Efficacy of gelatamp in controlling the postoperative sequelae following mandibular posterior teeth extraction - A split-mouth study.

Purpose: This study aimed to evaluate the effectiveness of gelatamp on soft tissue healing, bleeding, and pain following mandibular posterior teeth extraction. Methods: This study was designed as a split-mouth, prospective randomized double-blind controlled trial conducted in a single tertiary care center. Thirty-five subjects indicated for routine mandibular posterior teeth extraction were divided into two groups using the lottery technique: the experimental group (n = 30), which received gelatamp after extraction, and the control group (n = 30), which received no intervention. The primary outcomes included soft tissue healing(Landry, Turnbull, Howley index) and Pain(VAS score). The secondary outcomes assessed were bleeding(Maani et al. index) and swelling(Sauza and Consone assessment). Result: The results showed a statistically significant difference in soft tissue healing on the third and seventh days in the experimental group (p ≤ 0.05) than in the control group. A significant difference in bleeding scores at 5 min, 30 min, and 2 h postoperatively in the study group (p ≤ 0.05) was noted. There was no significant difference between the groups for pain on the first, third or seventh day postoperatively (p ≤ 0.05). The swelling assessment also showed no significant changes (p = 0.831) for the study and the control group. Conclusion: Based on the findings of this study, gelatamp can be effectively used to reduce postoperative sequelae such as bleeding with better soft tissue healing following extractions and surgical removal of tooth.

Reconstruction of osseous defect with symphysis block graft for implant placement.

Introduction: Symphysis being an autogenous bone graft serves as one of the best graft for augmenting osseous defects of alveolar process with excellent results. It has been favoured mainly due to its local availability, accessibility and lesser resorption compared to other bones in the region. Case report: A 21/M reported to the department of Implantology with the complaint of missing tooth in the upper front tooth region since 1 year. History revealed extraction of upper left central incisor an year ago following trauma. Diagnosis was made as Siebert's Class I with horizontal bone loss irt 21 region with a bone defect of 10.54 x 5.08 x 4.85 mm. So a complete prosthetic rehabilitation protocol was made with an implant placement and grafting was planned with symphysis being most favourable. Conclusion: The mandibular symphysis is a reliable intraoral graft site that can be used in the office setting with low morbidity. Because of the intraoral approach and lack of cutaneous scarring, patient acceptance is high.

An In vitro study of biomechanical comparison between titanium 4-hole 3D plates and titanium conventional 4-hole miniplates for internal fixation of mandibular angle fractures.

Background: Fracture fixation, in the present times, is classically done using mini plates. The position and number of plates to fixate a mandibular angle fracture have been and are still extensively researched and reported in the literature. A more recent addition is 3D mini plates. Aim: To compare and evaluate the biomechanical behavior of one 2.0 mm titanium 3D miniplate fixation plate (4- hole) and one 2.0 mm titanium 4-hole miniplate in internal fixation of mandibular angle fractures. Objective: To measure load at break, maximum load, and displacement at maximal load for internal fixation done with 3D mini plates and conventional mini plates respectively. Methods: Five dry cadaveric mandibles were sectioned into 10 hemi-mandibles. Each cadaveric mandible was sectioned at the angle of mandible to simulate unfavorable mandibular angle fracture. The obtained hemimandible were divided into experimental groups (GROUP 1 and GROUP 2) with 5 samples in each group, plated with a linear miniplate and 3D miniplate respectively. Maximal load, Load at break, and displacement at maximum load were the only obtained parameters for comparison. Results: Conventional miniplate showed greater mean maximum load values of 174.93 N±54.45 compared to 3D mini plates which recorded a mean maximum load value of 106.96 N ± 23.86. Load at break and displacement at maximum load were found to be both insignificant. Conclusion: The results in this study showed statistically no significant difference with any of the above parameters except maximal load, between the two groups evaluated. Conventional linear miniplate according to Champy's lines of osteosynthesis can be used successfully for providing satisfactory osteosynthesis with the definitive advantage of cost-effectiveness.

"3D printed locator guides"; Fusion deposited starch guides for surgical removal of impacted maxillary teeth.

The rapid prototyping technology helped to convert the virtual surgical plans into action by the help of fusion deposition techniques. Starch based polymers like PLA (Poly lactic acid) are commonly used in the field of tissue engineering for making scaffolds. In dentistry its use is limited because of lack of precision. We tried to make a 3D printed locator guide for surgical removal of impacted maxillary premolar by using a starch based polymer.

Mandibular access osteotomy: Gate way to parapharyngeal space - A case report.

