S, Subay RK, Sencer S. Anesthesia following overfilling of a root canal sealer into the mandibular canal: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006; 101:803-806. 2. Conrad SM. Neurosensory disturbances as a result of chemical injury to the inferior alveolar nerve. J Oral Maxillofac Surg, 2001; 13:255-263. 3. Froes FG, Miranda AM, Abad Eda C, Riche FN, Pires FR. Non-surgical management of paraesthesia and pain associated with endodontic sealer extrusion into mandibular canal. Aust Endod J, 2009; 35

Rereferences 1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg, 2003; 61:1115-1117. 2. Novince CM, Ward BB, McCauley LK. Osteonecrosis of the jaw: an update and review of recommendations. Cell Tiss Organ, 2009; 189:275-283. 3. European Medicines Agency (EMEA). Committee for Medicinal Products for Human Use (CHMP). EMEA/CHMP assessment report on bisphosphonates and osteonecrosis of the jaw. EMEA/CHMP/291125/2009. 4. Otto S, Hafner S, Grotz KA. The role of inferior alveolar

REFERENCES 1. Boris A., Gintaras J. (2015): Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: Systematic Review Of Surgical Techniques, Lithuania . Journal of Oral and Maxillofacial Research, Vol. 6, No.1, E.2, 1-13. 2. Bown S.R. (2003): Scurvy How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail. Thomas Dune Books. 3. Carpenter C.J.K. (1986): The History of Scurvy and Vitamin. Cambridge University Press. 4. Chee W., Jivraj, S. (2006): Connecting Implants to Teeth