Simple Method for Re-tightening IMF Wires without Breakage.

AIM: This clinical technique aims to retighten intermaxillary fixation (IMF) wires when loosened intra/postoperatively. BACKGROUND: Intermaxillary fixation is one of the most important steps to obtain stable and functional occlusion in maxillofacial trauma. However, IMF wires tend to loosen over time. This loosened wire is generally removed and a new wire is used for IMF. Removal and refixation is time-consuming for surgeon and unconformable for the patient. TECHNIQUE: We recommend a simple technique for re-tightening IMF wires without breakage, with the use of shepherd's crook explorer by making a small circular loop. CONCLUSION: This technique of re-tightening by looping further stretches and tightens the wire to regain stabilized occlusion with maximal intercuspation. CLINICAL SIGNIFICANCE: This technique eliminates the need for removal and refixation of IMF wires, thereby improving patient comfort, yet obtaining stable occlusion over a long period of time. How to cite this article: Madhu SK, Dominic S, Baptist J, et al. Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024;25(3):289-291.

A comparative evaluation of the effect of addition of 8†mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study.

Background: Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially. Aim: To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars. Methodology: A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures. Results: Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7. Conclusion: The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.

Diagnostic conundrum in an ambiguous posterior mandibular osseous lesion: Case report and radiological review.

INTRODUCTION AND IMPORTANCE: Non-odontogenic osseous lesions of the mandible are relatively uncommon entities compared to odontogenic lesions. Although the posterior mandible is not a usual site, it is not rare either for these osseous lesions, making the diagnosis ambiguous, and if misdiagnosed leading to different treatment protocols. CASE PRESENTATION: A 43-year-old female presented with a hard tissue lesion of the posterior mandible, misdiagnosed as a sialolith of the submandibular salivary gland in two other centers due to overlapping of symptoms, anatomic complexity, and inadequate investigations. The lesion was later diagnosed to be an osteoma of the posterior mandible with added investigations, and surgically excised. Histopathology confirmed the diagnosis. CLINICAL DISCUSSION: A variety of hard tissue lesions are known to occur in the posterior mandible like Submandibular sialolith, Osteomas, Calcified Submandibular lymph nodes, Phlebolith, and Tonsillolith. However, due to the region's structural complexity, localization of a hard tissue lesion may not always be forthright, even with radiographs. Moreover, in cases with conflicting symptoms, as was in this case there are more chances of misdiagnosis. The reasons for such diagnostic challenges are deliberated with radiological review of posterior mandibular osseous lesions. Recommendations are also suggested for proper investigations, thereby management of these posterior mandibular osseous lesions. CONCLUSION: Misdiagnosis of these posterior mandibular lesions may lead to the patient undergoing unnecessary surgical procedures as different lesions require different management. Differential diagnosis and adequate protocol for investigations are required.

Evaluation of the relationship between dermatoglyphics and mandibular third molar impaction: A cross-sectional study.

Background: Dermatoglyphics can be utilised in clinical settings to identify those who are more likely to have impacted teeth. Additionally, dermatoglyphics looks to have potential as a non-invasive diagnostic method for predicting the presence or absence of an impacted tooth. The goal of this study was to look at the most common dermatoglyphic pattern in people who had or didn't have an impacted mandibular third molar teeth and see if there was a dermatoglyphic signature. Methods: A cross-sectional study with 180 participants was conducted (90 cases and 90 controls). The rolling impression technique was used to apply blue duplicating ink to participants' fingertips, which was then recorded. There was an increase in the frequency of the whorl-plain pattern in the right-hand ring finger (60%; p=0.028) and left-hand little finger (33.3%; p=0.009), as well as the loop-ulnar pattern in the right-hand middle finger (74.4%; p=0.024) in individuals with a predisposition to the presence of impacted teeth. Results: The left-hand little finger was found to be the most predictive for impaction in a forward stepwise binary logistic regression analysis. Conclusions: Dermatoglyphics could be used as a non-invasive sign to predict whether or not a tooth is affected. Its value comes in early detection, which helps to avoid the surgical problems that come with symptomatic extraction of an impacted tooth.

Ocular Outcomes of Maxillofacial Trauma - A Decennary Descriptive Study.