INTRODUCTION: Para pharyngeal tumors often pose a challenge to surgeons for surgical interventions. Maxillofacial access osteotomies offer excellent visualization and permit unhindered surgical manipulation. Access osteotomy allows the surgeon an adequate access of the surgical field to resect the tumor completely and to preserve vital structures. Though numerous techniques exist, selection of the proper technique is the key factor in reestablishing the function and cosmesis. This article describes our experience with mandibular swing approach that has facilitated complete removal of a parapharyngeal space tumor. CASE PRESENTATION: 35years old female complained of deviation of tongue to one side and swallowing difficulty. Clinical and radiographic examinations were suggestive of a skull base lesion involving the hypoglossal nerve. After evaluation the tumor was excised through a mandibulotomy approach. Post operatively the patient was relieved completely of the symptoms and without any postoperative sequalae. CLINICAL DISCUSSION: Accessibility is the main concern while dealing with skull base lesions. But the success of surgery lies on the selection of right approach. Paramedian mandibular swing approach has its own advantages over various other facial osteotomies. The swinging of the mandible gives advantage of accessing neck and skull base together, which is not possible with other facial osteotomies. CONCLUSION: Management of skull base tumors involve a multidisciplinary approach. Choosing the right approach is often a major dilemma. Access osteotomies of facial skeleton is a hatchway to the skull base lesions. Of which mandibular swing approach is a good option for skull base tumors because of the ease of surgical technique even in inexperienced hands.

Association of taurine with ovarian follicular steroids and postpartum anestrus condition in Murrah buffaloes.

Taurine is an abundant intracellular beta-amino acid majorly synthesized in the liver and transported through plasma. In mammals, taurine was reported to be involved in various physiological functions, including the enhancement of testosterone levels, the major estradiol precursor. Therefore, we hypothesize that taurine levels are associated with ovarian follicular steroids as well as with a reproductive problem called postpartum anestrus (PPA) in dairy buffaloes. To understand the taurine levels and its possible role in buffalo ovarian follicles, a correlation was established among taurine, estradiol, and testosterone levels in the ovarian follicular fluid. For this purpose, buffalo ovaries were obtained from the slaughterhouse, and follicular fluid samples were collected from small (<4 mm), medium (4-8 mm) and large (>8 mm) follicles. Taurine and steroid levels in the follicular fluid were analyzed by TLC and ELISA, respectively. Taurine and testosterone levels were significantly (P < 0.05) higher in the follicular fluid of small and medium follicles than large follicles, whereas the estradiol levels were significantly (P < 0.001) higher in the large follicles. Thus, taurine showed a positive correlation (r = 0.75) with testosterone and a negative correlation (r = -0.77) with estradiol in buffalo follicular fluid, indicating its possible role in testosterone function during follicular development. Interestingly, significantly (P < 0.001) lower plasma taurine levels in PPA (n = 50) than normal cyclic (n = 50) buffaloes represented its association with PPA. Therefore, our present study recommends the need for future nutrition studies on taurine supplementation to PPA buffaloes.

"Canine tracker"; an app based on android platform for localisation of impacted maxillary canines using digital panoramic radigraphs.

The panoramic radiographs for localisation of impacted canines are now mostly available in the digital form. It is difficult to apply the localisation techniques in the digital format especially when it is viewed and diagnosed using smart phones. So in this paper we are describing about an app we created based on the android platform. Using this app three localisation methods can be applied by using multiple tools.

Ramon Syndrome- A Rare Form of Cherubism.

Cherubism is an inherited, autosomal dominant disorder that affects the jaws of children. The disease is usually obvious as a painless bilateral swelling in which bone is replaced with fibrous tissue. Affected children appear normal at birth. Swelling of the jaws usually occurs between 2 and 7 years of age and relapses as age progresses leaving a few facial deformities and malocclusion. The disease is microscopically indistinguishable from other giant cell lesions. The association of cherubism with gingival fibromatosis, epilepsy, mental retardation, stunted growth, and hypertrichosis is referred to as a rare case of possible Ramon syndrome with extraordinary tissue enlargement over the teeth. Here, we present a case of Ramon syndrome in a 6-year-old girl describing the clinical and radiographic features successfully treated with a brief review of literature.

Nasal Mucosal Cyst a Clinical and Surgical Dilemma.

A mucous cyst is a lesion which can show a wide range of symptoms but is benign and most of them can even appear several months or even years after nasal surgeries. Size of the displaced epithelial fragment is a crucial factor for the development of the mucous cyst. Complete resection of the mucous cyst is the ideal treatment. Surfing through the literature we came across 18 cases of mucous cyst formation following nasal surgery. Here we describe a mucous cyst which had resulted from a rhinoplasty procedure the patient had undergone earlier in her life.

Ameloblastic Fibroodontoma: Uncommon Case Presentation in a 6-Year-Old Child with Review of the Literature.

