Incidence of inferior alveolar nerve sensory deficit and intra-operative nerve encounters after advancement of retrognathic mandible - A cross-sectional survey study.

Aims and Objectives: The aim of the current cross-sectional study was to conduct a survey among the oral and maxillofacial surgeons of South India regarding their experiences of incidence of inferior alveolar nerve (IAN) neurosensory deficit after bilateral sagittal split osteotomy (BSSO) for correction of mandibular retrognathism and to assess the intra-operative nerve encounters and its effect on the inferior alveolar neurosensory deficit (NSD), 6 months post-operatively. Materials and Methods: A self-administered questionnaire (SAQ) was prepared using Google Forms (Google Inc.) and sent to the prospective participants through various social media outlets such as Facebook, WhatsApp groups etc., of the maxillofacial surgery specialty for a period of 3 months. SAQ from surgeons with more than 5 years of experience in orthognathic surgery were included. Results: The incidence of NSD post-BSSO advancement surgery from 859 cases after 6 months was 15.1% (130). After splitting the mandible, the IAN was seen in the proximal fragment in 472 sites and needed dissection. The nerve was transected and neurorrhaphy was carried out in 26 sites. A Chi-square test was used to analyse the qualitative variables. The IAN was not visible post-osteotomy in 140 sites and in the distal fragment in 1080 sites. These groups had decreased incidence of NSD. The NSD was significantly higher in cases where the nerve was transected and sutured, P value <0.001 as compared with the other nerve status, followed by the nerve in the proximal fragment needing dissection. Conclusion: The IAN status intra-operatively can be assumed to have a significant role in persisting NSD.

Quantitative assessment of platelet rich fibrin for the repair of extraction socket in a rat model.

The present study evaluated the quantitative effects of platelet-rich fibrin (PRF) for the repair of extraction socket in Sprague Dawley (SD) rat model by assessing several key clinical parameters. Seventy two male SD rats were subjected to surgical extraction of the maxillary right incisor. Rats were randomly divided into four groups with eighteen rats in each group based on the treatment received: extraction socket without treatment of PRF was taken as control (group I). Extraction socket implanted with 0.1, 0.2, and 0.4 mL of PRF was taken as study groups (groups II, III, and IV). The obtained results demonstrated that, low dose of PRF efficiently enhanced the natural healing cascade. Whereas, high dose interfered with native tissue contribution and altered the natural healing process. The beneficial effects of quantity-based application of PRF may raise the possibility of a new approach as complementary therapy besides conventional treatment.

Architectural and Ultrastructural Variations of Human Leukocyte-Rich Platelet-Rich Fibrin and Injectable Platelet-Rich Fibrin.

BACKGROUND: Platelet-rich fibrin (PRF) architecture and ultrastructure plays a crucial role in regulating and coordinating the cellular functions and provides a physical architecture, mechanical stability, and biochemical cues necessary for tissue morphogenesis and homeostasis. No study consciously reported the variation in architecture, ultrastructure, and morphology of leukocyte-rich PRF (L-PRF) and injectable PRF (i-PRF). OBJECTIVE: Hence, the present study was aimed to evaluate the fibrin architecture, ultrastructure, and cell contents of autologous L-PRF and i-PRF. MATERIALS AND METHODS: The autologous L-PRF and i-PRF were prepared from blood samples of healthy donors. The morphological and structural variations were assessed by histopathology, atomic force microscopy, confocal laser scanning microscope, and field emission scanning electron microscope. RESULTS: Disparity was found on architecture and ultrastructure of L-PRF and i-PRF fibrin network. The variation in platelet and leukocyte concentration attributed to the fibrin conformational changes. L-PRF shows thick fibrins with rough surface, whereas in i-PRF, smooth thin fibrins. CONCLUSIONS: The current study revealed that there is heterogeneity between L-PRF and i-PRF fibrin matrix architecture, ultrastructure, platelets, leukocytes, and the fibrin content. These speculate that the diameter, width, roughness, and smoothness of fibrin fibers, pore size, and shapes of L-PRF and i-PRF matrix may initiate and mediate the scaffold functions differently.

Cytokine Expression Pattern and Protein-Protein interaction network analysis of Leucocyte Rich Platelet Rich Fibrin and Injectable Form of Platelet Rich Fibrin.

