Comparative and clinical evaluation between piezoelectric and conventional rotary techniques for mandibular impacted third molar extraction.

Purpose: The aim of this study was to evaluate and compare the operative and postoperative outcomes of the mandibular impacted third molar removal using piezoelectric technique and conventional rotary bur technique. Settings: The study was conducted in the department of oral and maxillofacial surgery between January 1, 2019, and January 1, 2020. Materials and Methods: Thirty patients, with an age of 18-40 years, with asymptomatic bilateral impacted mandibular third molars, were selected for the study and randomly surgical extraction was done either using piezoelectric or the conventional rotary bur technique on each site. The intraoperative time taken, postoperative pain, swelling, and trismus were assessed over a follow-up period of 7 days postoperatively. Results: Study and control groups were compared using paired t-test. There was statistical significance in reduction of pain and swelling in the study group where the duration of surgery was increased in the study group. Conclusion: Even if piezoelectric technique takes more time but can be used safely as another technique to conventional surgical method with surgical bur and handpiece for removal of impacted mandibular third molars.

Evaluation of biphasic hydroxapatite and ß-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects - A clinical and digital radiological measurement study.

Aims and Objective: The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and ß-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Material and Methods: Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and ß-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Results: Overall, by the end of 6 months, biphasic hydroxyapatite and ß-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and ß-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. Conclusion: In the present study, biphasic hydroxyapatite and ß-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

Saliva as a Potential Diagnostic Tool to Evaluate Relationship between Oral Microbiome and Potentially Malignant Disorders for Prevention of Malignant Transformation.

OBJECTIVE: The current research was conducted with an aim to assess the association of oral microbiome with Potentially malignant disorders (PMDs) because usage of tobacco in any form alters the normal microbiome and shifts it towards dysbiosis. Thus, our definitive knowledge of the oral commensal bacteria and oral cancer link can definitely be used as a potential adjunct to early diagnosis and management of PMDs and prevent it's malignant transformation. STUDY DESIGN: A total of 100 individuals of minimum 18 years of age were included in the study which, were classified into 2 groups of tobacco users (50) and non-tobacco users (50). The tobacco users had a history of tobacco consumption for at least 5 years. RESULTS: The present study, showed highest percentage (72%) of anaerobic bacteria, followed by aerobic (22%) and lowest count of yeast (4%). CONCLUSION: The ecological shift to dysbiosis is a significant finding in oral carcinogenesis. Further investigation on a larger group of altered microbiomes will definitely help in establishing relationship of altered microbiome and PMDs, which can help in appropriate treatment and better prognosis.

Forensic endodontics and national identity programs in India.

National identity programs like Aadhaar in India can play an unique role in identification of an individual and has numerous beneficial applications for the government and the citizens. The biometric records of finger prints and iris provided in the database can be useful for the forensic purpose. In unfortunate incidence of disasters, accidents, and criminal cases such as severe burnings, the identification of the victims is possible through dental profiling where fingerprint matching is not possible. Endodontic treatment includes the radiography for diagnosis of the lesion, during working length determination, obturation, and various other procedures. The variations in tooth anatomy and morphology, post-endo restorations, root canal fillings, and sometimes, endodontic mishaps are recorded in these radiographs. This record can play an important role in identification of a person in case of unfortunate happenings. So, it is suggested to include dental profiling in National Identification programs, and the purpose of this article is to highlight the role of root canal procedures in dental profiling.

Assessment of validity and reliability of Kvaal's method for age estimation among a population sample - A retrospective study.

OBJECTIVES: The present research was carried out with an aim to estimate and correlate chronological age and estimated age by Kvaal's Method in North Indian population using digital panoramic radiography. Further, the study was an attempt to evaluate the reliability of Kvaal's method for age estimation and to arrive at a population-specific regression equation. MATERIALS AND METHOD: One hundred digital orthopantomograms of participants aged between 20 and 70 years of age were selected. The evaluation of 6 teeth according to Kvaal's method was carried out using measure tool of Sidexis Software (provided by the manufacturer). Correlation coefficient was carried out between chronological age and estimated age and further regression analysis was carried out for obtaining a population specific regression equation. RESULTS: It was observed that coefficient of determination (R2) is highest (0.223) for mandibular canine which indicates that age can be better estimated with this particular tooth. CONCLUSION: It was observed that large variations between the chronological and estimated age were not found. Also, Kvaal's formula proved accurate for estimating age using all the six selected teeth. Thus, it was concluded that mandibular canine would be the better tooth for age estimation, followed by maxillary second premolar and maxillary three teeth taken together.

Aggressive type of central giant cell granuloma in a woman on hormone replacement therapy: a histopathological insight.