Maxillofacial trauma is amongst the most frequently encountered trauma seen in the hospital emergency setting. It may be life-threatening on rare occasions, and with concomitant injuries, it is often severely debilitating. OBJECTIVE: The present study was conducted to determine the occurrence of concomitant orbital and ocular injuries amongst patients with maxillofacial trauma, and also helps in deriving a correlation between different patterns of maxillofacial fractures. METHODS: All the records of the patients with maxillofacial trauma who were admitted to our institution over a 10-year period were analyzed. The files were screened to isolate the patients with concomitant ocular and orbital injuries. RESULTS: Out of a total of 686 patients, 370 had associated ocular injuries. A total of 566 (82.5%) patients were males and 120 (17.5%) females. A total of 236 patients (34.4%) were in the 3rd decade. A total of 351 cases of orbital fracture (isolated + concomitant) were reported. About 44 (12.5%) cases of isolated orbital floor fractures were seen.Subconjunctival hemorrhage accounted for the maximum number of cases amounting to 59.19%. The least associated ocular injuries seen were of traumatic mydriasis (0.28%). Out of 370 cases of ocular injuries, 249 (67.3%) were associated with fractures of the zygomaticomaxillary complex. CONCLUSIONS: The present study draws attention to the concomitant orbital and ocular injuries in maxillofacial trauma patients. This study is strongly suggestive of a very high probability of concomitant ocular injury in maxillofacial trauma patients which necessitates strong interdepartmental coordination for holistic management of the maxillofacial trauma patients.

Potential Fluorinated Anti-MRSA Thiazolidinone Derivatives with Antibacterial, Antitubercular Activity and Molecular Docking Studies.

MRSA infection is one of the alarming diseases in the current scenario. Identifying newer molecules to treat MRSA infection is of urgent need. In the present study, we have designed fluorinated thiazolidinone derivatives with various aryl/heteroaryl units at 5th position of the thiazolidinone core as promising anti-MRSA agents. All the compounds were screened for antibacterial activity against four bacterial strains. Among the tested compounds, the halogenated compounds with simple arylidene ring, (5Z)-5-[(3-chloro-2-fluorophenyl)methylidene]-2-[(1,3-thiazol-2-yl)amino]-1,3-thiazol-4(5H)-one (4b), (5Z)-5-[(4-chloro-2-fluorophenyl)methylidene]-2-[(1,3-thiazol-2-yl)amino]-1,3-thiazol-4(5H)-one (4c), (5Z)-5-[(3-fluoro-4-methylphenyl)methylidene]-2-[(1,3-thiazol-2-yl)amino]-1,3-thiazol-4(5H)-one (4f) and (5Z)-5-[(3,5-difluorophenyl)methylidene]-2-[(1,3-thiazol-2-yl)amino]-1,3-thiazol-4(5H)-one (4g) showed excellent activity with MIC 3.125-6.25 µg/mL against S. aureus and P. aeruginosa organism. Furthermore, these potent compounds were screened against MRSA strains, ESKAPE panel organism, and H37Rv mycobacterium strain. Compounds 4c (MIC 0.39 µg/mL), and 4f (MIC 0.39 and 0.79 µg/mL) displayed promising activity against MRSA strains (ATCC and clinical isolates, respectively). The most potent compounds, 4c and 4f eradicated the growth of bacterial colonies in a time-kill assay indicated that these are bactericidal in nature. The preliminary toxicity study of the potent molecules revealed that these compounds are non-hemolytic in nature as they did not induce lysis in human RBCs. In addition, the molecular docking and dynamics studies of compounds 4b, 4c, 4f and 4g were carried out on MurB protein of S. aureus (PDB code: 1HSK). Docking results demonstrated remarkable hydrogen bonding interaction with key amino acids ARG310, ASN83, GLY79 and π-π interactions with TYR149 which confirm the mode of action of the molecules.

Problems in managing a co-morbid patient with no previous medical records undergoing alternative therapy.

Individuals with intellectual disability are often uncooperative for complete dental evaluation and treatment. Many of these patients fall within autistic spectrum disease. These patients are also said to be associated with other medically relevant disorders such as seizures, and metabolic and hormonal dysfunction. Undertaking treatment of such patients under general anaesthesia will require complete medical evaluation. As many of the antiepileptic drugs interact with anaesthetic agents, a sound knowledge of drugs taken by the patient is necessary. However, when the patient is under alternative therapy, this problem becomes multi-fold. This paper will discuss the basic, but real problems with the gap of understanding between allopathic and alternative therapy, the importance of reviewing the patients', previous medical records, and its medico-legal consequences. It will also raise the issue of delays in management with increased cost and time of hospitalisation in such patients.

