Comparative evaluation on surface nanohardness, surface microhardness, surface roughness, and wettability of plant-based organic nanoparticle reinforced polyetheretherketone as an implant material - An in vitro study.

AIM: Synthetic inorganic materials are commonly used as reinforcing agents in polyetheretherketone (PEEK) composite, whereas natural organic plant-based reinforcing agents are negligible. Surface hardness, roughness, and wettability are indicative factors of osseointegration behavior to be used as an implant material. This study evaluated micro surface hardness (MSH), nano surface hardness (NSH), surface roughness (SR), and contact angle (CA) of PEEK-Azadirachta indica reinforced at 10 wt%, 20 wt%, and 30 wt%. SETTINGS AND DESIGN: This was an in vitro study. MATERIALS AND METHODS: Neem (A. indica) leaf nanoparticles were prepared and reinforced with PEEK powder at 10%, 20%, and 30% weight ratios by injection molding. Sixty specimens underwent the microhardness and CA testing using a digital microhardness tester, and CA goniometer, respectively, and later nanoindentation test to analyze the nanohardness and SR. STATISTICAL ANALYSIS USED: A one-way ANOVA test with a 95% confidence interval for MSH and NSH, SR, and CA was performed on the samples. A post hoc Bonferroni test was conducted (α = 0.05) to compare the groups. RESULTS: There was a significant increase in nanohardness (P = 0.000) with zero difference in microhardness (P = 0.514). The addition of 10 wt%, 20 wt%, and 30 wt% nanoparticles increased the SR value of the pure PEEK from 273.19 nm to 284.10 (3.99%), 296.91 (8.68%), and 287.54 (5.24%), respectively. In the analysis of the CA, CA 20% shows the lowest angle (63.69) with the highest for control specimens (82.39). There is an increase in the PEEK composite SR with a decrease in CA. CONCLUSIONS: The addition of plant-derived nanoparticles into the PEEK matrix has a significant impact on the hardness and hydrophobicity enhancing cell growth and osteoblastic differentiation during osseointegration of dental implants.

Comparison of accuracy of immediate implant placement between planned and actual position in pre-extractive versus conventional method - A prospective study.

This study aims to evaluate the accuracy of immediate implants in mandibular molars between the conventional method and the pre-extractive inter-radicular method. MATERIALS AND METHODS: A total of 20 patients were equally divided into two groups. Implants were placed using the conventional method (Group A) and pre-extractive inte-rradicular method (Group B). Coronal, apical and angular deviation between planned and placed implants were evaluated by superimposing preoperative and postoperative three-dimensional (3D) STL models in Geomagic Freeform software. The data were subjected to an unpaired Student t-test. RESULTS: Results revealed that the coronal, apical and angular deviation were lower in the pre-extractive inter-radicular drilling method than in the conventional method, which was statistically significant. Apical deviation was greater than coronal deviation in both the sagittal and coronal planes. It was also found that the mean deviation was greater in the sagittal plane (mesio-distal axis) than in the coronal plane (bucco-lingual axis). CONCLUSION: Comparison of the two methods revealed significant changes between the planned and actual positions of implant. When stringent steps were followed, the degree of deviation was found to be less in the pre-extractive inter-radicular approach, proving it to be more accurate than the conventional method. However, large-scale research studies are required to extrapolate our findings.

Evaluation of Expression of WNT1 and PTCH Genes in Peripheral Blood of Patients with Odontogenic Cysts and Tumours of the Jaws by Quantitative RT-PCR: A Pilot Study.

