Potential for Osseous Regeneration of Platelet-Rich Fibrin-A Comparative Study in Mandibular Third Molar Impaction Sockets.

PURPOSE: This study investigated the potential of platelet-rich fibrin (PRF) for osseous regeneration and soft tissue healing in mandibular third molar impaction sockets. MATERIALS AND METHODS: A prospective in vivo study was performed. Randomization was performed after extraction. On one side, the socket was sutured primarily (control site); on the other side, autologous PRF gel was placed and then the socket was sutured (test site). Postoperatively, grid periapical radiographs were obtained at periodic intervals (weeks 1, 4, and 16) and digitalized. Gray-level values were measured at 3 different regions of the socket (for regions of newly formed bone) compared with the natural bone area using HL Image++ software, and the percentage bone fill was measured. Clinical evaluation of soft tissue healing was performed using the healing index of Landry et al (J Periodontol 60:212, 1994) at the specific intervals. RESULTS: Thirty healthy men and women (age range, 18 to 35 yr) with bilaterally impacted mandibular third molars were enrolled in this study. In general, there was markedly greater bone formation in sockets treated with PRF (P < .05). In the PRF group, the average gray-level values at the cervical, middle, and apical regions were 61.85 (standard deviation [SD], ±25.186), 64.54 (SD, ±24.831), and 67.80 (SD, ±23.946), respectively, with a mean value of 64.73 (SD, ±24.411). In the control group, these values were 51.58 (SD, ±15.286), 54.30 (SD, ±16.274), and 57.53 (SD, ±16.187), respectively, with a mean of 53.67 (SD, ±16.528). The average percentage of bone fill in the PRF group was 57.90 (SD, ±26.789) and that of the non-PRF group was 46.74 (SD, ±17.713; P < .05). Soft tissue healing as evaluated by the healing index of Landry et al also was found to be better at the PRF test site and it was statistically significant (P < .05). CONCLUSIONS: There was evidence for better osseous regeneration and soft tissue healing in response to PRF. Further investigations to evaluate the application of PRF in other areas of oral and maxillofacial surgery are imperative.

An ambiguous asymptomatic swelling in the maxillary anterior region-A case report.

INTRODUCTION: Glandular odontogenic cyst is a rare and recently recognized type of developmental odontogenic cyst. Being odontogenic in origin, because of the pluripotentiality of the odontogenic epithelium it can show glandular or salivary features. PRESENTATION OF A CASE: A 46 year old female patient was referred to the Oral and Maxillofacial Surgery department with chief complaint of painless swelling in the right anterior region of maxilla, radiographically associated with teeth 12, 13. Mucosa over the swelling was slightly bluish in colour and no associated palatal swelling was seen. No incidence of trauma was reported and involved teeth were not mobile. DISCUSSION: Although we have many differential diagnoses, our working diagnosis was a periapical cyst, so conventional treatment of root canal treatment, cyst enucleation, and apicoectomy was planned. CONCLUSION: Here we present a case which was initially misdiagnosed and mismanaged but on subsequent histopathologic examination revealed the final diagnosis.

The Versatility in the Use of Buccal Fat Pad in the Closure of Oro-antral Fistulas.

INTRODUCTION: Oroantral communications (OAC) are probable surgical complications of dentoalveolar procedures. OACs 2 mm in diameter or smaller are likely to close spontaneously without the need for any surgical intervention. However, OACs 3 mm in diameter or larger, or OACs associated with maxillary or periodontal inflammation, may persist, and surgical closure is recommended. Various surgical techniques have been suggested for the closure of oroantral defects. CASE DETAILS: We have found the technique of two layer closure with buccal fat pad (BFP) and buccal mucoperiosteum quite useful for closure of chronic Oroantral fistula (OAF) and this article reports a case of OAF in the left first molar region of a 50 year old male, which has been closed successfully with this technique. CONCLUSION: Buccal fat pad is a pedicled locally available flap which has its own blood supply and hence can be used with great efficacy in closure of OAF. This paper aims to elaborate the surgical details of this technique and its usefulness in closure of chronic OAF.

An interesting radiological picture of post traumatic TMJ ankylosis due to sagittal condylar fracture.

INTRODUCTION: In a condylar fracture whether to intervene or to go for conservative management still remains a dilemma. Studies and hypothesis suggests that it's medially dislocated condylar fracture segment that is more likely to ankylose, moreover no consensus have been put forth as to whether to remove the medially displaced fracture segment. PRESENTATION OF CASE: The current article describes a case of unilateral temporomandibular joint (TMJ) ankylosis, which resulted as a sequlae from conservative management of a bilateral condylar fracture of which, the ankylosed side had a sagittal fracture of condyle. In our case the post trauma CT shows the lateral segment abutting with the arch and that the area has become ankylotic in a span of 2 years. Here we report a case of posttraumatic unilateral TMJ ankylosis resulting from closed reduction of a bilateral condylar fracture with interesting radiological findings. DISCUSSION: We have tried to discuss a rather interesting radiological picture of posttraumatic TMJ ankylosis which resulted as a sequlae from conservative management of a bilateral condylar fracture. CONCLUSION: The dilemma for a clinician as to whether to intervene in a condylar fracture or to go for conservative management still remains at large. As in this case the medial fracture segment was intact and the lateral segment was resulting in ankylosis.

Ameloblastic fibro-odontoma.