Quite a few lesions of the oral cavity specifically of the gingiva have a greater inclination towards women and mostly occur during the first four decades of life, the cause of which may be credited to the changing levels of sex hormones. Out of all such lesions, one lesion whose aetiology is still unclear and which originats from the periosteum or periodontal ligament is central giant cell granuloma. Repeatedly, it is has been described as a reactive lesion, the cause of which may be secondary to local irritants or trauma, specifically plaque or calculus, which is not considered to be a true neoplasm. Here we present a case of a 51-year-old female patient with aggressive gingival growth within 10-13 months of hormonal replacement therapy. The aetiology, histological features and appropriate treatment are discussed in the light of current literature.

Cyclosporine A and amlodipine induced gingival overgrowth in a kidney transplant recipient: case presentation with literature review.

Drug-induced gingival overgrowth is a condition caused by side effects of treatment with one of three types of drugs: phenytoin (used in epilepsy treatment), cyclosporine A (used in transplantology after allogenic organ transplants) and calcium channel blockers (used in the treatment of hypertension). Gingival overgrowth leads to inflammation within the gums and periodontium and can amplify the existing periodontal disease leading to tooth loss. Patients who have undergone kidney transplant are given immunosuppressants to prevent transplant rejection and mostly it is accompanied with calcium channel blockers to treat hypertension associated with kidney transplant. This article reports a case of recent gingival enlargement associated with cyclosporine A and amlodipine given to a kidney transplant patient from the past 11 years.

Hybrid ameloblastoma: a mystified histopathological entity.

Ameloblastoma a benign neoplasm of the maxillofacial region has been divided into various histopathological types by WHO. A more complex and confusing type includes hybrid type, which as the name suggest include more than two variants mostly histopathological. Various authors have reported cases of this type but the exact histopathological features are still unclear and each case that is being reported add to the literature, which further strengthens its histopathological feature. Also, this is a lesion whose clinical and radiographical features are similar to all the variants and a definitive diagnosis is achieved by histopathology only. Here, we present a case of hybrid ameloblastoma with striking and unique histopathological features.

Review and Classification Update: Unilateral condylar hyperplasia.

Unilateral condylar hyperplasia is characterised by slow progressive growth of the different parts of mandible, the aetiology of which is still unclear. It is a self-limiting condition mostly seen between the age of 11-30 years causing facial asymmetry and its progression ceases after a certain time. In literature until now very few cases have been reported and every case that is being reported adds to its features or the aetiology. Previously, it has been classified into two types that is, hemimandibular hyperplasia and hemimandibular elongation. Here, we report a similar case with a few features distinct from those reported earlier.

Correlation of E-cadherin Immunohistochemical Expression with Histopathological Grading of Oral Squamous Cell Carcinoma.

OBJECTIVES: The current research was undertaken with an aim to correlate the expression of E-cadherin with histopathological grading in oral squamous cell carcinoma (OSCC) patients. Further, the objectives of the study were to evaluate the qualitative and quantitative expressions of E-cadherin in OSCC and to correlate the number of tumor cells of OSCC, immunopositive for E-cadherin with histopathological grading of OSCC. MATERIALS AND METHODS: Immunoexpression of E-cadherin antibody was evaluated in previously diagnosed, paraffin-embedded sections of 20 tissues each of well-differentiated and moderately differentiated OSCC, 17 tissues of poorly differentiated OSCC, and 10 tissues of normal oral mucosa; Chi-square test, analysis of variance, and Tukey's honestly significant difference test were employed for statistical analysis. RESULTS: E-cadherin immunoreactivity was inversely correlated to the loss of cell differentiation. There was a significant decrease in expression of E-cadherin (P < 0.0001) in advanced cases of OSCC. Furthermore, there was a significant reduction in intensity of E-cadherin expression with advancing histological grades of OSCC. CONCLUSION: From the present study, it is concluded that the reduced expression of E-cadherin may be a reliable indicator of increase in the invasiveness of OSCCs.

TMJ Arthritis Imaging: Conventional Radiograph vs. CT Scan - Is CT Actually Needed?

OBJECTIVE: The present study was conducted to evaluate the efficacy of conventional TMJ imaging in depicting osseous changes in mandibular condyle and glenoid fossa in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) by comparing the finding against CT and with an objective that if conventional TMJ imaging modality can appreciate the osseous changes in RA and OA then what is the need for CT scan. Thus further reducing the patient's radiation dose. MATERIALS AND METHODS: A total of 70 patients (40 Rheumatoid Arthritis; 30 Osteoarthritis) were taken in the study aged between 40 - 60 years and divided in to age groups. Then according to clinical history they were divided according to being symptomatic and asymptomatic. Further radiographic examination was carried out. First the trans-cranial view was obtained (conventional view left and right TMJ) and subsequently a CT scan was obtained and the interpretation was carried out to note the osseous changes like erosion, flattening, sclerosis and osteophyte formation. RESULTS: After comparison of the two radiographic methods it was observed that both were equally efficacious in evaluating the osseous changes in arthritic patients. CONCLUSION: Thus, it was concluded that when both the radiographic methods (conventional and CT scan) are equally efficacious in evaluating the osseous degenerative changes of TMJ in arthritis. Thus we should prefer the conventional technique so that the patient in not exposed to unnecessary radiation dosage.