Introduction: Odontogenic lesions of the maxillofacial region constitute a complex group of lesions with diverse histopathologic types and clinical behaviour. Early diagnosis is important to minimize the need for radical surgery and to improve quality of life of the patients. Tumour markers play an essential role in the molecular level understanding of Odontogenic lesions and also used for early diagnosis and target therapies which improves the quality of life of the patients. Patched, a tumour suppressor gene encodes the transmembrane protein PTCH and is a receptor for the morphogen Sonic Hedgehog. It is evident that PTCH gene mutations occur in odontogenic keratocysts and the Hedgehog signalling pathway has an important role during tooth formation. WNT 1 is a key signal molecule that controls cell growth and proliferation. WNT pathway abnormalities are reported to induce tumour occurrence. Hence, my study was to determine the presence of WNT1 and PTCH in peripheral blood of patients with Odontogenic lesions using quantitative RT-PCR. Materials and Methods: In this cross-sectional study, two groups were included: Group 1-blood samples from 8 individuals with odontogenic cysts and tumours, and Group 2-blood samples of 8 individuals without Odontogenic lesions. 2 ml of blood sample was collected from radial veins into PAX gene tubes containing RNA stabilizing agent and stored at a temperature of 2 to 4 degrees and transported to Enable Biolabs India Pvt Ltd., Chennai. PAX gene tubes were subjected to centrifugation at 8000 rpm to separate plasma fraction. Reverse transcription of mRNA was performed using miScript II RT Kit (Cat#218161, Qiagen, Germany) to synthesize cDNA. GAPDH house-keeping gene used as control. Results: The study group had 3 males and 5 females (n = 8) with a mean age group of 32.6 years and the control group had 2 males and 6 females (n = 8) with mean age of 35.2 years. Group I (study group) showed 37.5% positive expression of WNT1 gene with a p value of 0.055 (p > 0.05) and 50% positive expression of PTCH with a p value of 0.021 (p < 0.05) (Figs. 3 and 4) which was statistically significant when compared with control group. Group II (control group) showed 100% negative expression for WNT1 and PTCH genes. Conclusion: WNT1 and PTCH genes were expressed in peripheral blood of patients with odontogenic lesions. WNT1 and PTCH genes may be potential predictors in individuals who would develop odontogenic lesions. Further studies on expression of WNT1 and PTCH genes with larger number of samples might give a future scope for target therapy in odontogenic lesions.

Prognostic Significance of Proliferative Markers: Cyclin D1 and CENPF in Oral Squamous Cell Carcinoma Patients-A Cohort Study.

Introduction: Oral cancer ranks sixth place worldwide among other cancers and is known for its high morbidity and mortality rates. Among oral cancer, oral squamous cell carcinomas (OSCC) remains the most common. Expression of specific biomarkers are known to be related to the prognosis of the OSCC. Methodology: An immunohistochemistry study was performed to evaluate the expression of Cyclin D1 and CENPF for their prognostic significance in twenty OSCC patients. The follow-up period ranged from 10 to 18 months. The expression of these proliferative markers was correlated with demographic, clinical and histopathological grade of the disease. Results: The results revealed 28% mortality rates in relation to OSCC involving retro-molar trigone. Based on the Cyclin D1 and CENPF expression, high mortality rate (Pearson coefficient = 0.800) was seen with grade 3 and 4 expressions of the markers. Decreased survival rates (Pearson coefficient = 0.824) were observed with stage III and IV disease with grade 3 and 4 expressions of the markers. Conclusion: Cyclin D1 and CENPF have shown promising results as proliferative markers which can be linked with prognosis of OSCC in this study. Further studies with larger sample size are needed to extrapolate our findings.

Students Perception toward Effectiveness of Online Learning during COVID-19 Pandemic among University Dental Students in India and United Arab Emirates: A Multi Centric Study.