Impact of Noise in Operating Theater: A Surgeon's and Anesthesiologist's Perspective.

BACKGROUND AND AIMS: Noise is often considered as an undesirable sound. Excess noise is a health threat that deteriorates one's concentration and communication. Noise in the operating theater can be disturbing, impairs communication, and can lead to stress. The aim of this survey was to assimilate information about the perspective of surgeons and anesthesiologists regarding noise in the operating theater and whether it affects their work atmosphere. METHODS: A questionnaire consisting of 15 closed-ended questions excluding one open-ended question was given to surgeons from various specialties and anesthesiologists. The subjective response were analyzed and documented. Data analysis was done using descriptive statistics. Association was found out using Chi-square test. RESULTS: We collected a total of 290 responses, of which 87.6% (n = 254) considered noise to increase the stress level and deteriorates the quality of teamwork (83.8%, n = 243). Noise affects communication among the staff (86.2%, n = 250) and decreases their concentration level (85.5%, n = 248) which could be harmful in view of the patient's safety. 87.9% (n = 255) of the participants were in favor of limiting the number of people in the operating theater. Nonetheless, 73% (n = 211) considered music has a calming effect and were in favor of music in the operating theater. CONCLUSION: Noise in the operating theater can have distressing effects on surgeons, jeopardizing the patient's safety. However, a flip side to this is that music is considered to have a calming and soothing effect decreasing the anxiety and stress levels.

Effect of Submucosal Injection of Tramadol on Postoperative Pain After Third Molar Surgery.

PURPOSE: This study aimed to evaluate the effectiveness of submucosal injection of tramadol in treating postoperative pain after surgical extraction of impacted mandibular third molars. MATERIALS AND METHODS: We implemented a randomized controlled trial. The sample was divided into 30 cases (receiving tramadol injection) and 30 controls (receiving saline solution injection). Patients were asked to complete a visual analog pain scale (VAPS) at 0.5, 1, 2, 4, 6, 12, 24, and 48 hours. Patients also were asked to note the time at which rescue analgesics were taken, as well as the total number of analgesics taken. The VAPS data were analyzed using the unpaired Student t test. Other variables were analyzed using analysis of variance with the Bonferroni t test and Pearson χ2 test. P < .05 was considered significant. RESULTS: A total of 60 patients, 32 men and 28 women (mean age, 27.78 years; age range, 19 to 45 years), took part in this study. Postoperative pain scores, as recorded on the VAPS, were significantly lower in the tramadol group, with the differences being statistically significant at 0.5, 1, 2, 4, and 6 hours (P < 0.001, P = .006, P < 0.001, P < 0.001, and P < 0.001, respectively). The mean time at which the first tablet was taken and the total number of tablets taken by the tramadol group also were statistically significant (P = .001 for both). CONCLUSIONS: The results suggest that submucosal injection of tramadol has a significant effect on postoperative pain control after surgical extraction of impacted third molars.

Twin supernumerary teeth: A tale of two cases.

Multiple supernumerary teeth are one of the most common developmental anomalies in humans. They could be associated with prolonged retention of deciduous teeth, displacement or rotation of the adjacent teeth, crowding, aberrations in the root morphology (dilacerations), and failure in eruption or impaction of the succedaneous teeth. This article highlights 2 cases of non-syndromic mandibular twin supernumerary teeth in young female clients with a chief complaint of spacing between the teeth and over-retained deciduous teeth. A diligent clinical and radiographic monitoring is warranted considering the early innocuous effects and delayed adverse effects of this condition.

Les dents surnuméraires multiples sont parmi les anomalies développementales les plus communes chez les humains. Elles peuvent être associées à la rétention prolongée des dents lactéales, le déplacement ou la rotation des dents adjacentes, le chevauchement, les aberrations dans la morphologie de la racine (dilacérations) et l'absence d'éruption dentaire ou l'impaction des dents permanentes. Le présent article souligne 2 cas de dents mandibulaires jumelles et non-syndromiques chez de jeunes clientes ayant comme plainte principale l'espacement entre les dents et des dents lactéales gardées trop longtemps. Un suivi clinique et radiographique attentionné est nécessaire, compte tenu des effets anodins précoces et des effets indésirables tardifs de cet état.

Comparison of Surgical Outcome after Impacted Third Molar Surgery Using Piezotome and a Conventional Rotary Handpiece.

