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The dental anesthesia sonophoresis device (DASD) is a novel device that is intended to reduce the discomfort associated with intraoral mucosa needle puncture. The DASD produces ultrasonic energy that provides a sonophoretic effect on the oral mucosa, generating microchannels through the lipids between the keratinized cells that make up the stratum corneum. Once the topical anesthetic has permeated the stratum corneum, it quickly diffuses through the soft tissue, desensitizing the nerve endings and reducing the perception of pain caused by needle penetration. The aim of this study is to evaluate whether topical anesthesia applied using the DASD will reduce the discomfort of the needle puncture when compared to the control device. A split-mouth model, using 50 healthy subjects with puncture site at the maxillary canine vestibule, was used for this study. Subjects received a needle puncture on both sides of the mouth. Prior to the needle puncture, there was randomized application of 5% lidocaine with the DASD and a control device. Subjects rated their discomfort after needle punctures utilizing the visual analog scale pain scoring system. There was no statistically significant difference in the pain perception using the DASD versus the control device.

Introduction Nasal septum surgery has been associated with postoperative numbness or paresthesia of the anterior maxillary teeth, primarily involving the incisors and canines, with an incidence reported between 3% and 30%. This sensory alteration may result from trauma to the nasopalatine nerve or anterior superior alveolar nerve, which innervate the anterior maxilla. Current literature on this topic is limited, outdated, and primarily based on retrospective studies that lack long term follow-up. This study aims to investigate the impact of nasal septal surgery on anterior maxillary teeth sensation, focusing on the incidence, predisposing factors, and the timeline for sensory recovery. Methods This prospective study included 21 patients who underwent nasal septum surgery from September 2023 to September 2024. Patients with pre-existing conditions affecting dental sensation or those who recently underwent dental procedures were excluded. Sensory assessments were conducted preoperatively, post-topical anesthesia application, and at 10 days, one month, and three months post-surgery. Demographic data, surgical approach, and medical history were recorded. Results The cohort had an average age of 32.6 years (range 20-62), with 52% male participants. Significant temporary sensory loss was observed following the application of topical anesthesia (p=0.007). Postoperatively, sensory reduction occurred in two patients, resulting in a 9.5% incidence of sensory disturbances (p=0.4): one patient experienced numbness in all four incisors, while another reported numbness in the two central incisors. Both patients regained full sensation within one month after surgery. Multivariate analysis did not identify any significant predictive factors for sensory impairment, including surgical approach, presence of nasal fracture, or history of prior nasal surgeries. Conclusion Nasal septal surgery is associated with a low incidence of transient sensory disturbances in the anterior maxillary teeth, with full recovery typically occurring within one to three months. These findings suggest that careful surgical technique can minimize nerve injury and that the risk of permanent sensory loss is low. Additional research with larger patient cohorts is needed to validate these findings and identify possible risk factors, thus improving patient counseling and surgical techniques.

Dental implantation has been the primary method for the treatment of tooth loss, but longer than 3 months healing times are generally required. Because immediate load implants are suitable only for certain categories of implant patients, it has value to develop a novel method to facilitate the implant-bone osseointegration process. Cylindrical titanium implants were implanted in the tooth sockets of beagles, and microelectrode stimulation of the sympathetic nerves in the infraorbital nerve was performed after implantation for 1 week. The authors found that one-sided nerve stimulation was shown to evoke consistent electric potential changes in both sides of the infraorbital nerves. Moreover, after 4 weeks of implantation, more new bone was clearly observed around the implants in the beagles that received electrical stimulation treatment than was observed in the control animals. Furthermore, a higher mineralization density was measured in the new peri-implant bone tissues of the stimulated beagles when compared to controls. These results demonstrate that the simple and safe physical method of microelectrode stimulation to sympathetic nerves can promote the formation of new bone and the osseointegration of implants. This technique is worth promoting and has the potential to reduce the healing time of dental implantation in future clinical cases.

Introduction A patient requested dental implant therapy to replace his missing upper left central incisor. Pre-operative cone beam computed tomography (CBCT) imaging revealed a complex neurovascular supply to the anterior maxilla.Discussion Imaging demonstrated accessory neurovascular canals around the nasopalatine foramen which directly communicate with canalis sinuosus. They are, therefore, most likely to carry branches of the anterior superior alveolar nerve and vessels. One of these canals was directly in the path of proposed dental implant placement. A review of the dental literature suggests that such anatomical variation is relatively common. Some authors have proposed that injury to these structures is a cause of intractable pain following dental implant placement. Following discussion with the patient, it was agreed that the provision of an adhesive bridge was a realistic alternative in this case.Conclusion The availability of CBCT imaging in recent years has shown that complex neurovascular anatomy in the anterior maxilla is not uncommon. Evidence is lacking regarding the relevance of this to dental implant placement but it is possible that injury to these structures explains some cases of postoperative intractable pain.

Background Nerve fibers embedded within bone tissue play a pivotal role in regulating osseous homeostasis. Emerging evidence indicates the presence of neural networks surrounding dental implants. The functional integrity of these nerve fibers is maintained through various ion channels, particularly those belonging to the PIEZO family. This study aims to: (1) characterize the spatial distribution patterns of nerve fibers and PIEZO family around dental implants, and (2) investigate their potential correlations with bone microarchitecture surrounding dental implants. Methods Male rat models with right maxillary first molar dental implants were established. Following a 4-week osseointegration period, spatial variations in nerve fiber density and PIEZO family expression were quantitatively assessed across 8 anatomically defined buccolingual regions. Complementary Micro-CT analyses were performed to evaluate three-dimensional bone microarchitecture surrounding dental implants. Results The study revealed regional heterogeneity in nerve fiber density across the 4 anatomical zones. Nerve fiber density showed no significant difference between peri-implant and adjacent tissues. While PIEZO-positive fibers generally mirrored overall nerve fiber distribution, the apical region exhibited a significantly higher proportion of PIEZO2-positive fibers in peri-implant bone versus adjacent bone. Conclusions Peri-implant regions exhibited higher nerve fiber density and enhanced bone microarchitecture, suggesting neurogenic modulation of osseointegration dynamics. Mechanistically, the PIEZO family may mediate this neuro-osseous crosstalk during bone remodeling around implants. These findings offer novel perspectives on the mechanistic basis of peri-implant bone adaptation.

