Fabrication of an immediate surgical obturator for a patient with resection of the maxillary antrum and bony orbital floor.

An immediate surgical obturator is necessary for maxillectomy procedures to minimize functional disabilities in speech, swallowing, and egress of food and liquid into the surgical defect. Sometimes the extent of the tumor may be such that it may even require the removal of the maxillary sinus along with resection of the orbital floor. The resected orbital floor can be surgically reconstructed with autogenous soft and/or hard tissues or with alloplastic materials. This clinical report highlights one such situation where the surgical resection of the maxilla and the orbital floor were rehabilitated with an immediate surgical obturator extending to the orbital floor to support the visual apparatus.

An in vitro study of the bond strength of five adhesives used for vinyl polysiloxane impression materials and tray materials.

Although stock trays often provide mechanical retention for elastomeric impression materials, manufacturers typically recommend the use of an adhesive, whether a stock or custom tray is used. The mention of the bond strength on the adhesive packaging is not available, therefore the clinician has no idea whatsoever of the ideal adhesive. The aim of this study was to evaluate the bond strength of three vinyl polysiloxane (VPS) materials, one with a poly(methyl methacrylate) autopolymerizing (PMMA) specimen and another with a light-polymerizing tray material (VLC), using the adhesive recommended by the manufacturer of the impression material, and two universal adhesives. A total of ninety specimens (15 × 15 × 20 mm) were used, 45 specimens were made in PMMA and rest 45 was made in VLC. Five paint-on adhesives (Coltene, Caulk, 3M, universal Zhermack and universal GC) were applied. Three impression materials, Affinis, Reprosil, and 3M, were mixed and injected into a perforated poly vinyl chloride cylinder. Tray specimens were positioned against the open cylinder end in contact with the VPS material. Tensile strength tests were conducted until adhesive separation failure. Mean values and standard errors of the adhesive strength were recorded in MPa for each material combination. GC paint-on universal adhesive provided significantly higher adhesive strength values.

Demographic and Clinicopathological Spectrum of Gallbladder Carcinoma in a Tertiary Care Centre in Jharkhand: A Retrospective Study.

Introduction Gallbladder carcinoma is a rare but aggressive cancer of adults that affects females more than males. Its occurrence is more common in the regions of South America and Asia. Chronic inflammation and cholelithiasis are frequently associated risk factors of gallbladder carcinoma. The incidental discovery of a gallbladder carcinoma during cholecystectomy, gross or microscopic examination of the unsuspected gallbladder specimens is termed incidental gallbladder carcinoma (IGBC). Considering the lack of extensive studies on gallbladder carcinoma in the Eastern region of India, especially in Jharkhand, this study has been done to present the demographic and clinicopathological characteristics of gallbladder carcinoma in this region. Methods A retrospective and descriptive study was done at Rajendra Institute of Medical Sciences (RIMS), Ranchi, a tertiary care center in Jharkhand. The study sample comprised 2386 gall bladder cases received in the Department of Pathology over five years, from December 2018 to December 2023. Results Of 2368 specimens, 25 cases (n=25) were reported as primary gallbladder carcinoma. The female-to-male ratio was 4:1. Pain was the most common complaint by the patients. Of the 25 cases, 12 were suspected intra-operatively or diagnosed microscopically (IGBC). Most showed a mass at the neck. In six cases, no gross mass/lesion was seen. Cholelithiasis is present in 19/25 cases. Most cases showed adenocarcinoma (not otherwise specified). Out of the adenocarcinoma cases, most were well differentiated. At the time of diagnosis, most were at the pT2 stage. Twelve cases of IGBC were found. Eight out of 12 IGBC were early-stage carcinoma when diagnosed. Conclusion Twenty-five cases of gallbladder carcinoma were diagnosed in the last five years in our center, with 19 (76%) of them associated with cholelithiasis. Twelve (48%) of the cases were incidentally diagnosed either preoperatively or during gross/microscopic examination, and eight (66%) of those were discovered early, out of which five (62.5%) were observed to be in the T1b stage. At this stage, there is a diversion from the general surgical management of gallbladder carcinoma for a better prognosis. This underscores the significance of routine histopathological examination of gallbladder specimens, even if there is no preoperative suspicion of gallbladder carcinoma.

Metaplastic Breast Cancer: A Case Report on a Rare Neoplasm of the Breast.

