Stabilizing bony plate in guided endodontic surgery using an innovative approach.

Endodontic microsurgery in tandem with advanced radiographic techniques has led to the emergence of guided surgeries. Preservation of the cortical bone to enhance the healing and stabilization of tissues surrounding the tooth of concern can now be facilitated by bone cement used in the field of orthopedics. This case report details a guided endodontic surgery technique in 17 years old where a traumatic infliction leads to a phoenix abscess. The technique elaborated emphasizes on the three-dimensional printing of a surgical template with the help of cone-beam computed tomography, followed using a medical-grade bone cement in the most minimal manner to reposition the buccal cortical bone. A 12-month-old follow-up revealed the patient to be asymptomatic with a flawless periapical region radiographically. This case testifies that the optimum use of available biomedical material in surgical endodontics can assure a predictable prognosis.

An Illustrative Review of the Pathomechanisms of Symptomatic Developmental Venous Anomalies.

OBJECTIVE: Symptomatic developmental venous anomalies (DVAs) are rare. Here, we illustrate the varied clinicoradiologic profiles of symptomatic DVAs and contemplate the mechanisms that render these (allegedly) benign entities symptomatic supported by a review of literature. METHODS: Institutional databases were searched to identify cases of symptomatic DVAs. Clinical and imaging (angiographic and cross-sectional) data of 9 cases with 11 neurovascular symptoms consequent to inflow/outflow perturbations and mechanical obstruction that manifested because of the strategic topography of underlying DVAs were analyzed. A review of the existing literature on DVAs in agreement with our case series was performed on publications retrieved from the PubMed database. RESULTS: Symptoms secondary to venous hypertension arising from flow-related perturbations were broadly divided into those arising from restricted outflow and increased inflow. Restricted outflow occurred because of collector vein stenosis (n = 2) and collector vein/DVA thrombosis (n = 3), whereas the latter pathomechanism was initiated by arterialized/transitional DVAs (n = 2). A mechanical/obstructive pathomechanism culminating in moderate supratentorial ventriculomegaly was noted in 1 case. One patient was given a diagnosis of hemorrhage associated with a cavernoma. CONCLUSIONS: Awareness and contextualization of potential flow-related perturbations and mechanical insults that render DVAs symptomatic aid in accurate diagnosis, management, and prognostication.

Endodontic management of an aberrant germinated composite odontome: A case report.

To describe the endodontic treatment of a germinated composite odontome with atypical internal anatomy. A 35-year-old male presented with pain in the left mandibular second molar region. Intraoral examination and Cone-Beam Computed Tomography (CBCT) revealed a rare case of a germinated composite odontome with a 3-2-1 Vertucci configuration in the mesial root. Occlusal morphology and mesial root configuration required modifications in methods of isolation and access cavity preparation. Contemporary tools like magnification, ultrasonics and controlled memory rotary files were essential for executing the treatment plan. The tooth was functional at 18 months follow up and radiographs revealed no abnormality.

SARS-CoV-2 infection induces epigenetic changes in the LTR69 subfamily of endogenous retroviruses.

Accumulating evidence suggests that endogenous retroviruses (ERVs) play an important role in the host response to infection and the development of disease. By analyzing ChIP-sequencing data sets, we show that SARS-CoV-2 infection induces H3K27 acetylation of several loci within the LTR69 subfamily of ERVs. Using functional assays, we identified one SARS-CoV-2-activated LTR69 locus, termed Dup69, which exhibits regulatory activity and is responsive to the transcription factors IRF3 and p65/RELA. LTR69_Dup69 is located about 500 bp upstream of a long non-coding RNA gene (ENSG00000289418) and within the PTPRN2 gene encoding a diabetes-associated autoantigen. Both ENSG00000289418 and PTPRN2 showed a significant increase in expression upon SARS-CoV-2 infection. Thus, our study sheds light on the interplay of exogenous with endogenous viruses and helps to understand how ERVs regulate gene expression during infection.

Utility of 3D T1-weighted turbo spin echo black blood sequence for the diagnosis of cerebral venous thrombosis.

