Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study.

AIM: The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients. MATERIALS AND METHODS: About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months. RESULTS: No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures. CONCLUSION: A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures. CLINICAL SIGNIFICANCE: In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.

Determination of Labiopalatal Angulation of Maxillary Anterior Teeth Using Manual Method and Digital Methods: A Comparative Study.

AIM: The aim of the present study was to evaluate labiopalatal angulation of maxillary anterior teeth using Custom-made jig, Profile projector, and ImageJ computer software methods. MATERIALS AND METHODS: The subjects for this study were selected in the age-group of 20-30 years having permanent dentition, including 2nd molars and bilateral Angle's class 1 molar and canine relationship. Recording the labiopalatal angulation in proximal view was carried out by using one manual method and two digital methods namely using Custom-made jig, Profile projector, and ImageJ computer software, respectively. Alginate impressions were made for the subjects, and the spatial relationship of the maxilla to the cranium was recorded using a facebow. The casts were mounted in a semi-adjustable articulator, and the articulated mounted casts with the mounting ring were transferred to the Custom-made jig, and angulations were measured in proximal view. Digital methods of measurement were recorded by using Profile projector and ImageJ computer software methods. Data were tabulated and statistically analyzed. RESULTS: In males, the mean labiopalatal angulation of maxillary right and left maxillary canines of Custom-made jig was 91.94 ± 1.47 and 91.70 ± 1.68, in Profile projector method 87.41 ± 3.75 and 87.58 ± 3.79, and in ImageJ computer software 84.23 ± 5.72 and 83.29 ± 6.74, respectively. In females, Custom-made jig was 91.82 ± 1.55 and 92.17 ± 1.84, in Profile projector method 86.70 ± 5.58 and 86.94 ± 5.57, and in ImageJ computer software 82.76 ± 6.34 and 83.05 ± 6.12, respectively. There was a very high statistically significant difference found between different methods. CONCLUSION: In conclusion, the values obtained in the digital methods (i.e., both the Profile projector and ImageJ computer software) were more accurate than the manual method. However, the ImageJ computer software was most reliable in comparison with the values obtained in Profile projector. CLINICAL SIGNIFICANCE: The labiopalatal angulation of anterior teeth will act as a guideline in re-establishing the correct angulations and the anatomic contours of the maxillary arch to achieve the desired esthetics that provide adequate lip support and to restore the required functions.

Randomized Study on Postoperative Intra-alveolar Betadine Irrigation Versus Chlorhexidine Irrigation on the Incidence of Occurrence of Alveolar Osteitis After Mandibular Third Molar Surgery.

Purpose: To compare the effectiveness of two different antiseptic solutions for irrigation of the extraction socket and the incidence of occurrence of dry socket in the sample population in Bhubaneswar, Odisha. Patients and Methods: A prospective and randomized study among the patients reporting to the department of oral and maxillofacial surgery for surgical removal of impacted mandibular third molars under local anesthesia was done in a group of 100 patients meeting the inclusion and exclusion criteria. Two different intervention groups (groups A and B) were allocated which comprised irrigation of the extraction sockets continuously up to 7 postoperative days with chlorhexidine (hexidine 0.2% ICPA) and povidone iodine (Betadine® mouthwash 1%), respectively. Pain, edema, trismus, alveolar osteitis, infection, wound dehiscence and food debris impaction were the various outcome variables. Results: A total of 100 patients participated in this study, while there was a loss in the follow-up of 5 patients. Pain scores, edema and the incidence of occurrence of alveolar osteitis were significantly reduced in group A (p < 0.05). The effect on trismus was statistically insignificant. Pain scores had reduced significantly on the 7th-day follow-up in group A as compared to group B (p < 0.05). Conclusion: Chlorhexidine is therefore a good option for irrigation of the surgical site. There is also a decrease in incidence of occurrence of AO with chlorhexidine irrigation than with that of povidone iodine irrigation. Hence, chlorhexidine can be preferred over betadine for the routine preparation and irrigation of the surgical site.

Effects of Epidural Analgesia on Labor Pain and Course of Labor in Primigravid Parturients: A Prospective Non-randomized Comparative Study.