Metaplastic breast cancer represents a very rare and histopathologically diverse subtype of breast cancer. It shows neoplastic epithelial differentiation into squamous cells and/or mesenchymal-like components, resulting in its aggressive behavior and poor prognosis compared to other types of breast cancer. Here, we describe the case of a 43-year-old woman diagnosed with metaplastic carcinoma of the breast who presented like any other case of breast lump in the right breast for six months. The tumor had a large size with an ulcerative lesion of the breast. Ultrasound showed heterogeneous echogenicity and lymph node involvement. Surgical resection with axillary lymph node dissection was done. The microscopic examination after tissue processing showed highly pleomorphic tumor cells along with chondromyxoid stroma and osseous differentiation, suggestive of metaplastic breast cancer which was triple-negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 on immunohistochemistry. The axillary lymph nodes identified were negative for tumor cells. The rarity and aggressive nature of this cancer pose diagnostic challenges and highlight the importance of multidisciplinary approaches for effective management.

Comparative evaluation of osseodensification drilling versus conventional drilling technique on dental implant stability: A systematic review.

AIM: The present systematic review compares the stability, crestal bone levels and efficacy of osseodensification (OD) drilling techniques for dental implant placement to traditional drilling methods. SETTINGS AND DESIGN: The Cochrane online library, PubMed, Scopus, and other well-known online resources are used in the research. Using a systematic review design, the current study examines published qualitative studies with an emphasis on analysis. MATERIALS AND METHODS: Using precise keywords, a thorough search of pertinent databases was carried out in accordance with PRISMA standards. Studies testing dental implant stability, crestal bone levels and clinical results using both OD and traditional procedures were covered by the inclusion criteria. STATISTICAL ANALYSIS USED: The risk of bias and quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized controlled trials. RESULTS: A total of 170 patients and 334 implants from Egypt, India, and Brazil were included in eight papers that made up the systematic review. In several clinical situations, osseodensification outperformed standard drilling in terms of implant durability, bone development, and torque data. Statistical analysis presented the lowest risks, while blinded outcome assessment, allocation concealment, random sequence generation, incomplete outcome data and experimental technique revealed higher risks. Bias assessment found various risks across different components. CONCLUSION: The thorough examination of eight papers demonstrates that osseodensification is a technique with great promise in the field of dental implants. It exhibits superior torque values, bone development, and stability when compared to traditional drilling. The overall results highlight the potential of osseodensification to improve clinical outcomes and advance the science of dental implantology, even in the face of variances in bias concerns.

Intraoperative Assessment of Margin Accuracy in Patients Diagnosed With Oral Squamous Cell Carcinoma in a Tertiary Hospital of Jharkhand: Frozen Section Versus Histopathology.

Background The incidence of head and neck carcinoma is increasing. The use of an intraoperative frozen section plays a vital role in the evaluation of margin status in patients undergoing surgery for oral squamous cell carcinoma. A negative margin is not only an indication of successful surgery but also decreases the recurrence of disease and improves the overall survival of patients. Aims and objective The aim of this study is to assess the accuracy of margin in patients undergoing surgery for oral squamous cell carcinoma by intraoperative frozen section and compare it with conventional histopathological examination. Methodology The approach of our study was a hospital-based prospective study conducted on 28 patients diagnosed with oral squamous cell carcinoma. A frozen section was done on all patients undergoing surgery and compared with histopathological examination. Results Out of 28 patients undergoing surgery, the incidence of males was more than females, with a ratio of 6:1. The most common site of the tumor was left buccal mucosa comprising 28.57%, followed by gingivobuccal sulcus comprising 17.85%. In our study, the frozen assessed margin showed a sensitivity of 58.33%, specificity of 98.76%, and accuracy of 95.25%. Conclusion Frozen section is a reliable method for confirmation of margin accuracy and thus reduces the chance of re-surgery and recurrence of disease and increases overall patient survival.

A Comparative Study to Evaluate the Linear Dimensional Change and Compression Resistance of Four Elastomeric Interocclusal Recording Materials: An in vitro Study.

The transfer of interocclusal data from the patient's mouth to articulators utilizing various types of recording media is necessary for the production of dental prostheses. Occlusal errors in the final prosthesis result from any discrepancies in these interocclusal records. Materials and Methods: The purpose of this study was to assess the linear dimensional changes in the four elastomeric interocclusal recording materials as well as the material's resistance to compression during the cast mounting on the articulator. Result: All four elastomeric materials showed decreasing stability over time and 2 mm thickness showed the highest compression resistance with minimal articulation error. Conclusion: Dimensional stability depends on material and time factors, and compressive resistance decreases with increasing thickness.

Implant supported prosthesis after ridge augmentation procedure by distraction osteogenesis for atrophic mandible.

Rehabilitation of deficient alveolar ridges has long been a challenge. The distraction osteogenesis procedure before placement of dental implants has solved the puzzle and its advantages over block grafting includes simultaneous expansion of soft tissue, high degree of dimensional stability, abbreviated overall treatment time, and no graft required. In this case report distraction osteogenesis of deficient anterior mandibular ridge was performed and then an implant supported fixed prosthesis was fabricated.

