Identification and management of foreign body in the primary teeth.

Paediatric dentists encounter many emergencies in child patients and entrapment of foreign bodies in teeth is a commonly anticipated complication. It is more frequently seen in children with chronic carious lesions or due to teeth with wide open pulp chambers and pulp canals affected with caries or traumatic dental injuries. Here, we report a case of successful management of foreign body lodgement in the primary teeth of a middle childhood female patient along with a literature review of various foreign bodies identified in the past and some practical recommendations for the prevention of such incidents in the future.

Management of infected radicular cyst associated with immature maxillary permanent lateral incisor: a conservative surgical approach.

Radicular cysts are the most common cystic lesions which affect the jaw. Traumatic dental injuries cause injury to the periodontal ligament and dental pulp often leads to pulpal necrosis. The necrosed pulp eventually becomes the nidus of infection and irritates the periapical epithelial cell remnants, which in turn develops into a cyst eventually. This case report presents the successful conservative surgical management of a large infected radicular cyst which was associated with traumatised, necrotic, permanent maxillary lateral incisor with open apex by Partsch II surgical procedure followed by a combination of retrograde and orthograde root canal obturation. This report will guide the clinicians in the arena of surgical endodontics in a conservative approach.

SkiNet: A deep learning framework for skin lesion diagnosis with uncertainty estimation and explainability.

Skin cancer is considered to be the most common human malignancy. Around 5 million new cases of skin cancer are recorded in the United States annually. Early identification and evaluation of skin lesions are of great clinical significance, but the disproportionate dermatologist-patient ratio poses a significant problem in most developing nations. Therefore a novel deep architecture, named as SkiNet, is proposed to provide faster screening solution and assistance to newly trained physicians in the process of clinical diagnosis of skin cancer. The main motive behind SkiNet's design and development is to provide a white box solution, addressing a critical problem of trust and interpretability which is crucial for the wider adoption of Computer-aided diagnosis systems by medical practitioners. The proposed SkiNet is a two-stage pipeline wherein the lesion segmentation is followed by the lesion classification. Monte Carlo dropout and test time augmentation techniques have been employed in the proposed method to estimate epistemic and aleatoric uncertainty. A novel segmentation model named Bayesian MultiResUNet is used to estimate the uncertainty on the predicted segmentation map. Saliency-based methods like XRAI, Grad-CAM and Guided Backprop are explored to provide post-hoc explanations of the deep learning models. The ISIC-2018 dataset is used to perform the experimentation and ablation studies. The results establish the robustness of the proposed model on the traditional benchmarks while addressing the black-box nature of such models to alleviate the skepticism of medical practitioners by incorporating transparency and confidence to the model's prediction.

DMENet: Diabetic Macular Edema diagnosis using Hierarchical Ensemble of CNNs.

Diabetic Macular Edema (DME) is an advanced stage of Diabetic Retinopathy (DR) and can lead to permanent vision loss. Currently, it affects 26.7 million people globally and on account of such a huge number of DME cases and the limited number of ophthalmologists, it is desirable to automate the diagnosis process. Computer-assisted, deep learning based diagnosis could help in early detection, following which precision medication can help to mitigate the vision loss. METHOD: In order to automate the screening of DME, we propose a novel DMENet Algorithm which is built on the pillars of Convolutional Neural Networks (CNNs). DMENet analyses the preprocessed color fundus images and passes it through a two-stage pipeline. The first stage detects the presence or absence of DME whereas the second stage takes only the positive cases and grades the images based on severity. In both the stages, we use a novel Hierarchical Ensemble of CNNs (HE-CNN). This paper uses two of the popular publicly available datasets IDRiD and MESSIDOR for classification. Preprocessing on the images is performed using morphological opening and gaussian kernel. The dataset is augmented to solve the class imbalance problem for better performance of the proposed model. RESULTS: The proposed methodology achieved an average Accuracy of 96.12%, Sensitivity of 96.32%, Specificity of 95.84%, and F-1 score of 0.9609 on MESSIDOR and IDRiD datasets. CONCLUSION: These excellent results establish the validity of the proposed methodology for use in DME screening and solidifies the applicability of the HE-CNN classification technique in the domain of biomedical imaging.

Radicular cyst of primary tooth associated with maxillary sinus.

Radicular cyst is one of the most common odontogenic cystic lesions found in the jaws. It is inflammatory in nature and found mostly in relation to a non-vital tooth. It usually presents at a later stage in life because the formation of the cyst is the last step in the progression of inflammatory events after a periapical infection. The cyst usually goes unnoticed because of its painless nature and small size. We present the clinical, radiographic and histological characteristics of a radicular cyst along with its management. Cystic sac was removed surgically under general anaesthesia after the elevation of the mucoperiosteal flap. Histopathologically, the cystic sac was consistent with the features of a radicular cyst. Follow-up period of 21 months showed improved radiographical appearance on Coned Beam CT. Vestibular deepening was planned as a future treatment in the same region.

Harmonious functional and aesthetic correction of severe localised pregnancy-induced gingival enlargement associated with capillary haemangioma.

Gingival enlargement is a clinical condition that has been widely studied and is directly associated with specific local or systemic conditions. Pregnancy has been presented to increase susceptibility to gingival inflammation. Sex hormones are believed to be a risk factor for periodontitis because of their ability to proliferate specific periodontal microorganisms and affect host immunological response, but it is unclear whether pregnancy gingivitis exposes or proceeds to periodontitis. In this case report, the patient reported with severe localised enlarged gingival mass which initiated when she was pregnant. After parturition, gingival enlargement was persisting and causing functional and aesthetic problem. Enlargement did not resolve even after non-surgical therapy; therefore, surgical excision of the entire enlarged gingival mass was preformed. Histopathological examination revealed capillary haemangioma. No evidence of malignancy was seen. No recurrence was seen even after 2 years of follow-up.

