Central Giant Cell Granuloma of the Mandible: A Case Report.

This article presents a clinical case of a central giant cell granuloma (CGCG) resembling a periapical lesion of endodontic origin. A 39-year-old, otherwise healthy male patient was referred to the department of oral and maxillofacial surgery for its diagnosis and subsequent management. The patient presented with an asymptomatic, progressively increasing intraoral swelling associated with the mandibular left para-symphysis region. On radiographic evaluation, a unilocular radiolucent lesion involving 33-34 teeth was noted. An incisional biopsy presented a giant cell lesion, following which surgical curettage was done. Histopathological examination was in accordance with the diagnosis of CGCG. Therefore, it is imperative for clinicians to accurately diagnose and rule out similarly presenting lesions.

Comparative Evaluation of Different Alveolar Ridge Width Measurement Techniques in Dental Implant Treatment Planning: An in Vivo Observational Non-Interventional Study.

In todays era dental implant has become the dependable therapeutic treatment for the replacement of missing teeth. The success of dental implants depends not only on osteointegration of the implant but also on the surrounding hard and soft tissue. Presurgical evaluation of alveolar ridge width and height is of paramount important for implant placement. There are several methods to evaluate the alveolar ridge width and height such as ridge mapping and CBCT. This study included 30 sites from 8 patients in the age ranging from 30 to 65 years. A stent was prepared and the width of the alveolar ridge was estimated employing the following techniques: Group I: Measurement of alveolar ridge width on cone-beam computed tomography (CBCT) method, group II: Measurement of alveolar ridge width by ridge mapping technique, group III: Measurement of alveolar ridge width by surgical exposure. The minimum value for ridge mapping with caliper is 2 and maximum value is 9 with mean 4.5667 ± 1.63335 with standard error 0.29821. The minimum value for Cone beam computed tomography (CBCT) is 1.80 and maximum value is 9.30 with mean 4.6233 ± 1.67119 with standard error 0.30512. The minimum value for direct intrasurgical measurement with caliper is 2 and maximum value is 9 with mean 4.2000 ± 1.58441 with standard error 0.28927. Cone beam computed tomography could also be used to measure the ridge width accurately. Apart from measurement of alveolar ridge dimensions it had multiple other uses and thus can be advised as per requirement of the clinician.

Mucormycosis and Aspergillosis Infection Following Maxillofacial Trauma: Case Report.

An invasive fungal infection caused by saprophytic and aerobic fungi Rhizopus, Rhizomucor, and Cunninghamella genera of the family Mucoraceae is known as Mucormycosis. Typically, Mucormycosis manifests in patients with conditions like uncontrolled diabetes, renal failure, patients receiving chemotherapy, long term steroid therapy or patients who are immunocompromised such as Acquired Immuno Deficiency Syndrome. The authors report a case of mixed opportunistic fungal infection of Mucormycosis and Aspergillosis following maxillofacial trauma that was treated by both medical and surgical line of management.

Perceptions and challenges of a first-year dental student - A cross-sectional study.

Introduction: Undergraduate dental training is demanding and rigorous, unaware students face a lot of challenges after entering the course. Thus, the study aims to find out from a dental sophomore the challenges they face during the first year of dental school. Methodology: An e-questionnaire study was conducted on 932 second-year Bachelor of Dental Surgery students of India. The questions help us gauge problems and hurdles faced by a dental sophomore like information related to difficulty levels, laborious nature and so on. Chi-square test is to find out relativity and association between the variables. Results: Pre-clinical prosthodontics was found the most laborious and a gender-wise significant difference (P < 0.01) was noted amongst females (437, 71.06%) and males (157, 49.53%). Conclusion: This study highlighted that students are usually unaware about the course, the type of content reading, learning, laborious nature of practical work and so on.

Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla.