Prevention of Malignant Transformation of Oral Leukoplakia and Oral Lichen Planus Using Laser: An Observational Study

Objectives: The present observational study was conducted with an aim to evaluate the efficacy of diode laser in management of homogenous oral leukoplakia (OL) and reticular oral lichen planus (OLP), so that these potentially malignant disorders can be limited and further malignant transformation can be prevented. Further the assessment of associated postoperative complications after laser therapy was also carried out. Study Design: Present study was carried out using diode laser 810nm on 60 subjects, of whom 30 subjects were of homogenous OL and 30 subjects were of reticular OLP aged between 20 ­ 60 years, the diagnosis of which was histopathologically confirmed. Results: Of the 60 subjects none complained of pain during and immediately after surgery with no bleeding at any stage of the procedure. By the end of 3rd day post operative most subjects reported no pain and swelling and very few subjects had negligible pain and swelling when evaluated. On subsequent follow-up of 1,2 and 4 week(s) none of the subject reported of pain, swelling or bleeding and it was noted that all the areas treated with laser had healed without scarring with no signs of recurrence. Fibrosis was seen in two male patients and one female patient treated for OL and OLP respectively. Conclusion: Patient compliance and contentment without any postoperative complications were observed to be of high degree in the present study. Thus diode laser can be considered as a best alternative to conventional surgical treatment modality in managing OL and OLP and preventing its further transformation.

Assessment of clinical efficacy of locally delivered 0.2% Thymoquinone gel in the treatment of periodontitis.

OBJECTIVES: To evaluate the potential benefits of local application of Thymoquinone gel as an adjunctive to scaling and root planing (SRP) in subjects with chronic periodontitis. MATERIAL AND METHODS: Twenty subjects with 40 test sites were selected according to inclusion and exclusion criteria. They were further divided into 2 groups. Group I comprised of study subjects (Thymoquinone in addition to SRP) and Group II comprised of control subjects (only SRP). Clinical parameters such as Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Relative Attachment Level (RAL), were monitored at baseline and 6 weeks post operatively. Alkaline phosphatase (ALP) levels in gingival crevicular fluid (GCF) were evaluated at baseline and 6 weeks post operatively using microcapillaries. In addition antimicrobial efficacy of Thymoquinone was evaluated against 3 bacteria using antimicrobial strains. RESULTS: Statistically highly significant reduction was observed in PI, GI and PPD, rise in RAL and GCF ALP level in both the groups at 6 weeks from baseline. On comparison between Group I and Group II, former demonstrated statistically significant reduction in PPD, GCF-ALP levels and rise in RAL but statistically no significant differences were observed in PI and GI at 6 weeks. On microbiological assessment of 0.2% Thymoquinone gel, it was observed to be sensitive against P. gingivalis, A. actinomycetemcomitans and P. intermedia. CONCLUSION: Significant changes in clinical and biochemical parameters were achieved in the current study. Hence, it is concluded that intracrevicular application of 0.2% Thymoquinone gel could be a beneficial adjunct to SRP in treating chronic periodontitis.

Evaluation of Collagen in Leukoplakia, Oral Submucous Fibrosis and Oral Squamous Cell Carcinomas Using Polarizing Microscopy and Immunohistochemistry

Objectives: Picrosirius red and MMP are capable of degrading extracellular matrix proteins, expressed in lesions such as squamous cell carcinomas. The present study was undertaken with an aim to analyze and compare changes in collagen using Picrosirius red staining under polarizing microscopy and immunohistochemical staining using anti MMP-13 in samples of oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma. Materials and Methods: A total of 70 slides were prepared and divided into 3 groups. Group I comprised 10 slides of normal gingival tissue, Group II 40 slides of potentially malignant disorders and Group III 20 slides of well differentiated oral squamous cell carcinoma. Half the slides for each group were stained with Picrosirius red stain and the remainder with antibodies to MMP-13. Rerults: In Group II, MMP-13 connective tissue expression was greater in OSMF as compared to leukoplakia. Group III showed elevated expression among 70% of cases. Picrosirius red staining in Group II cases, showed higher staining Yellow-Orange andGreen-Yellow mature fibers in OSMF than leukoplakia cases while in Group III, 50% OSCC cases showed Green-yellow stained immature thin fibers. Conclusion: In future, therapeutic measures targeted against MMP-13 may inhibit collagenolysis to some extent and delay spread of tumors. An easy and reliable method to determine the state of the stroma in such cases may be Picrosirius red staining with polarizing microscopy.