Prosthodontic rehabilitation of velopharyngeal disorders-a case series.

Acquired palatal defects results from cancer resection, whereas cleft palate is the main cause of congenital defects. Both these condition leads to impaired speech intelligibility, seepage of nasal secretions into the oral cavity and vice versa while difficulty in swallowing and hyper nasality is also eminent. In this case report three different technique for treating velopharyngeal disorders have been described.

Efficacy of implantoplasty in management of peri-implantitis: A systematic review.

Aim: Peri-implantitis causes progressive loss of the supporting bony structure around the dental implant. Implantoplasty mechanically removes contaminated threads to achieve smoother implant surface thus reducing the bacterial load enabling fibroblastic growth to stimulate the healing effect. This Systematic review is done to appraise the outcome of implantoplasty on surface quality of Implant (roughness), biocompatibility of implants in peri-implantitis cases. Settings and Design: The Settings of the studies are major online databases like PubMed, Scopus, and Cochrane online library. The design of the current study is systematic review of published qualitative studies. Materials and Method: 37 articles were identified for the present review and systematic electronic literature search was done from August 2022 to January 2023, via PubMed, Scopus, Medline, and The Cochrane Library (Wiley) databases [PRISMA guidelines]. In vitro studies on implantoplasty for peri-implantitis were included for the review. 2 examiners independently selected based on the inclusion criteria and recorded the necessary data. Statistical Analysis Used: Risk of bias assessment tool was evaluated with Newcastle Ottawa scale (NOS) and screened based on Selection, Comparability, and Outcome with the following categories: - maximum of 4, 2 and 4 points respectively. The observations were tabulated and analysed. Results: Among the 8 selected studies, two studies reported no statistical difference between implantoplasty and control, one study proposed carbide burs were better than diamond burs, another study also suggested multilaminar burs were better than diamond and carbide. The Newcastle Ottawa scale (NOS) score for the quality of the included studies ranged from 6 to 8. Two of the studies had score of 6 points, eight had 7 points and one had 8 points. Conclusion: Implantoplasty has been recommended as an efficacious treatment protocol for peri-implantitis that helps to diminish the inflammation and accompanied by a high success rate.

Hypocalcemic cardiomyopathy: a rare presenting manifestation of hypoparathyroidism.

Hypoparathyroidism patients present with features of hypocalcemia like carpopedal spasm, numbness and paresthesias but hypocalcemic cardiomyopathy leading to congestive heart failure (CHF) is a rare presentation. We present here a case of 55-year-old Asian man who was a known case of dilated cardiomyopathy for 6 months, presented with the chief complaints of shortness of breath on exertion and decreased urine output. On general physical examination, features suggestive of CHF were seen. Chvostek and Trousseau's sign was positive. The patient had a history of cataract surgery of both eyes 15 years ago. Further investigations revealed hypocalcemia. Echo showed severe global hypokinesia of left ventricle with left ventricle ejection fraction 15%. This CHF was refractory to conventional treatment, though, with calcium supplementation, the patient improved symptomatically. On follow-up after 3 months, an improvement was seen in the echocardiographic parameters with ejection fraction improving to 25%.

Unilateral renal artery stenosis presenting as acute flaccid paralysis: a rare presentation.

Renovascular hypertension is one of the common causes of secondary hypertension. Here we report a case of patient of renal artery stenosis presenting to the emergency department as a case of acute flaccid paralysis. Renal artery stenosis has been associated with hypokalaemia, but rarely reported to be symptomatic. Initial correction of hypokalaemia leads to improvement of weakness and aetiological work up for hypokalaemia with hypertension revealed hypokalaemia due to hyperaldosteronism secondary to unilateral renal artery stenosis. The patient was managed medically with aldosterone antagonist in the anti hypertensive therapy and weakness did not recur despite withdrawal of potassium supplements. On follow-up, the patient was ambulatory with no signs of weakness, controlled blood pressure and normal potassium level.

Magnet retained intraoral-extra oral combination prosthesis: a case report.

Facial prosthesis is generally considered over surgical reconstruction to restore function and appearance in patients with facial defects that resulted from cancer resection. Retention of the prosthesis is challenging due to its size and weight. Retention can be achieved by using medical grade adhesives, resilient attachments, clips and osseointegrated implants. It can also be connected to obturator by magnets. This clinical report highlights the rehabilitation of a lateral midfacial defect with a two piece prosthesis that included an extra oral facial prosthesis and an intraoral obturator with the use of magnets.