BACKGROUND AND AIM: One of the most commonly performed surgical procedures by oral and maxillofacial surgeons all over the world is the removal of impacted teeth. The most critical and important steps in third molar extraction are bone cutting or osteotomy. Many techniques are used for this purpose including chisels and mallet, rotary instruments, and ultrasonic-based bone cutting instruments. Piezotome is newer and innovative device for osteotomy based on piezoelectric vibrations. Piezotome is considered very efficient in performing osteotomy because of its selective cutting; being inert against soft tissues, including nerves and blood vessels. The aim of this study was to compare the surgical outcome of third molar surgery using conventional handpiece and piezotome with all other criteria remaining same for all the individuals. MATERIALS AND METHODS: All patients reporting to the Department of Oral and Maxillofacial surgery, Manipal College of Dental Sciences, Mangalore, for impacted mandibular third molar removal were screened. A total of 30 patients with same Pederson difficulty index for bilateral impacted third molar were selected for the study. The study involved the use of piezotome on one side (Side A) and rotary technique (Side B) on the other side for osteotomy on the same patient with an interval of 1 month. Therapeutic management was same for both the sides. Operating time was recorded in each surgery. Patients were examined postoperatively on 1st, 3rd, and 7th day and pain, edema, trismus, paresthesia, and dry socket were evaluated and compared on both the sides. Data collected were analyzed statistically. RESULTS: The mean operating time was 48.13 min in piezotome (Side A) and 32.90 min in conventional handpiece (Side B) which was statistically significant (P < 0.001). Furthermore, there was statistically significant difference (P < 0.001) in the level of pain (P < 0.001), number of analgesics taken (P < 0.001), and trismus (P < 0.01) on 1st, 3rd, and 7th days postoperatively. There was no statistically significant difference in edema between the two sides. Paresthesia was present in one patient (3.3%) in Side B, while no paresthesia was present in Side A. No incidence of alveolar osteitis was reported on both the sides. CONCLUSION: Operating time with piezotome was more than that of conventional handpiece, but the postoperative responses such as pain, trismus, and edema were less in piezotome. Hence, despite being a slower procedure, piezotome can be an effective alternative for osteotomy in impacted third molar surgery. We recommend using piezotome for bone cutting and conventional rotary handpiece for tooth sectioning in order to obtain favorable outcomes as well as decreasing the operating time.

Third molar in the orbital floor: A precarious presentation of odontogenic keratocyst-A case report and review of literature.

The case illuminates the likelihood of a dental pathology presenting with discrete signs and symptoms and the importance of the differential diagnosis of some incongruent clinical entities. The purpose of this article was to present a case report of odontogenic keratocyst (OKC) arising in the orbital floor, finding the common thread in rare pathology, and highlighting the aberration in our treatment plan by collating all the wealth of information published in the literature.

Pterygoid Hamular Bursitis: A Possible Link to Craniofacial Pain.

A striking feature of the skull base is the pterygoid hamulus known for its bizarre morphology and biomechanical location. Pterygoid hamular bursitis is an inflammation of bursae located between the tendon, muscle, and bony prominences. The minimal objective finding in an apparently normal orofacial apparatus and dependence on the subjective symptoms experienced by the patient with widespread referral pattern often perplexes the clinician. Bursitis should be considered in the differential diagnosis of craniofacial neuralgia, temporomandibular joint dysfunction, and chronic craniofacial pain. Clinical signs and symptoms of this intriguing entity are diverse and multifaceted that can sometimes demand services of clinicians across various specialties considering the anatomic density of the region. Care must be taken to avoid delay, misdiagnosis, and overtreatment.

Expression of Laminin in Oral Squamous Cell Carcinomas

Background and objectives: Laminin is a significant basement membrane (BM) glycoprotein, the expression of which reflects BM integrity more precisely than do other ECM proteins. The present study aimed to evaluate laminin expression in oral squamous cell carcinomas OSCC and to determine any associations with clinico-pathological parameters (surgical margin status, lymph node involvement, survival and recurrence). Methods: Laminin expression was evaluated in 31 cases of biopsy-proven OSCC by immunohistochemical staining and its association with prognosticators and the Brynes grading system was determined by appropriate statistical analysis. Results: We observed a significant increase in linear staining pattern (p<0.001) at the tumour-host interface in well-differentiated OSCC cases, in contrast to poorly differentiated lesions which exhibited intense cytoplasmic expression within tumour cells. Higher cytoplasmic laminin expression was seen in 33.3% of cases with involved surgical margins and 69.2% of cases with lymph node metastasis (along with weak/absent staining of laminin around the tumour-host interface ­ Basement membrane around tumour islands). Similarly, in 60% of the cases who died and in 81.8% of cases with tumour recurrence, moderately intense cytoplasmic laminin expression was seen within tumour cells. On comparing variables of the Brynes grading system, significant cytoplasmic expression of laminin was linked with mild inflammation (p<0.0016) and increased mitotic activity (p<0.008). Conclusion: Based on these observations, immunohistochemical expression of laminin might be useful to evaluate histological differentiation and aggressiveness of OSCCs.