BACKGROUND AND AIM:  The aim of this study was to compare the effects of epidural analgesia on relief of labor pain, progress, and outcome of labor in primigravid parturients to those who did not receive any analgesia. METHODS: This was a hospital-based, quasi-experimental study conducted on 70 primigravid parturients at term with a single fetus in a cephalic presentation in active labor. Parturients who were willing to receive epidural analgesia formed group S (n=35) and parturients who refused epidural analgesia formed group C (n=35). The primary objective was to compare alleviation of pain measured by the Visual Analogue Scale (VAS) score. Secondary objectives were to compare the duration of labor, mode of delivery, and neonatal outcome. RESULTS: Pain intensity was significantly lower in group S compared to group C at all measured points of time (p<0.001). There was a quick fall in mean VAS score in group S from 7.94 to 3.86 within 20 min with the bolus dose, it further dropped to 1.03 after 3 h. Further, 88.6% of parturients in groups rated their pain relief as excellent and good satisfaction score. Prolongation of active phase of the first stage of labor (>6 h) was not significant (17.1 % in epidural group versus 5.7% in control group; p=0.259). However, prolongation of the second stage of labor (> 2h) was significant (18.2% in study group versus 0% in control group; p=0.024). The rate of cesarean section, instrumental vaginal delivery, and neonatal outcome was similar in both groups. No adverse effects were observed on maternal vitals, fetal heart rate and Apgar score at 5 min. CONCLUSION:  Epidural analgesia alleviated labor pain in all primigravid parturients who opted for it, without an increase in cesarean section and instrumental vaginal birth. Improved parturients' satisfaction with associated neonatal safety provides a positive birth experience. There was no effect on duration of active phase of the first stage of labor, but the duration of the second stage of labor was slightly prolonged.

Use of Elastomeric Separators in Maxillofacial Fracture Reduction.

BACKGROUND: Management of maxilla and mandibular fractures are based on the principles of reduction, fixation and immobilization of the fracture segments. PURPOSE: One of the processes of reduction is to apply continuous and gradual elastic traction by placing elastics from the upper and lower arch bars in a definite manner and direction as per the fracture line. Orthodontic elastic separators are versatile, and the major advantage is the higher traction forces as compared to conventional elastics. METHODS: Prestretched separator elastics were guided over the arch bar or fixed orthodontic appliances to provide desired traction. RESULTS: Orthodontic elastic separators are therefore versatile, and the major advantage is the higher traction forces as compared to conventional elastics. They provide an edge over the use of wires as they tend to break off by work hardening. CONCLUSION: Therefore, we have adapted orthodontic separators and have used them in place of conventional elastics for the last 10 years with appreciable results after taking informed consent from the patients.

Preoperative Anatomic Evaluation of the Relationship Between Inferior Alveolar Nerve Canal and Impacted Mandibular Third Molar in a Population of Bhubaneswar, Odisha, Using CBCT: A Hospital-Based Study.

PURPOSE: To evaluate the correlation between the position of inferior alveolar nerve canal and the angulation of impacted mandibular third molars using cone beam computed tomography (CBCT) in a hospital-based study in the state of Odisha, India. MATERIALS AND METHODOLOGY: Three hundred cases of impacted third molars in 200 patients (154 males; 46 females) were included in the study, for whom an initial periapical or panoramic radiograph had revealed that the mandibular canal and the lower third molars were in close proximity. A CBCT scan of each patient was carried out to assess how the canal position influenced the class and position of impaction, angulation of impaction and bone contact. RESULTS: Class II position B impactions were found in 78.37% cases where the position of ID canal was approximate to the lingual plate and inferior to third molar (73.75%). The results were statistically significant (p = 0.00). 80% of the ID canals showed bone contact. Of these 73.75% ID canals showed lingual bone contact. Mesioangular impactions were most common in mandible and significantly associated with lingual and inferior positioning of the canal. CONCLUSIONS: The study mostly exhibited patients having mesioangular class II position B third molar impactions of the mandible. The position of the canal has a significant influence on the type of impaction and the bone contact.

An analysis of approach toward oral and maxillofacial surgery: A survey of 1800 health-care specialists, students, and general people in Odisha, India.

AIM: The aim of the study is to assess the perception of oral and maxillofacial surgery (OMFS) by health-care professionals, students, and general public in the state of Odisha, India. MATERIALS AND METHODS: A questionnaire form was formatted that listed ten clinical situations and given by hand to 1800 individuals, divided into six groups: Group I - general medical practitioners; Group II - specialties of dentistry; Group III - general dental practitioners; Group IV - medical students; Group V - dental students; and Group VI - general public, each comprising 300 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire and in due course educate and inform the society about the treatment OMFS provides. RESULTS: Most of the respondents in Groups II, III, and V agreed that specific conditions listed in the questionnaire were within the domain of OMFS, but such response was not seen in Groups I, IV, and VI (P < 0.05). An overall awareness level of OMFS was found to be 50.8%. CONCLUSION: The liability and responsibility of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.

A rare nonsyndromic case of adenomatoid odontogenic tumor associated with multiple impacted supernumerary teeth.