Objectives: The rationale of this study was to compare the efficiency of online learning and the differences in outcome between the two universities in India and United Arab Emirates (UAE). Materials and Methods: A cross-sectional study was conducted with a validated questionnaire among dental students of a dental college in India and a dental college in the UAE. The data were analyzed using the SPSS software version 22, and comparison was done using the Chi-square test, ANOVA, correlation, and regression analysis. Statistical significance was set at P < 0.05. Results: A total of 491 students responded to the questionnaire, of which 314 were from India and 177 from UAE. The awareness of online learning among students had increased after COVID-19, and Zoom was the most common platform (30.9%). The satisfaction ratio was 78.4%, and smartphones were commonly used by students. Based on the satisfaction of online learning, study participants from UAE had a higher mean attitude score (2.72 ± 0.98) as compared to Indian students (2.47 ± 0.77) (P < 0.027*). Conclusion: The study results show that online learning was comparable to traditional method of learning. Although poor network connectivity was a deterrent for online learning among students from India and UAE, future teaching methods could inculcate online teaching methods and hence encourage blended learning as part of the teaching curriculum.

Mini - Retromandibular access to sub condylar mandibular fractures - Our experience.

Condylar fractures alone accounts to about 25% to 40% of all the fractures of mandible. Management of condylar fractures has always been a controversy. Nowadays there has been more emphasis on open reduction of condylar fractures by the surgeons.The reasons could be the result of complications of closed reduction where the patient may not be able to masticate properly and deviation still present thereby the structural and functional loss forcing the surgeons' choice to open up. The anterior parotid approach has lesser risk of injury to parotid gland and also to facial nerve we attempted to use mini retro mandibular access for such fractures. So the aim was to explore the feasibility of the mini retro mandibular approach to sub condylar fractures. The patients reported to the department of oral and maxillofacial surgery department clinically and radio logically diagnosed and treated for condylar fractures were included. The maximal mouth opening, protrusive and lateral excursive movements, midline orientation with opposing arch, scar visibility, sialocele and facial nerve weakness were all recorded post operatively and compared with pre-operative recording. The mini retro mandibular access with anterior parotid transmessetric approach to sub condylar fractures can be the choice for the surgical management of sub condylar fractures which is absolutely easy, reliable, with less visible scar and with less chances of landing in facial nerve complications.

Management of recurrent lymphangioma of the cheek in an adult patient: An interdisciplinary approach.

Lymphangiomas are congenital malformations. Swellings in the cheek may arise from infection, cyst and tumors.Pathological lesions are not always confined to its common site and age of occurrence. Occurrence of lymphangioma in buccal mucosa especially in adults are very rare. Exact knowledge about anatomy and nature of lesion is mandatory for its complete removal as incomplete removal results in recurrence. Herewith,a rare case of recurrent lymphangioma involving left buccal mucosa in an adult is presented with its management. Emphasis is laid on the necessity of combined approach through multidisciplinary team while treating such lesions.

Comparison of the efficiency of arm force versus arm force plus wrist movement in closed method extractions an observational study.

BACKGOUND: Atraumatic dental extraction preserves not only the bone, but also maintains the gingival architecture, hence allows immediate or late dental implant placement. The incidence of fracture of roots and buccal cortical plates increases when wrong force is used. Currently, there is insufficient literature evidence with regard to the appropriate method for application of arm and wrist force at the time of dental extraction. AIM: Therefore, the aim of the present study was to compare the efficiency of arm force only versus arm force plus wrist movement during closed extractions. MATERIALS AND METHODS: The patients who underwent extractions of right upper molars (n = 50) in the Oral and Maxillofacial Surgery Department were selected for the study after obtaining Informed Consent. The patients with grossly decayed broken teeth and mobile teeth were excluded. The procedure was carried out by interns and was observed by three maxillofacial surgeons of more than 5 years of experience independently. RESULTS: It was observed that 30% of the trainees used arm only force during dental extraction and were unaware about it. The time taken for tooth removal in the group which used arm and wrist force was significantly lesser (P < 0.001). It was also observed that the breakage of tooth and alveolar bone fracture was more common with the group who used only arm force. CONCLUSION: From the results of the present study, it can be concluded that during exodontia procedures, the principle of using arm and wrist facilitates safe and easy removal of tooth with less time.

Impact of Lockdown on the Attitude of University Students in South India-A Cross-Sectional Observational Study.