Fluorinated pyrrole incorporated 2-thiazolyl hydrazone motifs: a new class of antimicrobial and anti tuberculosis agents.

In aim of obtaining novel bio-active compounds, a new series of fluorinated 1-(4-(aryl)thiazol-2-yl)-2-((1-(aryl)-2,5-dimethyl-1H-pyrrol-3-yl)methylene)hydrazines (5a-t) and 1-(4-(4-aryl)thiazol-2-yl)-2-((3-(2,4-dichlorophenyl)-1-phenyl-1H-pyrazol-4-yl)methylene)hydrazines (8a-d) were synthesized and screened for their antibacterial and antifungal activities. The potent compounds were further screened in vitro for anti-tuberculosis activity against Mycobacterium tuberculosis H37Rv strain. Compounds 5a, 5c-5h and 5m were found to be good inhibitors of B. subtilis with MIC ranging from 0.2 to 0.8 µg mL-1, which are nearly three to ten times more potent than the standard drug Ciprofloxacin. Compounds 5a, 5h-5k and 5o exhibited potent antifungal activity against C. albicans strain with MIC ranging from 0.4 to 1.6 µg mL-1. Compounds 8a-8c were found to be excellent inhibitors of A. niger. Compounds 5a and 5k showed significant anti tubercular activity with MIC 3.12 and 6.25 µg mL-1 respectively. Furthermore, highly active compounds were tested for their preliminary toxicity profile by hemolytic assay and were found to be non hemolytic at higher concentration with good selectivity index. Cytotoxicity of the potent compounds 5a, 5d, 5g, 5i and 5k was checked by MTT assay using normal embryonic kidney cell line HEK 293 and found to be non-toxic up to 50-200 times the MIC for antibacterial activity.

Facial Atrophy in Oral Submucous Fibrosis: An Association or a Coincidence.

The anecdotal clinical presentation of OSMF that includes vesicle formation, burning sensation, intolerance to hot and spicy food, and trismus due to circumoral fibrous bands has been ringing in our ears for decades but the current paper flags novelty by portraying a rare presentation of an advanced stage of OSMF.

Tumour-Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma- A Boon or a Bane?

INTRODUCTION: The infiltration of tumour stroma by eosinophils, Tumour-Associated Tissue Eosinophilia (TATE) is known to modulate the evolution of Oral Squamous Cell Carcinoma (OSCC). Identification of eosinophils in the inflammatory stroma has been proven to be an important factor in prognostication of malignant tumours including cancers of mouth, oesophagus, larynx, pharynx, breast, lung, intestine and genitourinary tract. AIM: Our study aimed to assess the role of TATE as a prognosticator in OSCC as visualized by Haematoxylin and Eosin (H&E) and congo red staining. MATERIALS AND METHODS: Thirty histologically-proven cases of OSCC were retrieved from the archives of Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India. Two serial sections of 4µm thickness were made and subjected to routine staining with H&E and modified congo red staining, where eosinophil granules stained red and nuclei stained blue. In 40x magnification, 10 HPF at invasive tumour front were assessed for counting eosinophils by placing a 49 square grid (measuring 0.0289 sq mm). STATISTICAL ANALYSIS: The TATE was compared with the prognosticators using Mann-Whitney U-test. The grades of carcinoma were correlated with TATE using Kruskal-Wallis test followed by Post-hoc Bonferronis correction. Agreement of the number of eosinophils counted in the two staining techniques (H&E and Congo red) in OSCC was achieved using interclass correlation coefficient, and Friedman's test. A value of p< 0.05 was considered statistically significant. RESULTS: Our results showed that tissue eosinophil counts were higher in well-differentiated cases of OSCC, cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. H&E stain showed significantly better visualization of eosinophils resulting in higher eosinophil counts than when seen with Congo red (p=0.008). CONCLUSION: Thus, TATE can be used as a surrogate marker in prediction of survival and recurrence in OSCC. H&E proved to be a better stain for evaluation of eosinophils.