PURPOSE: Platelet-rich fibrin (PRF) such as leucocyte-rich PRF (L-PRF) and injectable form of PRF (i-PRF) are widely used in various surgical applications. L-PRF- and i-PRF-derived cytokine variations and functional pathways are still unexplored. The aim of the study was to evaluate the expression pattern of Th1-, Th2-, and Th17-related cytokines by L-PRF and i-PRF under in vitro. METHODS: Cytokine levels were evaluated using multi-analyte ELISArray kit. Using elevated level of cytokines, the protein-protein interaction and pathway were predicted by computational method. RESULTS: The expressed cytokine levels were higher in L-PRF than in i-PRF. Specifically in L-PRF, IL8, IL2, IL6, and IL1A were expressed abundantly, whereas IL4, IL10, and IL6 were significantly high in i-PRF. Furthermore, protein-protein interaction (PPI) networks (cytokine-cytokine interactions) and pathway analyses were predicted using higher-order cytokines. PPI networks and gene ontology enrichment analysis showed functional variations between L-PRF and i-PRF. Kyoto Encyclopedia of Gene and Genome pathway analysis found that L-PRF mediates NF-k B signaling, Toll-like receptor signaling (TLR), and MAPK signaling via T-cell receptor signaling pathway. i-PRF is significantly involved in JAK-STAT signaling pathway through upregulation of STAT1. CONCLUSION: Our study concludes that L-PRF and i-PRF act via different pathways that confirm functional variations between them. Therefore, we speculate that L-PRF may be effective in acute phase of chronic wounds such as in diabetes mellitus and immunocompromised patients whereas i-PRF may have a better outcome in acute wounds.

Reliability of Orthopantamogram in Lower Third Molar Surgery: Inter- and Intra-observer Agreement.

CONTEXT: The evaluation of relationship between the roots of impacted lower third molar (IL3M) and inferior alveolar nerve injury (IAN) with orthopantamogram (OPG) is mandatory before performing de-impaction surgery. An investigation is considered reliable if it can be reproduced by various examiners. Assessment of OPG is subjective and varies among examiners. OPG is reliable to clinicians if the interpretation is not a product of guess work. AIM: The aim of this study was to evaluate the magnitude of agreement among oral surgeons and oral radiologist in observing intimate relationship between IL3M and mandibular canal. MATERIALS AND METHODS: OPGs were evaluated by two oral surgeons and one oral radiologist for nerve root relationship. All the three were from different institutions with 10-15 years of experience. The three observers were blinded from each other's findings. A total of 127 OPGs were evaluated for inter-observer agreement. Fifty OPGs were evaluated after 60 days for intra-observer agreement.The agreement was evaluated based on Cohen's κ statistics. RESULTS: Our results denote that the interpretation of OPG among specialists is not in good agreement. We suggest development of methods to standardize evaluation of OPG and the exposure technique to improve inter-observer agreement among the dental specialists.

Alternative Approach to Prevent Inferior Alveolar Nerve Injury in Lower Third Molar Surgery: A Pilot Study on Coronectomy.

CONTEXT: Injury to inferior alveolar nerve (IAN) in lower third molar (L3M) surgery may lead to unpleasant sensation or anesthesia of lower lip. Considering the quality of life of the patient and the litigations faced by the dentist, alternative treatment approaches to odontectomy have been studied by various researchers. Coronectomy is one such option to prevent the nerve injury. AIMS: The aim of this study was to assess the efficacy of coronectomy to reduce nerve injury during L3M surgery in high-risk cases as per radiological signs. SETTINGS AND DESIGN: A pilot study was conducted in the oral surgery department of Rajah Muthiah Dental College, Annamalai Nagar, Chidambaram, India to evaluate coronectomy and its usefulness. MATERIALS AND METHODS: Sixty-five patients who satisfied the inclusion and exclusion criteria for coronectomy were included in the study. The patients were followed up to 1-year period. STATISTICAL ANALYSIS USED: Descriptive statistics was used. RESULTS: None of the patients in the study group had IAN impairment. CONCLUSIONS: Coronectomy is a safe alternative for complete odontectomy in high-risk L3M surgery cases. Root migration, infection, and need for second surgery are potential complication. Further studies with more samples and variables need to be performed.

Modified Palatal Flap with a Tissue Bridge in the Closure of the Oroantral Fistulae: A Prospective Study.