Primary oral tuberculosis on the tongue mimicking squamous cell carcinoma.

Tuberculosis is chronic granulomatous disease with rare oral manifestations. But if so are overlooked by most of the health care professionals. Clinically, most of the times, a tuberculous ulcer may mimic an ulcer of malignant origin and may be misdiagnosed. So, keeping in mind the etiology and the nature of the ulcer, it should be differentially diagnosed and a histopathological examination should only confirm the final diagnosis of the ulcer.

The use of dental records as a tool for the Unique Identification Authority of India in personal identification: A proposal.

The Unique Identification Authority of India is a statutory authority established in 2009, which had started a campaign of issuing Aadhaar (unique identification) cards to every citizen of India under the slogan "Mera Aadhaar Meri Pehchaan" (my unique identification my identity). The government is taking all possible initiatives to make Aadhaar card the identity of an individual and is taking all measures of linking all the valid government-issued documents (such as driving license, PAN card, subsidies etc.) with this card. However, it is a matter of great sadness that some antisocial elements of the society forge or misuse the government-issued identity card and create a fake identity. To strengthen this initiative of unique identification, the dental records need to be amalgamated with this campaign. This article evaluates the importance of maintaining dental records and personal identification and also defines a proposal of linking these dental records to Aadhaar card in India.

ZACD: A Retrograde Panoramic Analysis among Indian Population with New System of Classification.

INTRODUCTION: Zygomatic Air Cell Defect (ZACD) has been considered as a normal radiographic variant with a spare knowledge. This should be judged before any surgical procedure of the temporal region as lack of which can lead to infections of cranium and may other complications. AIM: The present study was undertaken to estimate the prevalence and characteristics of ZACD and to propose a classification for the same using digital panoramic radiography. MATERIALS AND METHODS: A total of 6825 digital panoramic radiographs were evaluated retrospectively of subjects aged between 4-90 years from both genders. The radiographs were evaluated by 4 (four) oral radiologists and the ZACD was recorded only when the decision was indisputable. RESULTS: Out of 6825 digital panoramic radiographs evaluated ZACD was noticed in 133 subjects with an overall prevalence of 1.94%. A male predilection was noted in the present study with the maximum prevalence during the second, third and fourth decade of life and as the age increases its prevalence decreases. Most commonly it was found to be unilateral and the unilocular presentation being more common. CONCLUSION: Most of the finding of the present study is in acceptance with those conducted previously, but some of the finding contradicts those in the previous ones. It can be because of low sample size of the previous studies. Moreover this study gives a new system to classify these defects to help diagnose the nature of the defect.

Role of forensic odontology in the Indian Armed Forces: An unexplored arena.

Forensic odontology (FO) is a branch of forensic medicine that in the interest of justice deals with proper handling and examination of dental evidence. Teeth can survive in most conditions encountered at death and during decomposition, even when the body is exposed to extreme forces and/or temperatures. FO is being practiced worldwide since 1775, after which it has not only become an integral part of the judicial system of the developed countries but also been adopted by the armed forces and investigative agencies of these countries. In India, the awareness of FO is gaining pace since the last decade after the establishment of various organizations and the Dental Council of India making it a part of the curriculum. However, its identity as an individual endeavour is still to be established. Awareness and applicability of FO in the Indian Defense Forces would be of great help for better and accurate record keeping of the dedicated and vigilant warriors of our army. These records will be of great help for easy recognition of our army men at the time of calamities, wars, and other difficulties. It would also be useful in the identification of terrorists who enter our country and travel easily in disguise.

Determination of normal range for fasting salivary glucose in Type 1 diabetics.

BACKGROUND: The most commonly employed investigative procedure for monitoring glucose levels is blood investigation, which is invasive and gives discomfort to the patient. The purpose of the study was to validate a noninvasive, easy, and reliable method for predicting glucose levels in Type 1 diabetics and to validate a regression equation for converting the known values of salivary glucose to blood glucose. MATERIALS AND METHODS: 200 volunteers consisting of 100 Type 1 diabetics and 100 healthy controls were included, and their fasting blood and salivary glucose levels were assessed, using a semi-auto analyzer. RESULTS: On analysis of the data, statistically significant positive results were obtained (P < 0.05) when the blood and salivary glucose levels were considered among the study group participants, control group participants, and both study and control group participants. A cut-off value for salivary glucose (11.60 mg%) was defined, above which a person may be considered as diabetic. Also, the regression equation was obtained which could be used for the conversion of known value of salivary glucose to blood glucose and vice versa. CONCLUSION: The present study successfully demonstrated the role of saliva as a noninvasive and reliable marker for the prediction of glucose levels in Type 1 diabetics who show elevated blood glucose levels.