Aim: To present a case of adenomatoid odontogenic tumor (AOT) associated with impacted maxillary lateral incisor in a 12-year-old female that mimicked dentigerous cyst. Background: Adenomatoid odontogenic tumor (AOT) was first mentioned by Steensland in 1905, which is a rare tumor of odontogenic origin. Dreibladt in 1907 coined the term pseudo ameloblastoma. In 1948, Stafne considered it a distinct pathological entity. Case description: A 12-year-old female reported to the Department of Oral and Maxillofacial Surgery with the chief complaint of progressive swelling on the left maxillary anterior region for 6 months. The clinical and radiographical findings of the case represented a dentigerous cyst or unicystic ameloblastoma, but the histopathological interpretation was interpreted as AOT. Conclusion: The AOT is an unusual entity that is commonly misdiagnosed as a dentigerous or odontogenic cyst. Histopathology plays a vital role in diagnosis and further management. Clinical significance: The interest and relevance of the present case are the difficulties in diagnosing accurately based on the radiograph and histopathology. Both dentigerous cysts and AOT are entirely benign and encapsulated lesions, and enucleation poses no major difficulties. The case report highlights the importance of early diagnosis of neoplasm arising in odontogenic tissues. The fact that in cases of unilocular lesions surrounding the impacted tooth in the anterior maxillary region, AOT should also be considered as a differential diagnosis. How to cite this article: Pawar SR, Kshirsagar RA, Purkayastha RS, et al. Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla. Int J Clin Pediatr Dent 2022;15(6):770-773.

Biomechanical evaluation of different fixation techniques following modified sagittal split ramus osteotomy using buccal step: An in vitro study.

Objective: This study was to evaluate the efficacy of three different designs of rigid fixation using polyurethane hemimandible replicas following modified sagittal split ramus osteotomy with buccal step. Materials and Methods: Forty-eight polyurethane hemimandible replicas have been used. Following the osteotomy and fixation, each specimen has been mounted on a Universal Testing unit using a prefabricated customized jig and has been tested to a range of vertical forces starting from 0 N on the incisal edge of lateral incisor and lateral forces of on lateral surface of mandibular first molar. Progressive load has been applied until a deflection of 10 mm was observed. SPSS version 20 has been used for analyzing the data. The biomechanical stability of different osteosynthesis has been compared using a one-way ANOVA with post hoc Bonferroni test. P ≤ 0.05 will be considered statistically significant. Results: After advancement of 7 mm, comparison of vertical load and lateral load among different miniplate systems showed that load was maximum in bicortical screws in inverted L pattern followed by T-shaped miniplate system and was least in single six-hole straight plate (0.001) at P ≤ 0.05. Conclusion: Our study concludes that bicortical screws in inverted "L" pattern are more resistant to lateral load as well as on the application of vertical load when compared to other fixation techniques and statistical difference was evident.

Clear cell odontogenic carcinoma in maxilla: A rare case report.

A rare and aggressive form of tumor with a female predilection and more seen with mandible is the clear cell odontogenic carcinoma (CCOC). The World Health Organization categorized it as a malignant neoplasm in 2005. This type of tumor is characterized by local recurrences as well as distant metastasis apart from being highly aggressive in nature. Due to the presence of clear cells, it is a diagnostic challenge to the pathologist. Only about 84 cases of maxillary variant have been reported in the literature. Here, we present a case report of a 31-year-old male with CCOC in the maxilla from the pathological and diagnostic point of view.

Odontogenic Keratocyst: Developing a Protocol for Surgical Intervention.

The aim of this study was to report the outcome of a conservative treatment protocol - "enucleation and packing open" for odontogenic keratocyst (OKC). Ten patients with OKC were treated at our institute by peripheral ostectomy, enucleation followed by open packing. This conservative treatment protocol was selected because of relatively young age of the patients and relatively large size of the lesions. All the cases were monitored at regular predetermined intervals using clinical evaluation and panoramic radiographs. There was no evidence of recurrence during follow-up. The conservative treatment protocol for OKC, based on enucleation followed by open packing would be a possible choice in view of the simplicity of surgical procedure and low morbidity. This treatment modality has a low recurrence rate and may be particularly useful in young patients and patients with advanced systemic disease not amenable to major surgical intervention.