INTRODUCTION: An oroantral fistula is by definition 'An abnormal communication between the oral cavity and the maxillary sinus.' AIM OF THE STUDY: The aim of this study is to describe the acute and chronic OAFs and to evaluate the efficiency of the modified palatal flaps with tissue bridge in the closure of both acute and chronic OAFs of small to medium size. METHODOLOGY: The study sample was derived from a population of patients from January 2013 to 2018 with the complaint of pain and discharge through the socket. RESULT: The results of this series support the view that the use of modified palatal flap with tissue bridge is a reliable flap for the repair of both acute and chronic oroantral fistulae. CONCLUSION: The ease of mobilization, superior blood supply and minimal donor site morbidity make it an ideal flap and a reliable alternative when other techniques fail.

Impacted Upper Lateral Incisor in a 16-Year-Old Female-"Compound Odontome" the Culprit-A Case Report.

Odontoma is the most commonly found odontogenic tumor. Odontomas are an abnormal mass of calcified dental tissue, usually representing a developmental anomaly. They are benign and originate from an alteration of differentiated mesenchymal and epithelial odontogenic cells. They have the capacity of forming enamel, dentin, and cementum. Etiology in still unknown, but different theories have been postulated. Because these tumors are asymptomatic, 75% of all cases are diagnosed before the second decade of life, due to a delay in eruption of permanent teeth. Treatment of choice for these tumors is enucleation. The authors describe one such case of compound odontome obstructing the eruption of a permanent lateral incisor.

Assessment of Regeneration of Bone in the Extracted Third Molar Sockets Augmented Using Xenograft (CollaPlugTN Zimmer) in Comparison with the Normal Healing on the Contralateral Side.

INTRODUCTION: Alveolar bone resorption is a significant clinical problem. Bone loss in third molar region following extraction or surgical removal not only leads to periodontal problems in second molar region but also it may lead to some serious problems like increased incidence of angle fractures. In order to reduce the risks following third molar surgery, the socket should be augmented with bone grafts. In recent days guided tissue regeneration is the most accepted and successful technique followed many authors and its efficacy has been proved. MATERIALS AND METHODS: Based upon our clinical experience, the use of bio absorbable collagen wound dressing such as CollaPlugTN has achieved quick healing and more primary wound coverage. Amongst the graft materials collagen is preferable due to its high biocompatibility and hemostatic ability. This study was done to assess the regeneration of bone in the extracted third molar sockets using xenograft (CollaPlugTN-Zimmer) which was compared with the normal healing on the contra lateral side. The assessment was done to analyze post-operative healing complications and to compare the bone density formed between control site and implant site radiologically. CONCLUSION: On this basis of this study, the use of collaplugTN appears to be beneficial to the patient in postoperative wound healing and also for better bone formation. The use of this material was advantageous because of its simplicity of application cost effectiveness and availability. There is enhanced wound healing and early bone formation.

Assessment of risk factors for oral squamous cell carcinoma in Chidambaram, Southern India: a case-control study.

Oral squamous cell carcinoma, the fifth most common cancer worldwide, is a major cause of morbidity and mortality in India. The effect of lifestyle factors, including tobacco chewing, smoking and alcohol drinking, diet and dental care, on the risk of oral cancer was investigated in a case-control study conducted in Rajah Muthiah Dental College and Hospital, Annamalainagar, Annamalai University, Chidambaram, Tamil Nadu, India during the period 1991-2003. The study included 388 oral squamous cell carcinoma cases and an equal number (388) of age and sex-matched controls. All participants were interviewed using a structured questionnaire that contained data on demographic factors, family history of cancer, tobacco habits, use of alcohol, frequency, duration, cessation of these habits, dietary practices and oral hygiene. The data were analysed using multiple logistic regression model. Among people with chewing habits, those who chewed betel quid with tobacco [odds ratio (OR) 3.19, 95% confidence interval (CI): 0.48-2.13] and tobacco alone (OR 2.89) showed a greater risk than controls. Bidi smoking (OR 4.63) and alcohol drinking (OR 1.65) emerged as significant risk factors for oral cancer. These three habits showed increasing risk with increasing frequency and increase in duration of habits. Addition of alcohol to other habits also enhanced the risk for oral cancer. The combination of chewing and smoking together with alcohol drinking showed very high relative risk (OR 11.34). A positive association was observed between non-vegetarian diet, poor oral hygiene and poor dentition with the risk of oral squamous cell carcinoma. The fact that these risk factors are modifiable emphasizes the need for increasing awareness among the general public and policy makers as a first step in the prevention and control of oral squamous cell carcinoma.