Comparison of Crestal Bone Loss and Osteocalcin Release Kinetics in Immediately and Delayed Loaded Implants: A Randomized Controlled Trial.

PURPOSE: To compare concentration and release kinetics of osteocalcin and crestal bone loss under immediate and delayed loading conditions during osseointegration. MATERIALS AND METHODS: Forty-one patients who were indicated for rehabilitation with dental implants randomly received either implant with placement of permanent prosthesis after 3 months (delayed loading) or implant with placement of permanent prosthesis within 7 days (immediate loading). Radiographic assessment of crestal bone loss at the mesial and distal surface was done at 3, 6, and 12 months after implant placement. Peri-implant sulcular fluid was collected immediately from the buccal surface at two sites after implant insertion and also, at 7, 15, 30, and 90 days after surgery. The level of osteocalcin was evaluated using ELISA and data were compared using two sample t-test. Differences between two groups were analyzed by unpaired Student's t test. Intragroup comparison was done by repeated measures ANOVA. RESULTS: Mean crestal bone loss was lower in the immediate loading group compared to the delayed loading group at 3, 6, and 12 months (p < 0.001). Intragroup comparison revealed a statistically significant increase in osteocalcin levels in both group I (delayed loading) (F = 26712.2) and group II (immediate loading) (F = 10497.2) at the predetermined time intervals. CONCLUSIONS: Less crestal bone loss and early release of osteocalcin was found in the immediately loaded group than in the delayed loaded group. The study substantiates that immediately loaded implants show less crestal bone as well as early release of osteocalcin facilitating upregulation of bone metabolism, improving long term health of bone and prognosis of implants. Immediately loaded implants can be a better treatment protocol provided there is adequate bone and primary stability.

Dental Care in Head and Neck Cancer Patients Undergoing Radiotherapy.

External beam radiotherapy is an integral part of the management of head and neck cancer. Radiotherapy for head and neck cancer lead to many treatment-related toxicities, including a wide range of dental morbidities. These complications depend on the various patient and treatment-related factors. Patients with poor oral hygiene, pre-existing periodontal disease, and the conventional mode of radiotherapy delivery are major factors leading to acute and severe late dental problems. Most of the complications are preventable with proper oral and dental care before, during and after radiotherapy. Pre radiotherapy dental evaluation to diagnose patients with potential risk and timely intervention can reduce long-term morbidities like carries, osteoradionecrosis, etc., thereby improving patients' quality of life. This article highlights the various aspects of dental care and management in head neck cancer patients before, during and after radiation therapy.

Biological and esthetic outcome of immediate dental implant with the adjunct pretreatment of immediate implants with platelet-rich plasma or photofunctionalization: A randomized controlled trial.

Aim: The purpose of the study was to assess biological and esthetic outcomes of immediate dental implant in esthetic zone with the adjunct pretreatment of immediate implants with photofunctionalization or platelet-rich plasma in comparison to standard tapered root form implant without pretreatment. Settings and Design: Patients visiting department of Prosthodontics of a tertiary care health Institution. Design of the study was randomized controlled trial. Materials and Methods: Ninety subjects who required replacement of maxillary anterior teeth immediately after extraction were selected and randomly divided into three groups: control group and two case groups. Two case groups were treated with immediate implants with pretreatment with Photofunctionalization (PF group) or platelet-rich plasma (PRP group). Delayed loading protocol was followed with prosthesis given after 6 months. Follow-up was performed at 2nd and 4th weeks and 2, 4, 6, and 12 months (P < 0.05). Biological outcomes (mean marginal bone loss, implant stability), esthetic outcome (pink esthetic score and white esthetic score), and success and survival rate were evaluated. Statistical Analysis Used: Outcomes were compared using one-way ANOVA, while intragroup changes with baseline and follow up were assesed using repeated-measures ANOVA. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA). The level of significance was set at <.05. Results: Mean marginal bone loss was not significantly different in PF group and PRP group than the control group. PF group and PRP group showed significantly greater implant stability as compared to the control group. Pink and white esthetic scores were not significantly different among groups. Conclusion: Pretreatment of commercial dental implants with PF or PRP exhibited a statistically significant difference in implant stability but not with other outcomes.

An assessment of variation in macular volume and RNFL thickness in myopes using OCT and their significance for early diagnosis of primary open-angle glaucoma.