Ameloblastic fibroodontoma is a benign mixed odontogenic neoplasm considered in patients with asymptomatic swelling and unerupted teeth that exhibit histologic features between ameloblastic fibroma and complex odontoma. Radiographically, this lesion appears as radiolucency admixed with focal radio opaque masses of irregular shapes and sizes. This lesion is confirmed by the presence of proliferating odontogenic epithelium, ectomesenchyme, and dental hard tissue formation on pathological analysis supplementing clinical and radiographic findings. As this tumour is less commonly seen in routine clinical practice, ameloblastic fibroodontoma with detailed orofacial features and periodic approach to its diagnosis is discussed. This paper reports a case of ameloblastic fibroodontoma of the mandible in a 6-year-old male patient with an uncommon case presentation and review of the literature.

An extensive swelling in the anterior mandible - A case report.

INTRODUCTION: Glandular odontogenic cyst is a rare developmental odontogenic cyst, which often pose a challenge to diagnose it clinically. PRESENTATION OF A CASE: A 32 year old female patient was referred to the oral and maxillofacial surgery department with a chief complaint of a painless swelling in the anterior mandible, extending from mandibular left premolar to right first molar region, with fluctuancy and egg shell crackling at right premolar region. The associated teeth were firm. Radio graphically a large radiolucent lesion was seen extending from mandibular left premolar to right first molar region. DISCUSSION: We had many differential diagnoses including keratocystic odontogenic tumour, ameloblastoma and radicular cyst. Incisional biopsy was taken from the most fluctuant area, which was histopathologically suggestive of glandular odontogenic cyst. Enucleation of the cyst, peripheral ostectomy, extraction of teeth and Carnoy's solution application were done under general anaesthesia. CONCLUSION: We often neglect to include uncommon lesions in the differential diagnosis, which may lead to inadequacy in the management protocol. Whenever possible, incisional biopsy should be performed to confirm the lesion before surgical enucleation. Here we present a case in which we were fortunate enough to diagnose the lesion by an incisional biopsy and managed according to the standard protocol.

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.

Intramuscular hemangioma of the masseter muscle- a case report and review of literature.

INTRODUCTION: Intramuscular hemangioma, is a distinctive type of vascular tumor occurring within the skeletal muscle. Most IMH are located in the lower extremity, particularly in the muscles of the thigh and rarely in head and neck region. PRESENTATION OF CASE: 35 years old male reported with a swelling in the left cheek region since 3 years. Clinical and radiological evaluation leads to the diagnosis of Intramuscular hemangioma. Surgical excision was performed and histopathology confirmed the diagnosis. DISCUSSION: Hemangiomas of skeletal muscle represent 0.8% of all benign vascular neoplasm Welsch and Hengerer, 1980 [4]. Of these 13.8% occur in the head and neck region, with the masseter muscle being the most common site, followed by the trapezius and sternocleidomastoid muscles respectively. The lesions previously described as deep infiltrating angiolipomas have now been recognized by the WHO as intramuscular hemangiomas. numerous theories proposed for ethiopathogenisis of vascular lesions have been discussed. CONCLUSION: In conclusion, angiolipomas are rare in the head and neck region, and it should be considered in the differential diagnosis of masses in these regions. Proper radiological and clinical examination will reveal the type of vascular lesion. Excellent results can be obtained with timely management and good surgical skills.

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.

Lingual thyroid.

Lingual thyroid is an abnormal mass of ectopic thyroid tissue seen in base of tongue caused due to embryological aberrancy in development of thyroid gland. Most of the ectopic tissue is seen in the tongue. Their identification and proper management is essential since they may be the only functioning thyroid tissue occurring in the body. We report a case of lingual thyroid in a 40 year old female patient who was hypothyroid with posterior swelling of tongue. Tc-99 scintigraphy confirmed the clinical diagnosis and surgical excision of entire tissue was done by midline mandibular split osteotomy and patient was placed under lifelong thyroxine replacement. Follow up showed excellent results with minimum patient discomfort.

Traumatic bone cyst of mandible.

The traumatic bone cyst, an uncommon lesion of the jaws, belongs to the category of 'pseudocyst' owing to its lack of a lining epithelial membrane. It is an asymptomatic lesion, which is often diagnosed accidentally during routine radiological examination commonly present in the posterior mandible as a unilocular radiolucency with scalloping borders. The exact etiopathogenesis of the lesion is still debated, though the role of trauma is often associated. Here we report a rare case of traumatic bone cyst in the anterior mandible, in a 16-year-old female patient with a previous history of trauma to chin; diagnosed and treated successfully in our surgical unit. The case is discussed in relation to its clinical presentation, etiopathogenesis, diagnosis, management and prognosis.

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.