Objective The aim of this study was to evaluate the posterior superior alveolar canal (PSAC) in patients with cleft lip and palate (CLP) as compared to patients with no cleft lip and palate (NC) using cone-beam computed tomography (CBCT). Materials and methods This was a retrospective multicenter study based on two steps: (1) evaluating intra- and inter-calibration and (2) detecting the presence or absence of PSAC and its location, diameter, and anastomosis with anterior superior alveolar canal. Results A total of 300 patients were selected for the study, out of which 150 were categorized as CLP (75 men, 75 women; mean age: 29.8 years) and 150 were categorized as NC (75 men, 75 women; mean age: 40.3 years). PSAC in patients with CLP and NC was visible in 100% of the cases, in men and women, bilaterally. PSAC location in CLP was middle and upper third of the maxillary sinus as compared to NC (lower third) (chi-squared < 0.001). PSAC mean diameter in CLP was 1.12 mm. It was larger compared to 0.6 mm in NC (t-test < 0.0001). Conclusion PSAC location in patients with CLP was predominantly in the middle and upper third of the maxillary sinus, compared with NC. PSAC mean diameter in CLP was 1.12 mm. It was larger compared to that of 0.6 mm in NC. Clinical relevance These anatomical variations in CLP are important and should be acknowledged by surgeons for the following reasons: (1) to perform pre-surgical planning, (2) to avoid bleeding, and (3) to avoid neurosensory alterations.

Purpose The location of the infraorbital foramen and its variations are important during periorbital, dental, plastic, and oromaxillofacial surgeries. The aim of this study is to document the most practical anatomical soft tissue landmarks for defining the location of infraorbital foramen and infraorbital nerve for effective nerve blockade and to decrease its risk of injury during periorbital surgeries. Methods Forty sides from 20 adult fixed cadavers were used for this study. The position of the infraorbital nerve was determined in reference to the lateral edge of the ala of the nose, medial and lateral palpebral commissures. All these three soft tissue landmarks were then connected to each other forming a triangular shaped region. Results In 75 % of the cases the infraorbital foramen was located on the line which is connecting the lateral palpebral commissure to the ala of the nose. The closest distance of infraorbital foramen to the inferior orbital margin and to facial midline was also measured. The infraorbital foramen was located outside the previously defined triangular region in 20 % and inside the triangle in 5 %. The closest mean distance between the infraorbital foramen and the infraorbital margin was measured as 8.8 ± 1.0 mm and the distance between the medial wall of the infraorbital foramen and the facial midline was measured as 30.3 ± 2.7 mm. Conclusion The triangular region and the soft tissue landmarks we offered in this study may facilitate prediction of the locations of the infraorbital foramen thus, the infraorbital nerve.

Background Reports of post herpetic maxillofacial complications have been very rarely documented in the literature that includes periapical lesions, calcified and devitalized pulps, resorption of roots, osteonecrosis, and spontaneous exfoliation of teeth. The atypical feature of the case of concern to the dental surgeon is the rare complication of spontaneous tooth exfoliation following herpes zoster. Case report This case reports a male patient of age 47 years who reported to the Department of Periodontology with the chief complaint of mobility in the left upper central incisor. Patient history revealed herpes zoster infection that began 11 days earlier along with underlying diabetes mellitus condition. We hereby report a known diabetic patient with history of herpes zoster infection who presented with rare complication of spontaneous tooth exfoliation involving the maxillary division of the trigeminal nerve. Discussion Limited number of cases has been reported in the literature regarding spontaneous teeth exfoliation secondary to herpes zoster. The exact pathogenesis regarding the spontaneous exfoliation of teeth in herpes zoster patient is still controversial. Thus, an oral health care provider should be aware of this rare complication while managing a case of tooth mobility with the previous history of herpes zoster of trigeminal nerve.

The infraorbital canal in the Japanese macaque is composed of main and accessory canals. However, the morphological features of the infraorbital canal, such as the canal course and the supply of infraorbital vessels and nerves in the maxilla, are poorly characterized. In this study, we show the structure of the infraorbital canal of the Japanese macaque (adults; 10 male, 9 female), including the distribution of these vessels and nerves, using cone-beam computed tomography and a macroscopic apparatus. The superior and lateral margins of the orbit were correlated with the infraorbital canal on three-dimensional reconstruction images (P < 0.05). We classified three types of multi infraorbital foramina as follows: type 1 had one accessory foramen, type 2 had two accessory foramina, and type 3 had three accessory foramina in the infraorbital canal. The infraorbital canal also formed three structures, specifically, a tube-like shape, a funnel shape, and a pinched shape. The accessory canals also contained nerves and blood vessels, and the canals ran downward and supplied the maxillary sinus, teeth, and midfacial region of the craniofacial skeleton, while passing through a few branch canals. These accessory canals proved valuable for blood vessels and nerves and allowed us to recognize the maxilla in the Japanese macaque skull.