INTRODUCTION: The whole world is under the effects of the COVID-19 pandemic which has put all nations in a unique lockdown situation to contain the disease. Though the environment got ameliorated with low pollution levels, this unexpected lockdown has taken a toll on humans' mental health. As the effects of lockdown can affect college students due to fear, anxiety and stress, this study intends to assess the attitude of the university students. METHODOLOGY: An online questionnaire survey comprising 15 questions was conducted among four South Indian state university students. Their responses were recorded through Google Forms. The submitted responses were analysed using SPSS software version 17. RESULTS: In total, 1241 responses were recorded from university students belonging to various faculties. Though 43% considered this lockdown as a convenient break, 60% could not focus on their studies. The importance of renewing relationships was felt by 47%, and 83% tried to learn a new skill. Students from Tamil Nadu were looking forward towards a brighter future after the lockdown. CONCLUSION: This survey conducted in the early days of lockdown indicated that the university students were not anxious about the long-term effects of the pandemic but showed a decline in their academic performance.

Immediate Psychological Impact of Dental Students on COVID-19 Epidemic in India - A Cross Sectional Study.

INTRODUCTION: The 2019 coronavirus disease (COVID-19) epidemic is a global health threat and is by far the largest outbreak of atypical pneumonia since after SARS over the past few decades. Within weeks of the initial outbreak the total number of cases and deaths exceeded those of SARS. Such mass Casualties often trigger waves of heightened fear and anxiety in many population. AIM: To assess the psychological impact and mental health status among the dental students studying in the Vinayaka Mission's Sankarachariyar Dental College, Salem, India. MATERIALS AND METHOD: A total of 21 psychological state questionnaires along with demographic aspects were distributed to 460 under graduate dental students from Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamilnadu. The Psychological state was assessed using the Depression, Anxiety and Stress Scale (DASS). RESULTS: 404 questionnaires were taken for our study as they responded all questions. The results were calculated based on the responses obtained year wise, gender, Place of residence, Living with family, Steady family income and Acquaintance affected with covid and compared among the three psychological assessments Depression, Anxiety and stress. The results of the study were done using SPSS (V21.0IBM, Chicago) Software. CONCLUSION: We attempted to correlate the socio demographic datas with psychological status of the dental students' in our university using the DAS scale. This study focused on the need for treating the psychological impact of the society at this outbreak as the mental health is the most important to deal with.

Lingual Hypoglossal Reflex: An Unusual Reflex of Head and Neck.

INTRODUCTION: Oral-pharyngeal reflexes demonstrate a wide range of complexities due to their intricate synaptic pattern. Most of the reflexes are protective in nature such as preventing aspiration. These reflexes in oral cavity affect the muscles and can be evoked either in isolation or in combination in order to achieve a specific response. Certain sensory inputs induce an entire motor behavior pattern as seen in lingual hypoglossal reflex. MATERIALS AND METHODS: A case report depicting this reflex have been presented. To our knowledge, this is the first case documented in a living human. Along with this, cadaveric studies have been also done in fifteen specimens. RESULTS: Extralingual anastomosis between lingual nerve and hypoglossal nerve were found in six specimens. CONCLUSION: Hereby, we present a clinical paper of this unusual phenomenon which has not been documented in the literature.

Evaluation of the Role Played by Cyclin D1 as a Diagnostic and Prognostic Marker in the Progression of Oral Carcinogenesis.