Evaluation of Neurosensory Function Following Inferior Alveolar Nerve Lateralization for Implant Placement.

BACKGROUND: Adequate bone height and width is the most important parameter for success of implants. Prolonged edentulous area in mandibular posterior region is often associated with atrophy precluding the use of dental implants. Inferior alveolar nerve (IAN) lateralization is a challenging surgical procedure as it involves the exposure of the neurovascular bundle from its compact bony compartment and adequate retraction while immediate placement of implant. AIM: Evaluation of neurosensory disturbances related to IAN lateralization for implant placement in the posterior atrophic edentulous mandible. MATERIALS AND METHODS: Ten patients above the age of 18 years with an edentulous span in mandibular posterior region showing distance from alveolar crest to IAN ≤ 8 mm (CBCT) were included in the study. The postoperative analysis of NDs was done using Semmes-Weinstein Monofilaments (SWM). Readings were made on the 1st and 7th postoperative day and every month thereafter until the neural sensations were restored. RESULTS: All patients reported neurosensory disturbance on post-op day 1. None of the patients responded to SWM lesser than 4.56 on first postoperative day, which indicated 100% incidence of neurosensory disturbances. The minimum time required for complete recovery was 2.0 months, and maximum was 4.0 months. CONCLUSION: IAN lateralization is a useful method for managing the atrophic posterior mandible with dental implants. If done precisely with experienced personnel, it can provide a worthy option for surgical restoration of atrophic mandible with minimal temporary NDs.

Maxillofacial injury from a leopard attack.

Although leopards are found worldwide, the incidence of leopard attack on humans is reported most often from India and Nepal. Usually, leopards avoid contact with people, but humans may occasionally be targeted as prey. Animal bite wounds may express as punctures, abrasions, tears, or avulsions. The force and bluntness of the teeth increase the probability of a crush injury with devitalized tissue. The clinical presentation and appropriate treatment of infected bite wounds vary according to extent of the wound. These wounds are considered complex injuries infected with a unique polymicrobial inoculum. As the bite injuries are commonly found on the face, an oral and maxillofacial surgeon should be familiar with the management of animal bites. This article reviews a case of a victim attacked by the leopard, the treatment provided to the victim, and brief notes on the management of such facial animal bite injuries.

Comparative Evaluation of the Intranasal Spray Formulation of Midazolam and Dexmedetomidine in Patients Undergoing Surgical Removal of Impacted Mandibular Third Molars: A Split Mouth Prospective Study.

PURPOSE: The purpose of this prospective randomized single blinded split mouth study was to conduct a comparative evaluation of the efficacy of intranasal atomised spray formulation of Dexmedetomidine with Midazolam in patients undergoing surgical removal of bilaterally impacted mandibular third molars. METHODS: This prospective study was conducted in twenty volunteers. Each volunteer underwent the surgical removal of an impacted mandibular third molar at two separate appointments at an interval of two weeks. The first third molar surgery was conducted using either intranasal Midazolam (Group M) or intranasal Dexmedetomidine (Group D). At the second appointment the surgical procedure was performed using the sedative agent not used at the first appointment. The primary testing outcome variables were Plasma oxygen saturation (SpO2), pulse and blood pressure and Modified Observer's Assessment of Alertness/Sedation (OAA/S) scale. These were recorded at predetermined intervals starting 10 min before the administration of local anaesthesia and continued up to 10 min after completion of the procedure. In addition surgeon's opinion regarding the patient cooperation, event amnesia, post operative nausea & vomiting were obtained. RESULTS: The sample composed of twenty patients (M = 9 and F = 11). There was statistically no significant difference between Group M and Group D with respect to mean SpO2. Minor differences were however noted at 20 and 30 min after sedation. There was no significant difference between the groups with respect to mean pulse rate, blood pressure, OAA/S, event amnesia, post operative nausea and vomiting and patient cooperation. CONCLUSION: We conclude that Midazolam and Dexmedetomidine are equivalent and can be used in minor oral surgery with minimal complications. These drugs can be used intranasally using nasal atomization device in routine outpatient basis in otherwise normal healthy but anxious patients. All procedures must however be performed in the presence of an anaesthesiologist and with ready availability of emergency drugs and equipment.