PURPOSE: An assessment of variation in Macular Volume and RNFL Thickness in myopes using OCT, and their significance for early diagnosis of Primary Open Angle Glaucoma(POAG). MATERIALS AND METHOD: Total of 122 eyes of 61 Indian Myopic subjects of both sex and various age groups underwent retinal nerve fiber layer thickness, macular volume in 6mm analysis by Rtvue Avanti SD-OCT, Optovue Technology V6.1.1,after taking due consent from ethical committee. Subjects were divided into two groups based on their refractive error, Group A <6 D and Group B >6D. The results were evaluated to determine the above mentioned measurements and their variation with myopic refractive error. RESULTS: The RNFL thickness in four Quadrants and an inner circle were taken. The mean thickness in inner circle in both groups were 101.48µm (SD±13.34 µm) and 92.38 µm (SD±11.99µm) respectively, which was statistically significant. The difference was also significant in superior, nasal and inferior quadrant. Statistically the difference was not significant in temporal quadrant. The macular volume was calculated in 6mm diameter. The mean value in Group A was 7.82mm3±0.54 mm 3. The mean value in Group B was 7.44mm3±0.98mm3. The statistical analysis showed the difference between the two groups is statistically significant. CONCLUSION: RNFL thickness is an established way to diagnose open angle glaucoma in preperimetric stage. Macular Volume is also found to be co-related with the risk. Myopes are known to be at higher risk to develop POAG. Hence, measurement of RNFL thickness by OCT should be made a mandatory investigation in High Myopes.

Evaluation of various treatment modalities in sleep bruxism.

STATEMENT OF PROBLEM: Sleep bruxism (SB) is an oral condition that is associated with tooth wear, orofacial pain, and interference with sleep. The most recommended management technique is the use of an occlusal splint. Although the mandibular advancement device (MAD) has shown good results, few well-designed randomized controlled trials are available with which to compare these treatment options. Therefore, an evaluation of the effect of these 2 appliances on SB is needed. PURPOSE: The purpose of this study was to evaluate the effect of a MAD and a maxillary occlusal splint (MOS) on the sleep quality and SB activity of participants with SB. MATERIAL AND METHODS: In this randomized controlled trial, 28 participants were randomly supplied with either a MAD or MOS. The sleep quality of the participants was evaluated with the Pittsburgh Sleep Quality Index (PSQI) and their SB activity with electromyographic activity of the masseter with polysomnography. These variables were measured at baseline, 1 month, and 3 months. RESULTS: Of 32 participants, 28 had data available for statistical analysis, as 4 participants did not return for follow-up examination. Both the MOS and MAD significantly reduced the PSQI and SB episodes and bursts in participants after 3 months (P<.05). The MAD provided greater reduction in SB episodes per hour after 3 months compared to the MOS. Participants supplied with a MAD reported more discomfort in their feedback form than participants using a MOS. CONCLUSIONS: Both the MAD and MOS provided significantly improved sleep quality and a decrease in SB episodes at 3 months.

Morphological Pattern of Cutaneous Adverse Drug Reactions due to Antiepileptic Drugs in Eastern India.

INTRODUCTION: Cutaneous manifestations of adverse drug reactions are a common occurrence and need to be differentiated from other causes of similar manifestations. Antiepileptic drugs (AED) usually are responsible for severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophillia and systemic symptoms (DRESS). There is paucity of published research regarding morphological pattern of CADR due to various antiepileptic drugs AED. OBJECTIVE: To study the morphological patterns of CADR due to AED and common anticonvulsant drugs implicated particularly in severe CADR such as SJS/TEN and DRESS in a tertiary care teaching hospital in eastern India. MATERIALS AND METHODS: A prospective, observational study was conducted over a period of 4 years from August 2009 to July 2013 after the approval of the Institutional Ethics Committee using self-reporting method for selection of cases. SETTINGS: All patients with CADR after AED consumption for various conditions presenting to the Dermatology outpatient department (OPD) and Pediatric OPD and Indoor patients of a tertiary care teaching hospital located in Rohtas district of Bihar were included in this study. RESULTS: During the study period, 64 cases of severe CADRs were included in this study. Out of 64 patients, 28 were male and 36 were female with mean age 36.1 years (range 6 years to 72 years). Most common AED implicated for CADR was Phenytoin. Maculopapular rash was the most common cutaneous manifestation of ADRs (42.85%). Serious CADR like TEN and SSJS were more likely in patients prescribed Phenytoin and Carbemazepine simultaneously. CONCLUSION: CADRs are a common occurrence and awareness about the same is essential for diagnosis and prevention. This study identified combined use of phenytoin and carbamezepine as a most important risk factor for serious CADR like SJS and TEN.

Clinico-immunological profile and their correlation with severity of atopic dermatitis in Eastern Indian children.