INTRODUCTION: Ameloblastic fibro-odontoma (AFO) is a quite rare, mixed odontogenic tumour generally seen in the early stages of life. Frequent signs of this tumour are asymptomatic swelling, delayed tooth eruption and mixed radiological appearance within well-defined borders. Management of the lesion includes enucleation of the tumour and long-term follow-up. PRESENTATION OF CASE: A 10-year-old girl was referred to our oral and maxillofacial surgery clinic with an incidental radiological finding of radiopaque mass in the posterior region of maxilla. OPG showed unerupted tooth bud of upper right second molar and was being prevented from eruption by the odontome. Under general anaesthesia, the lesion was enucleated and the permanent right upper second molar tooth bud removed. DISCUSSION: Mixed odontogenic tumours are a group of rare and interesting lesions which can mislead the clinician to variety of differential diagnosis. Adequate clinical and radiological investigations, proper surgical excison, accurate histopathological diagnosis, and long term follow up will ensure the right treatment plan for the patient. CONCLUSION: The possibility of a mixed rare tumour should be kept in mind by the clinician where they deal with the swellings of posterior maxilla in children. Histological assessment revealed a final diagnosis of ameloblastic fibro-odontoma.

A Comprehensive Proforma for Evaluation of Mandibular Third Molar Impactions.

We have developed a simple, but comprehensive proforma for evaluating mandibular third molar impactions and formulating a proper treatment plan. This proforma is aimed at residents in Oral and Maxillofacial Surgery, to help them during their initial phase, in evaluating and treating impacted mandibular third molars. This comprehensive proforma will help them to analyse third molar impactions, assess and anticipate the difficulty, judge intraoperative problems they might encounter, and evaluate the patient at post operative follow-up.

Novel nanoporous bioceramic spheres for drug delivery application: a preliminary in vitro investigation.

BACKGROUND: Bioceramics and their composites have found myriad applications in medicine as superlative osteoalloplasts. Their potential to function as a biocompatible resorbable drug delivery system is being explored. The present study is a preliminary investigation into the efficacy of these indigenously developed nanoporous materials as vehicles for therapeutic agents. An in vitro experiment was conducted with the goal of assessing this material and comparing it with a commercially available gentamicin-loaded polymethylmethacrylate cement. STUDY DESIGN: The drug-eluting characteristics of gentamicin bone cement and indigenously designed nanoporous bioceramic granules were analyzed spectrophotometrically and compared. Regression analysis was done. RESULTS: The first 5 days saw the elute from both samples containing drug concentrations >100 µg/g. CONCLUSIONS: Both samples exhibit a high initial-burst release, which is ideal for prophylactic purposes. Drug eluent levels for both materials were >100 µg/g, which is sufficient for bactericidal activity.

Traumatic pseudoaneurysm of the superficial temporal artery.

Aneurysms of the superficial temporal artery are relatively rare vascular complications following trauma. Two cases of pseudoaneurysm of the anterior branch of the superficial temporal artery, subjected to blunt maxillofacial trauma are presented here. The first case was treated by surgical resection and the second was cured by application of continuous pressure. The review of the English literature has also been included. An awareness of these vascular injuries, despite their infrequency, is necessary to facilitate early diagnosis, proper investigation and prompt treatment.

A rare massive exophytic gingival growth.

Oral surgeons ought to be aware of variety of lesions that can present as focal exophytic gingival overgrowths. Most gingival lesions arise due to local irritating factors. The case presented share dramatic clinical pictures and findings of a long-standing fibrous gingival lesion. A massive growth of 6×7 cm in size and 5 years duration from the maxillary left posterior gingival region in a 64-year-old female causing severe facial disfigurement is presented. Lesion was characterized by the central core of woven bone formation. The article discusses on the clinical findings of peripheral ossifying fibroma and stresses on the unrestricted growth potential of this interesting lesion.

Extensive gingival myiasis - Diagnosis, treatment, and prevention.

Myiasis is a rare disease primarily caused by infestation of tissue by larvae of houseflies. Oral myiasis is still more "rare" and "unique" owing to the fact that oral cavity rarely provides the necessary habitat conducive for a larval lifecycle. Here we report a case of extensive gingival myiasis, in an 81-year-old female patient, diagnosed and treated successfully in our department. The case is discussed in relation to its clinical presentation, etiopathogenesis, management, and prognosis.

Potential for osseous regeneration of platelet-rich plasma--a comparative study in mandibular third molar sockets.

Platelet-rich plasma (PRP), the concentrate of platelets in plasma contains various growth factors that enhance osseous regeneration. This study utilized homologous platelet-rich plasma in the treatment of third molar extraction sockets in a total of fourteen human subjects, who were randomly assigned into one control and one test group, each comprising of seven members. Clinical parameters like pain on palpation, number of analgesic tablets consumed, swelling, degree of mouth opening, and condition of mucosa overlying the surgical site were assessed at intervals of 1,3,5,7,9,12, and 16 weeks post operatively. The margins between the socket and surrounding bone, radiopacity of bone filling the socket, and presence oftrabecular bone formation were evaluated simultaneously. Soft tissue healing differed significantly between the two groups, with the test group exhibiting better results. Radiographic evidence of bone formation was visible as early as I week in test subjects. It was concluded that PRP contributed to better healing of soft tissues and bone and is a viable means of growth factor delivery.