Efficacy of Ketamine as an Adjunct to Local Anesthesia in the Surgical Removal of Impacted Mandibular Third Molars - A Split Mouth Prospective Controlled Clinical Study.

INTRODUCTION: The removal of impacted teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Reduction of discomfort post-operatively and efficient local anesthesia are imperative for success in surgical practice. At sub-anesthetic doses, ketamine has a noticeable analgesic action, which can be used to supplement local anesthesia with minimal side effects. AIM: To assess the efficacy of low-dose ketamine as an adjunct to local anesthesia in the management of pain, swelling and trismus after surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: Twenty five patients with bilaterally symmetrical impacted mandibular third molars requiring surgical removal under local anesthesia were selected for the controlled clinical study. The third molar sites of all patients enrolled in the trial were randomly assigned into 2 groups: Local Anesthesia (Lignocaine) Alone [LAA] and Local Anesthesia plus ketamine [LAK]. 5ml of local anesthetic (Lignocaine Hydrochloride 2% with epinephrine 1:100,000) was injected in the 'LAA' group while the 'LAK' group received 5ml of local anesthetic plus 0.2mg/kg ketamine. Patients were blinded to the solution used and the operator recorded the group (LAA or LAK) and the respective site (Right or Left) for analysis. Bilaterally symmetrical impacted mandibular molars were removed at an interval of 15 days. RESULTS: Facial swelling on post-operative days was significantly lower in the LAK group than in the LAA group (p<0.05). The pain scores on the VAS were significantly higher in the LAA group than in the LAK group (p<0.05). CONCLUSION: The role of ketamine in low doses as an analgesic and anti-inflammatory is evident in our study. The combination of a local anesthetic and sub-anesthetic doses of ketamine injected for surgical removal of impacted third molars provides good local anesthesia while alleviating post-operative sequelae for the patient by providing a degree of post-operative analgesia with less swelling.

Immediate, Non Submerged Root Analog Zirconia Implant in Single Rooted Tooth Replacement: Case Report with 2 years Follow Up.

This report demonstrates the clinical use of a modified, truly anatomic, root analogue zirconia implant for immediate replacement of a right mandibular first premolar. A 22-year-old female patient with chronic apical periodontitis of the right mandibular first premolar was referred and the tooth was carefully extracted. A truly anatomical, root identical, roughened zirconia implant modified by macro-retentions was manufactured and placed into the extraction socket by tapping 3 days later. After 4 months a composite crown was cemented in place. No complications occurred during the healing period. A good functional and aesthetic result was achieved with minimal bone resorption and soft tissue recession at 18 months follow-up. This report describes the successful clinical use of an immediate, single stage, truly anatomical root-analogue zirconia implant for replacement of a single rooted tooth. Significant modifications such as macro-retentions yielded primary stability and excellent osseointegration. This novel approach is minimally invasive, respects the underlying anatomy and aids socket prevention. In addition the procedure saves time and cost, has good patient acceptance as there is no need for osteotomy, sinus lift or bone augmentation.

Complications in the use of bilateral inferiorly based nasolabial flaps for advanced oral submucous fibrosis.

Surgical management of advanced oral submucous fibrosis (OSMF) using bilateral inferiorly based nasolabial flaps is becoming increasingly popular. However no comprehensive analysis of delayed complications using this technique is available in the literature. The authors have conducted a retrospective study to examine the delayed complications of bilateral inferiorly based nasolabial flaps used in advanced oral submucous fibrosis at their institute along with a detailed review of literature on the subject. Thirty-two patients from January 2004 to December 2015 with OSMF and an interincisal distance less than 15 mm were included. All patients were treated with bilateral inferiorly based nasolabial flaps for correction of the restricted mouth opening. All patients had postoperative physiotherapy and were followed up for a minimum period of 6 months. All complaints of patients during the follow up phase were included in this study. In this series, complications such as partial necrosis, intra-oral hair growth, unacceptable extra-oral scar, wound dehiscence, orocutaneous fistula, and pincushioning effect were observed. Numerous complications can occur with the use of nasolabial flaps for the management of advanced oral submucous fibrosis. Although most complications are of inconsequential nature the surgeon must observe due diligence when using this flap.