Adenomatoid odontogenic tumour (AOT) is a rare benign odontogenic tumour characterized by a progressively slow growing pattern and symptomless behavior. The differential diagnosis between AOT and other odontogenic tumours, such as ameloblastoma, should be well conducted in order to avoid extensive ablative surgery. The present case report is of a 27 year old female who reported with a chief complaint of mild intermittent pain and a swelling which was gradually increasing in size, on the left mid-facial region since 6 months. Radiographic Investigations revealed a round uni-locular radiolucent image of an intra-osseous lesion with a well defined border in the left maxilla. The tumor was encapsulated and was attached with 2 impacted supernumerary teeth which were fused and shaped as maxillary premolars. The images also showed multiple impacted supernumerary teeth in the maxilla and mandible. The clinical and radiographic diagnostic hypothesis of Adenomatoid odontogenic cyst and a differential diagnosis of Dentigerous Cyst was given. Surgical enucleation of the lesion was done under General Anaethesia. The histological sections were consistent with AOT.

Evaluation of Donor Site Morbidity Associated with Iliac Crest Bone Harvest in Oral and Maxillofacial, Reconstructive Surgery.

INTRODUCTION: Iliac crest is the most common donor site for autogenous bone grafting as cortical bone, cancellous bone or combination of both can be harvested in abundance depending upon the need. Ilium provides highest concentration of osteo-component cells and greater quality of bone with less morbidity. AIM: The study was conducted to evaluate the donor site morbidity associated with autogenous iliac crest bone grafting for reconstruction in maxillofacial surgery. MATERIALS AND METHODS: Around 12 patients, who had undergone iliac crest bone harvesting for various maxillofacial and reconstructive surgical procedures like cleft alveolus repair, malar augmentation, mandibular reconstruction following tumour resection and cyst enucleation and other surgical procedures performed in the Department of Oral and Maxillofacial Surgery, over a span of two years. The donor site was evaluated for the following factors: pain, neuropraxia, abnormal gait and scar evaluation. RESULTS: None of the 12 patients had intraoperative complications like haemorrhage, damage to the muscles/ligaments, fracture of the ilium and damage to the acetabular fossa/femur head. Any major postoperative complications were also not recorded. Minor postoperative complications like pain, contour defect, walking difficulty were present, which gradually got resolved by the time of discharge. CONCLUSION: Anterior iliac crest provides an adequate harvest of cancellous, corticocancellous or bicortical grafts for reconstruction of various osseous defects in the maxillofacial region with least morbidity and should be considered as a major reservoir of bone for bony reconstructive procedures.

A review of temporomandibular joint-related papers published between 2014-2015.

We conducted a retrospective study and reviewed the temporomandibular joint (TMJ)-related papers published in a leading international journal, Journal of Oral and Maxillofacial Surgery, between January 2014 and December 2015. The study was conducted to ascertain and compare the trends of articles being published in the years 2014 and 2015. A total of 28 articles were reviewed, of which most of the full-length articles were on clinical management and outcomes and the role of radiology. The bulk of the studies were prospective, and less interest was shown in experimental research. A thorough review and analysis thus gives the impression that there is a great need for well-designed clinical studies on TMJ.

Orthognathic Surgery: A Review of Articles Published in 2014-2015.

OBJECTIVES: We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published. METHOD: A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea. RESULTS: Bulk of the studies were retrospective, and less interest was shown onto experimental researches. CONCLUSION: A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.

Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis.

INTRODUCTION: Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. AIM: To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. MATERIALS AND METHODS: Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). RESULTS: The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. CONCLUSION: Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas.

Oral Health of Pre-School Aged Children in Dhanbad District, Jharkhand, India- A Peek into their Mother's Attitude.

INTRODUCTION: Mothers are directly responsible for the dental health of their children and play a major role in shaping the dental health behaviors of their children. They also play an important role in preventing oral diseases in them. OBJECTIVE: To assess the level of attitude of mothers in relation to their pre-school aged children, which in turn can influence the level of oral health. METHOD: A cross-sectional study was carried out among 312 mothers, selected randomly from eight blocks of Dhanbad district, Jharkhand, India. They were administered with a structured questionnaire on attitude, by an interviewer. RESULTS: The overall data indicated that the attitude of mothers about oral health in their pre-school children increased as their age increased which was not statistically significant (p>.066). Mothers who had less than higher secondary school education and belonged to socio-economically lower groups had poor knowledge of oral health which was statistically significant (p<.001). CONCLUSION: Mothers should be motivated so that their attitude about their child's oral health is enhanced which in turn would improve their oral health related quality of life.

Emerging trends of herbal care in dentistry.

Herbs are staging a comeback and herbal 'renaissance' is happening all over the globe. The herbal products, today, symbolize safety, in contrast to the synthetics that are regarded as unsafe to humans and the environment. A herb, botanically speaking, is any plant that lacks the woody tissue which is characteristic of shrubs or trees. More specifically, herbs are plants which are used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and an effective source of treatment for various disease processes. Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The use of herbal medicines continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis, thereby improving immunity.