OBJECTIVE: To study the clinical features, absolute eosinophil count, and total immunoglobulin E (IgE) level and their association with severity of atopic dermatitis in Eastern Indian children (Bihar). DESIGN: Prospective hospital-based study. SETTINGS: Pediatrics out-patient Department (OPD) and Dermatology OPD of a Tertiary Care Teaching Hospital located in Rohtas District of Bihar. The study was carried out over a period of 2 years during January 2010 to December 2011. PARTICIPANTS: One hundred and thirty two children aged 0 month to 15 years were diagnosed with atopic dermatitis. MAIN OUTCOME: Demographic profile, common clinical features, absolute eosinophil count, and total IgE level and their correlation with severity of atopic dermatitis in Eastern Indian children. RESULTS: Out of a total 1829 pediatric patients aged 0 month to 15 years with some pediatric dermatoses, 132 (7.21%) had atopic dermatitis. Of 132 patients, 57 (43.2%) were boys and 75 (56.8%) were girls, with a male to female ratio 1:1.3. Of these 29 were infants and 103 were children. Two (62.1%) patients belonged to rural area whereas 50 (37.9%) belonged to urban area. Personal history, family history (up to third degree relatives), and both personal and family history of atopy were present in 43.18%, 33.34%, and 12.1% of the subjects respectively. Majority (89.4%) of patients had onset before 5 years of age. In infantile Atopic dermatitis (AD), mean age ± SD at onset was 5.2 months ± 3.01 months. In infantile group, 8 (27.6%) had mild, 14 (48.3%) moderate, and 7 (24.1%) had severe atopic dermatitis. Infantile AD had statistically significant higher SCORing Atopic Dermatitis (SCORAD) index score in all three grades of severity of the disease. One hundred and three patients had childhood AD, out of which 40 (38.8%) were boys and 63 (61.2%) were girls, with a male to female ratio 1:1.57. In childhood AD, mean age ± SD at onset of the disease was 3.47 years ± 3.02 years. Sixty three (61.1%) belonged to rural area whereas 40 (38.9%) were from urban area. One hundred and thirty (98%) patients presented with itching. Ninety two (69.7%) patients had high absolute eosinophils count (AEC) with mean ± SD of 1004.1 ± 596.2 (range 325-2510). Eighty seven (65.9%) patients had increased total serum immunoglobulin E (TsIgE) with mean ± SD value of 1127.11 IU/ml ± 731.69 IU/ml (range: 125-2680 IU/ml). CONCLUSION: Epidemiological data on atopic dermatitis in India are mainly hospital-based, true-point prevalence in community is still scanty. Although the prevalence of AD is considered to be increasing, it still remains low in comparison to developed countries. In Indian children, the disease is relatively milder than children of developed countries. This study identified that both AEC and TsIgE increased significantly in about 66% patient and directly correlated with the severity of the AD.

A simplified technique to fabricate tissue bolus device to manage dose distribution in maxillectomy patient with orbital exenteration.

The primary goal of radiotherapy is to deliver maximum dose to tumor but minimal dose to normal tissues. Irregular surfaces along with cavities sometimes make it difficult to deliver a homogenous radiation dose. Data incorporated in the delivery of prescribed dose are measured from the dosimetric system which are homogenous in nature, hence the exposed medium (i.e. tumor) should posses the same property in constituents and nature. At the inference of two different mediums, such as in case of cavity in the treatment field; there occurs build up and build down effects in dose delivery that may result into hot spot and cold spot. These cold spot may result in recurrences. The aim of this paper is to fabricate a simple, cost effective tissue bolus device, which may be filled with normal saline to reproduce homogenous and regular medium at the time of radiotherapy.

A study to compare the efficacy and safety of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy.

AIMS AND OBJECTIVES: To compare the efficacy, safety, and rate of response of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy. MATERIAL AND METHODS: 100 antenatal cases of gestational age 14-32 weeks were included in this prospective study. Cases were randomly divided into two groups. Group A, having 50 cases received intravenous iron sucrose, and 50 cases in Group B received intramuscular iron sorbitol. Response to therapy in both groups was studied and compared. RESULTS: The mean pretherapy hemoglobin in group A was 6.49 gm/dl and in group B was 6.48 gm/dl. The rise in hemoglobin after 4 weeks of starting therapy was 3.52 gm/dl in group A and 2.33 gm/dl in group B. The difference was statistically significant (P < 0.01). The mean time taken to achieve target hemoglobin (≥11 gm/dl) was 6.37 weeks in group A and 9.04 weeks in group B. In group A, 8 % (four) cases had grade I adverse effects. In group B, 24 % (12) cases had grade I adverse effects. The difference was statistically significant (P = 0.027). In both the groups, no case discontinued the therapy. CONCLUSION: Intravenous iron sucrose is safe, convenient, more effective, and faster acting therapy than intramuscular iron sorbitol therapy for treating moderate to severe anemia during pregnancy.