ABSTRACT: Cyclin D1 is linked with the development and progression of oral squamous cell carcinoma (OSCC). This case-control study was directed to characterise the immunoreactivity of the protein cyclin D1 and its correlation with the clinicopathological parameters of patients with OSCC and potentially malignant disorders (PMD). A group of patients with OSCC were followed up after treatment, and the cyclin D1 expression was reviewed for correlation of cyclin D1 expression with prognosis of the patients. METHODOLOGY: Sixty individuals were included in this study: OSCC (20), PMD (20) and Control (20). Immunohistochemistry assay was evaluated. The clinicopathological parameters were correlated with the staining intensity of cyclin D1. The results were subjected to Pearson's correlation test. RESULTS: Age, gender and site showed no statistically significant correlation with cyclin D1 expression in OSCC and PMD. The cyclin D1 score did not show a significant difference with histopathological diagnosis of OSCC. Cyclin D1 was not expressed in 60% of the Control and 30% PMD cases while the expression of cyclin D1 was seen in 100% of OSCC cases although cyclin D1 score did not show a statistically significant association in the prognosis of the disease among the OSCC patients.

Neurilemmoma of Maxillary Alveolus: A Rare Case Report and Review of Literature.

Schwannomas or neurilemmomas are benign, slow growing, usually solitary and encapsulated tumor, originating from Schwann cells of the nerve sheath. Intraoral schwannomas account for 1% of head and neck region and are commonly seen at the base of the tongue. Most of the literature, reports of schwannomas in the tongue region are common. In this article we report a rare occurrence of schwannoma in the maxillary alveolus region and its management. A 45 year old female patient reported to the department of oral and maxillofacial surgery with a complaint of swelling in the left maxillary alveolus in relation to molar teeth that had been present for more than 3 months. Apparently the swelling was small one initially, which gradually increased in size. Such a rare cas e of intraoral schwannoma should be followed up periodically to look for any malignant transformation and recurrences. An important conclusion that has evolved from the reviewed articles, is that the differential diagnosis of painless nodules in head and neck must include schwannomas.

Mini review: Multifaceted role played by cyclin D1 in tumor behavior.

The objective of this paper is to discuss and put forward the various diversified roles of cyclin D1 in cancer. Neoplasia is defined by abnormal regulation of the cell cycle. Cyclin D1 could be a protein derived from the PRAD1, CCND1, or bcl-1 sequence on body 11q13 that is concerned in each traditional regulation of the cell cycle and pathologic process. Within the G1 (resting) part of the cell cycle, cyclin D1 in conjunction with its cyclin-dependent enzyme (cyclin-dependent kinase) partner is accountable for transition to the S (DNA synthesis) part by phosphorylating the merchandise of the metastatic tumor sequence (protein retinoblastoma) that then releases transcription factors vital within the initiation of DNA replication. Amplification of the sequence or overexpression of the cyclin D1 releases a cell from its traditional controls and causes transformation to a malignant composition. Analysis of those changes provides vital diagnostic information in oral carcinogenesis and is of prognostic value in several cancers. Data of cyclin D1's role in malignancy at the assorted sites provide a basis on which future treatment directed against this molecule will proceed.

A Comparative Study on Microvascular Anastomosis of Vascularised Free Fibular Flap with Couplers and Suturing in Mandibular Reconstruction.

INTRODUCTION: Successful outcome of any vascularised free flap basically depends upon the successful restoration of circulation in the flap after anastomosis. As the flap ischemic time is the significant factor which determines the outcome of any free flaps, due consideration is given to reduce the time for anastomosis for reperfusion. The present study compares and evaluates whether the usage of microvascular couplers with the conventional suturing reduce the ischemic time of the free flaps. MATERIALS AND METHODS: Thirty patients were randomly divided into two groups (each group consisting of 15 patients) for mandibular reconstruction using free fibular microvascular flap. In group 1, microanastomosis was done with conventional suturing whereas microvascular couplers were used in group 2. Intraoperatively, patency, leakage and tissue perfusion were assessed. The time taken for anastomosis (time taken for suturing and applying couplers) and flap ischemic time (from the time of flap division from the donor site till the flap is reperfused after anastomosis) were calculated for both the groups. RESULTS: Significant decrease in time for anastomosis was observed in group 2, which resulted in decrease in flap ischemic time and in overall operating time.

Anesthetic efficacy of 4% articaine versus 2% lignocaine during the surgical removal of the third molar: A comparative prospective study.