Profusely bleeding oral pyogenic granuloma in a teenage girl.

Pyogenic granuloma (PG) is a kind of inflammatory hyperplastic soft tissue lesion of the oral cavity. The lesion, however, is not related to infection and arise as a reactive growth in response to various stimuli. It has a very high vascularity because of the presence of numerous prominent capillaries. The lesion has a bleeding tendency, even after a minor traumatic episode, such as during mastication. Bleeding may be at times very severe and difficult to control. We present the case of a profusely bleeding young PG in a young teenage child.

An endo-aesthetic management of crown dilaceration in a permanent mandibular central incisor.

Traumatic injuries to primary dentition may result in a wide range of developmental disturbances to succedaneous permanent teeth. The prevalence of morphological disturbances, secondary to dental injuries in the primary dentition, ranges from 12% to 69%. One of the morphological disturbances are crown dilacerations which are defined as the displacement of a portion of the developing crown at an angle to the longitudinal axis of the tooth. The prevalence of crown dilaceration constitutes 3% of the total injuries in developing teeth and is usually because of intrusion or avulsion of their primary predecessors. The present article narrates a case of crown dilaceration of a permanent mandibular right central incisor with open apex and large periradicular pathosis and its endo-aesthetic management with 2 years of follow-up.

Management of oral submucous fibrosis by different surgical approaches: report of three cases.

Oral submucous fibrosis (OSMF) is an insidious chronic progressive disease of the oral cavity which is considered as a precancerous condition. The suggested aetiological factor is the practice of certain customs/habits of the inhabitants of South East Asia. As the disease progresses, the oral mucosa becomes stiff due to the formation of fibrotic bands in the cheek, ultimately leading to reduced mouth opening and trismus. The early form of the disease can be treated by medicinal means, however, advance form needs surgical excision of the fibrotic tissue bands. The defect created due to the excision needs to be repaired by various grafts including split thickness skin grafting, bilateral nasolabial flaps, palatal island flaps, tongue flaps, buccal fat pad graft and temporalis muscle flap graft. We present the management of trismus following OSMF by various surgical approaches in three cases.

Intraoral lipoma: a rare clinical entity.

Lipoma is a painless soft tissue tumour of the mesenchymal origin, which is slow growing and well circumscribed. The occurrence of lipoma is rare in the oral cavity (1-4%); however, the frequency is much higher in the head and neck region. The tumour is mostly present in the buccal mucosa, lips, tongue, palate, buccal sulcus and floor of the mouth. Sometimes the tumour becomes large enough to cause difficulty in speech and mastication. Histologically, lipoma is composed of mature fat cells, surrounded by normal fat. We present two cases of intraoral lipoma in two female patients.

Management of trismus following radiation therapy by cost-effective approach.

Radiotherapy when used in head and neck cancer treatment can produce side effects in patients such as the trismus. If allowed to progress trismus can become so severe that the patient becomes debilitated due to lack of nutrition. Furthermore, trismus and limited oral access present a challenge to the clinician for dental treatment. This article describes a simple and cost-effective appliance for management of trismus.

Dental lamina cysts in a newborn infant.

Cystic lesions of transient nature viz. Epstein pearls, Bohn's nodules and dental lamina cysts are frequently found in the oral cavities of newborn infants. These cysts arise from the developing dental tissues or from their remnants. These cystic lesions are not commonly seen by the dental surgeons due to their self-limiting nature and ignorance of the parents to seek the professional opinion. However, when contacted by anxious parents seeking treatment, dental surgeons should be able to explain and reassure the parents about the transient nature of these lesions and need for no treatment but regular follow-up. The present case report was written with the purpose to increase the awareness in dental surgeons about the peculiar clinical presentation and self-limiting nature of these cystic lesions, so that unnecessary surgical intervention can be avoided in such young infants.

A biochemical and histopathological evaluation of generalized pulp calcification in young permanent teeth.

Pulp calcifications are a frequent finding on bitewing and periapical radiographs in older age-groups but their occurrence in the entire dentition in young subjects is unusual. We report such an unusual occurrence of generalized pulp calcification in a 13-year-old Indian female. Radiographic examination of the dentition revealed pulp calcifications in all permanent teeth, located mostly in the pulp chamber but with some in the root canals. The patient's dental, medical, and family history was noncontributory. Biochemical analysis of the removed pulp calcification from one of the teeth during endodontic treatment showed large amounts of calcium, phosphorus, and carbonate. However, metabolic evaluation of patient through liver and kidney function tests and other blood investigations did not reveal any metabolic disorder. The patient was also evaluated for any systemic, syndromic, or genetic involvement but this was also noncontributory. Therefore, we propose that this unusual case of generalized pulp calcification is of idiopathic origin. In this work, histopathological and biochemical evaluations of the pulp calcification was done to try and understand the initiation and progress of calcifications in pulpal tissue.

Hemoperitoneum as a first manifestation of HCC with bleeding from ruptured aberrant vessel: a case report.

A young man presented with a history of abdominal pain and distension for 4 days. Diagnosis of spontaneous hemoperitoneum was made after clinical examination, abdominal USG and a diagnostic peritoneal tap. Emergency laparotomy revealed massive hemoperitoneum with extensive bilobar hepato-cellular carcinoma (HCC). A ruptured aberrant vessel communicating between the intercostal vessel and HCC in the liver had caused massive hemoperitoneum.