Have Smartphones Contributed in the Clinical Progress of Oral and Maxillofacial Surgery?

BACKGROUND: Dental surgeons who encounter complex situations, such as those in unscheduled care, often have limited resources to provide a structured and specialty care. Therefore, there is always a need for cost-effective, easy to handle, easy to carry "Smartphones". OBJECTIVE: The purpose of this paper was to undertake a review of literature on "Smartphone in Oral and Maxillofacial Surgery" online data-base and discuss the case series with emphasis on the role of attending dental surgeon and the maxillofacial surgeon. MATERIALS AND METHODS: The available literature relevant to oral and maxillofacial surgery in online data-base of the United States National Library of Medicine: PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) was searched. The inclusion criterion was to review the published clinical papers, abstracts and evidence based reviews on 'Uses of Smartphone in Oral and Maxillofacial Surgery'. RESULTS: Six articles were found with the search term "Smartphone in Oral and Maxillofacial Surgery" in the literature searched. Five articles met the inclusion criteria for the study. The relevant data was extracted, tabulated, and reviewed to draw evidence-based conclusions for uses of smartphone in oral and maxillofacial surgery. CONCLUSION: Utilization of smartphones in oral and maxillofacial surgery facilitate in differential diagnosis, treatment, follow up, prevention of the disease further and thereby improve the quality of patient care without requiring the presence of the maxillofacial surgeon in remote areas.

Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: a series of 10 cases and surgical guidelines.

AIM: To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. METHOD: Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. RESULTS: All cases showed satisfactory bone healing without any growth disturbance. CONCLUSION: Open reduction and rigid internal fixation (ORIF) with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

Retromandibular approach in the management of condylar fractures by open reduction and internal fixation a prospective study.

AIM: To evaluate the efficacy and safety of the retromandibular approach in the management of condylar fractures by open reduction and internal fixation (ORIF). MATERIALS AND METHODS: A total of 20 patients with unilateral mandibular condylar fractures underwent ORIF using retromandibular approach. Pertinent data were collected and subjected to evaluation. RESULTS: The retromandibular approach was found to be expeditious in adequately exposing the fracture site and enabling ORIF. The anatomic reduction of the fractured segments and the fixation was satisfactory in all the cases. Average duration of surgery was 39 min (range: 17-56 min) for satisfactory exposure, reduction, and fixation of each condylar fracture. CONCLUSION: The retromandibular approach provides adequate exposure of the subcondylar region and should be considered as commendable alternative in the management of condylar fractures.

Evaluation of microbial flora in orofacial space infections of odontogenic origin.

BACKGROUND: The microbiology of acute dental infections has been in the midst of many researches. Various bacteriological studies show variations in their conclusion. The purpose of our study was to evaluate the microbial flora in orofacial space infections of odontogenic origin, which is essential for appropriate antibiotic selection. MATERIALS AND METHODS: Thirty-five patients with odontogenic infection causing fascial space involvement were included. Aspirated specimen was transported in nutrient broth and thyoglycollate media within an hour for further culture and sensitivity testing. RESULT AND CONCLUSION: This study indicates that orofacial odontogenic infections are usually polymicrobial, consisting of a complex mixture of both anaerobes and aerobes.

Gorlin-Goltz syndrome: A series of three cases.

The Gorlin-Goltz syndrome (GGS) is also known as nevoid basal cell carcinoma syndrome. It is characterized by multiple keratocystic odontogenic tumors (KCOTs) in the jaw, multiple basal cell nevi carcinomas and skeletal abnormities. The syndrome may be diagnosed early by a dentist during the routine radiographic exams in the first decade of life, since the KCOTs are usually one of the first manifestations of the syndrome. This article reports the series of 3 cases, emphasizing its clinical and radiographic manifestations of GGS.