AIM: The study aimed at evaluating the clinical efficacy of articaine over lidocaine in the surgical removal of impacted mandibular third molars. OBJECTIVE: The objectives were to compare the onset of anesthesia, pain during injection, during the procedure and after the procedure, compare the duration of anesthesia, and need for re-anesthesia. MATERIALS AND METHODS: A prospective study was conducted on 70 subjects planned for surgical removal of mandibular third molars. Subjects were randomly administered one of two local anesthetics. The anesthetic agent used was unknown for the patient and the observer who performed the measurements. RESULTS: The differences in latency with 4% articaine (56.57 ± 9.8 s) and with 2% lignocaine (88.26 ± 12.87 s), pain during procedure for articaine 1.31 ± 0.87 and for lignocaine 2.60 ± 1.06, pain after procedure was 0.89 ± 0.58 for articaine and 1.31 ± 1.05 for lignocaine, and mean duration of anesthetic effect for articaine was 231 ± 57.15 min and 174.80 ± 37.02 min for lignocaine, which was statistically significant. For re-anesthesia, 6 out of 35 patients needed re-anesthesia at the frequency of 8.57% for articaine and 13 out of 35 patients needed re-anesthesia at a frequency of 18.57% for lignocaine. CONCLUSION: The results proved that articaine had a significant faster onset of action and longer duration of action when compared to lignocaine. Hence, the pain experienced by the patients during and after the surgical procedure was significantly less. The study was concluded that articaine is a safe alternative to lignocaine, which is potent and effective in minor surgical procedures such as removal of mandibular third molars.

A Single Pre Operative Dose of Sub Mucosal Dexamethasone is Effective in Improving Post Operative Quality of Life in the Surgical Management of Impacted Third Molars: A Comparative Randomised Prospective Study.

OBJECTIVE: The aim of the study was to observe and compare the effects of dexamethasone on pain, swelling and trismus administered as one dose preoperatively sub mucosal (study group 2) versus intramuscular injection (study group 1) keeping control as those who received no dose of steroid in the management of third molar surgery. MATERIALS AND METHODS: The group 2 (20 patients) is the study group in which all the patients had single dose of pre-operative sub mucosal dexamethasone of 4 mg/2 ml. The group 1 patients (20 patients) received single dose of pre-operative intra muscular dexamethasone of 4 mg/2 ml. The control group (20 patients) did not receive steroid in any form. The post operative pain, swelling and trismus were assessed for all the groups. RESULTS: The submucosal dexamethasone group showed marked improvement in the mouth opening in the follow ups than the intra muscular dexamethasone group. In those five cases of bilateral impaction, in study groups 1 and 2, the mouth opening was very much significant when sub mucosal dexamethasone was given. CONCLUSION: The pre operative use of submucosal dexamethasone effectively reduces the post operative pain, swelling and trismus showing statistically significant results. The number of post operative use of analgesic tablets taken by the patients in the study group 2 were less compared to the study group 1 and the control group showing clinically significant results.

Unusually large-sized peripheral ossifying fibroma.

Fibrous growths in the gingiva with the histopathological presence of calcifications are a common occurrence in the oral cavity. These lesions can be neoplastic in nature with either odontogenic or non odontogenic origin or they can be reactive lesions. This is a case report of an unusual presentation of peripheral ossifying fibroma , unusual because of its abnormally large size with review of literature.

Adenomatoid odontogenic tumor associated with dentigerous cyst in posterior maxilla: A case report and review of literature.

Adenomatoid odontogenic tumor (AOT)-a benign (hamartomatous) lesion of odontogenic origin-is an uncommon tumor which affects young individuals with a female predominance, mainly in the second decade. This lesion is most commonly located in the anterior maxilla and is usually associated with an impacted canine tooth. This is a case report of a 39-year-old female patient presented with a large AOT of the posterior maxilla associated with an impacted second molar - a very rare situation.