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Ameloblastoma is a benign tumor of odontogenic epithelium which is slow growing, locally invasive, expansive that may result with asymmetries of the face. Conservative treatment of odontogenic tumors with marsupialization is not common but can be done successfully in those with cystic pattern. The aim of this case and literature review is to propose marsupialization as an initial procedure for its treatment. We have presented a case of an ameloblastoma involving 56-year-old male patient. Orthopantomography and computed tomography showed the lesion extended between the right molar region and left molar region of mandible with both buccal and lingual expansion and root resorptions. On clinical examination, expansions of mandible and slight tooth mobilities were seen. An incisional biopsy was carried out and histopathologic examination revealed ameloblastoma although clinical features of lesion were more suggestive of cyst. Our case was treated by obturator marsupialization with a good healing. This case and review of the literature discusses the available treatment option according to macroscopic features of jaw lesions and emphasizes on the importance of the most conservative treatment option. Conservative treatment preserves integrity of bones while radical treatment can leave major cosmetic and functional sequelae such as pathologic fractures, complication with reconstruction plates.

Background: This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery. Methods: This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer. Results: Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013). Conclusion: The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

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