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.

Ponticulus Posticus: An Important Diagnostic Finding Often Missed in Lateral Cephalograms.

AIM: The purpose of the current study was to investigate the presence of the ponticulus posticus (PP) frequently encountered in lateral cephalograms. MATERIALS AND METHODS: About 500 patients of age 12-40 years were selected whose digital lateral cephalogram was recorded and traced to confirm the presence of the PP and categorize as: (A) Absent, as evidenced by lateral cephalograms. (B) Complete PP evidenced by the presence of circumferential bone bridge that connected the upper articular process to the atlas's posterior arch. (C) Partial PP: presented as a bone spike that protruded from the top articular process or the posterior arch of the atlas and extended above the vertebral artery sulcus. Symptoms of migraine, shoulder discomfort, orofacial pain, and headache were also evaluated on interaction with the patients. Using the Chi-square test, the relationship between the patient's gender and the presence of the PP was assessed. A p-value of 0.05 or less was regarded as statistically significant. RESULTS: About 10% of the patients reported with the presence of complete variant, 70% with partial variant and rest 20% of patients with neither a partial nor a complete form of PP. There was no statistically significant association between the PP and gender, as indicated by the Chi-square values (3.146; p = 0.526). CONCLUSION: On conclusion, according to the findings of the current study, patients with a complete form of PP experience more symptoms than those with a partial form of PP. In both groups, the PP frequency was higher in females. CLINICAL SIGNIFICANCE: In lateral cephalograms, the cervical spine region is typically ignored and given little weight. A common variation of atlas vertebrae is the PP, which is located in the posterior arch of the atlas. The PP exacerbates symptoms, such as migraine, tension headaches, shoulder pain, double vision, vertigo, stroke, and pain in the neck and orofacial region. Therefore, orthodontic specialists serve as initial diagnosticians and direct the patients to qualified physicians so that they can experience symptom relief.

Influence of Three Different Denture Cleansers on Surface Roughness and Strength of Heat-polymerizing Resin: An In Vitro Study.

AIM: The purpose of the current study was to evaluate the impact of three different denture cleansers on the strength and surface roughness of heat-polymerizing resin. MATERIALS AND METHODS: A total of 120 resin discs (10 mm in diameter and 2 mm thick) were created using a stainless steel mold for surface roughness testing and flexural strength testing (in accordance with the American Dental Association (ADA) Specification No.12). Samples were divided into one of three groups (40 samples in each group): group I: Clanden, group II: Clinsodent, group III: Fittydent. Samples were immersed in denture-cleansing solutions for 30 minutes every day, and this process was repeated over a period of 15 days. Samples were stored in distilled water at room temperature in between the immersions. A surface analyzer was utilized to compare the surface roughness of each sample before and after immersion treatments. For recording flexural strength, each sample was subjected to three-point bending test by mounting samples on Universal testing machine. Comparing mean values between groups using one-way ANOVA and the Tukeys honest significant difference (HSD) post hoc test. A significance level of 0.05 was used for all statistical calculations Results: After 15 days, the maximum change of mean surface roughness of heat-polymerizing resin was found in Clanden denture cleanser group (2.64 ± 0.12) followed by Clinsodent group (2.26 ± 0.09) and Fittydent group (1.92 ± 0.06). After 15 days, the maximum change of mean flexural strength changes of heat-polymerizing resin was found in Clanden denture cleanser group (94.78 ± 0.14), followed by Fittydent group (98.64 ± 0.03) and Clinsodent group (99.26 ± 0.21). CONCLUSION: Within the limitation, the current study concluded that changes were observed in surface roughness and flexural strength of all heat-polymerizing resin samples after immersion in all three denture cleansers; but least surface roughness and flexural strength changes were observed with the Fittydent cleanser group and Clinsodent group, respectively. CLINICAL SIGNIFICANCE: Cleaning dentures is crucial for maintaining both the prosthesis and oral health; therefore, it is necessary to select a cleanser that is effective without negatively affecting the base resin's qualities over time.

Assessment of Microgap and Microbial Leakage of Two Different Implant-abutment Interfaces: An In Vitro Study.

AIM: The purpose of the current study was to evaluate Titanium and Bioneck TRI implant-abutment interfaces for microgaps and microbiological leakage. MATERIALS AND METHODS: In this in vitro experiment, 40 dental implants were split into two groups, each of which had 20 samples. Group I: Titanium dental implant, group II: Bioneck TRI. E. coli strain was cultivated in MacConkey media for 24 hours at 37°C. To achieve a bacterial concentration of 1 × 108 colony-forming units per mL at 0.5 scale of MacFarland, the brain-heart infusion (BHI) broth was injected. The CFU count was done to evaluate the microbial leakage. The parts were first submerged, carefully cleaned in an ultrasonic bath, and then installed using a digital torque meter with a 20 N/cm preload. These were attached to a stub of approximately 13 mm using carbon tape, and the microgap evaluation was performed using a scanning electron microscope at a magnification of x1000. Unpaired t-test was used for the calculated data's statistical analysis. The p-value less than 0.05 was considered as statistically significant. RESULTS: The maximum microbial leakage was in Bioneck TRI implants (10000 ± 0.01) followed by Titanium dental implants (8.60 ± 3.16). The mean difference was 9991.40 and there was a statistically significant difference found between the two different groups. The maximum microgap was found in the Bioneck TRI implants (9.72 ± 0.96), followed by Titanium dental implant (6.82 ± 1.10) and there was a statistically significant difference was found between the groups (p < 0.001). CONCLUSION: The present study concluded that the microorganisms can infiltrate the microgap between the implant and abutment interface. When compared with Titanium dental implants, Bioneck TRI implants showed significantly higher levels of microbial leakage. CLINICAL SIGNIFICANCE: A microgap between the implant and abutment connection might operate as a bacterial source, may produce inflammation, even osseointegration in danger, and subsequently alter clinical and histological parameters. Therefore, having an understanding of the compatible components aids in overcoming treatment planning challenges.

Cell Type-Specific Effects of Implant Provisional Restoration Materials on the Growth and Function of Human Fibroblasts and Osteoblasts.

Implant provisional restorations should ideally be nontoxic to the contacting and adjacent tissues, create anatomical and biophysiological stability, and establish a soft tissue seal through interactions between prosthesis, soft tissue, and alveolar bone. However, there is a lack of robust, systematic, and fundamental data to inform clinical decision making. Here we systematically explored the biocompatibility of fibroblasts and osteoblasts in direct contact with, or close proximity to, provisional restoration materials. Human gingival fibroblasts and osteoblasts were cultured on the "contact" effect and around the "proximity" effect with various provisional materials: bis-acrylic, composite, self-curing acrylic, and milled acrylic, with titanium alloy as a bioinert control. The number of fibroblasts and osteoblasts surviving and attaching to and around the materials varied considerably depending on the material, with milled acrylic the most biocompatible and similar to titanium alloy, followed by self-curing acrylic and little to no attachment on or around bis-acrylic and composite materials. Milled and self-curing acrylics similarly favored subsequent cellular proliferation and physiological functions such as collagen production in fibroblasts and alkaline phosphatase activity in osteoblasts. Neither fibroblasts nor osteoblasts showed a functional phenotype when cultured with bis-acrylic or composite. By calculating a biocompatibility index for each material, we established that fibroblasts were more resistant to the cytotoxicity induced by most materials in direct contact, however, the osteoblasts were more resistant when the materials were in close proximity. In conclusion, there was a wide variation in the cytotoxicity of implant provisional restoration materials ranging from lethal and tolerant to near inert, and this cytotoxicity may be received differently between the different cell types and depending on their physical interrelationships.