PURPOSE: Accurate assessment of dural sinus, deep and cortical venous thrombosis on MR imaging is challenging. The aim of this study is to evaluate the accuracy of 3D-T1 turbo spin echo (T1S), sequences in detecting venous thrombosis and comparing it with susceptibility-weighted imaging (SWI), magnetic resonance venography (MRV) and post contrast T1 magnetization-prepared rapid acquisition gradient echo (T1C). METHODS: A blinded retrospective observational analysis of 71 consecutive patients evaluated for cerebral venous thrombosis (CVT) and 30 control patients was performed. Multimodality reference standard adopted included T1C, SWI with MRV. Sub-analyses in superficial, deep and cortical venous segments were performed in addition to correlation of signal intensity of thrombus with the clinical stage. RESULTS: A total of 2222 segments in 101 complete MRI examinations were evaluated. Sensitivity/specificity/positive predictive value/negative predictive value/accuracy and precision of T1S for detection of cortical vein thrombosis was 0.994/1/1/0.967/0.995/1, 1/0.874/0.949/1/0.963/0.950 for detection of superficial venous sinus thrombosis and 1/1/1/1/1/1 for deep venous thrombosis. The AUC yield for T1S was 0.997 for cortical, 1 for deep and 0.988 for superficial venous segments. CONCLUSION: T1S paralleled the accuracy of conventional sequences in the overall detection of CVT but showed superior accuracy in the detection of cortical venous thrombosis. It makes a fitting addition to the CVT MRI protocol in scenarios demanding negation of gadolinium administration.

Evaluation of volumetric substance loss and precision in targeted endodontic re-treatment with guided versus conventional access cavity preparations: An in vitro study.

Introduction: Root canal retreatment is typically viewed as an "all or nothing" approach. Whether there is periapical pathosis or not, it is advised that all restorative and obturation materials be removed from all roots. Selective root retreatment, a new therapeutic strategy, allows retreatment to be restricted to a single root or multiple roots exhibiting periapical pathosis. To address the issues, "guided endodontics," a unique guided technique for the preparation of apically extended access cavities, was introduced. Materials and Methods: In this in vitro experimental study, 22 freshly extracted two-rooted maxillary first premolars were selected and divided into two groups (n = 11). Pretreatment cone-beam computed tomography imaging of all teeth was performed. Root canal treatment was performed for all samples followed by postendodontic composite restorations with the occlusal stamp technique. Then targeted endodontic retreatment (TER) was done with the conventional method and guided method respectively. The tooth substance loss was measured and evaluated using Ez3D-i-3D-software (VATECH) and work precision was determined by calculating the dentinal loss. Statistical data analysis was done by Independent t-test for substance loss measurement and Chi-square test was used to measure the dentinal loss. Results: TER with conventional method showed significantly higher substance loss with t = 4.591 (P < 0.05) and significantly higher dentinal loss measured in conventional method (P < 0.05). Conclusion: In comparison to traditional TER, TER using a customized bur and three dimensions (3D)-guide results in much less substance loss. The dentinal loss was much lower in 3D-guided approach.

Cyclic and spontaneous movement of a fractured and extruded instrument back into the root canal: A rare case report.

Retreatment of endodontically involved teeth may require the removal of obstruction from root canal space. Instrument fracture is an undesirable and stressful incident which can negatively affect the prognosis of the tooth. Any corrective step taken should be performed with utmost care to prevent extrusion of the fragment into periapex. This case report describes a rare occurrence of movement of a fractured instrument during inter-appointment period. A previously treated left mandibular first molar with a fractured instrument was taken up for retreatment. During the course of treatment, the fractured fragment which was previously located in the apical third of the distal canal was dislodged into the periapical region. However, it was found that fragment moved back inside the canal after the inter-appointment period. The same sequence of events repeated before the instrument could be retrieved. Hydrostatic and vascular pressure build due to periapical inflammation could be cited reasons for such a movement.

Internal root resorption: A rare complication of vital pulp therapy using platelet-rich fibrin.

Internal root resorption (IRR) is a specific type of pulp disease categorized by the loss of dentin as a consequence of the action of clastic cells stimulated by pulpal inflammation. It is one of the rare complications following a vital pulp therapy (VPT) procedure. Reported here is a case of IRR as a complication of VPT platelet-rich fibrin pulpotomy procedure in a mature permanent tooth. Diagnosed using cone-beam computed tomography and management of the resorptive defect using biodentin with a follow-up of 1 year.

Single-shot generation of composite optical vortex beams using hybrid binary fork gratings.

We design and experimentally demonstrate a simple, single-shot method for the generation of arbitrary composite vortex (CV) beams using hybrid binary fork gratings (hBFG). These gratings were computationally generated by removing the central region around the fork-dislocation of azimuthal charge ℓ1 and substituting it with a BFG of a different charge ℓ2. The geometrical parameters of hBFGs were optimized for the efficient generation of CV beams. The method was further extended to the generation of CV beams consisting of three different ℓ and of higher radial charges p. This simple generation method may be useful to generate complex beam shapes with engineered phase fronts without complicated interferometry based techniques.

Comparative evaluation of novel customized cushees during rubber dam isolation using self-designed evaluation criteria: A randomized clinical study.

BACKGROUND: Rubber dam plays essential role in dentistry and various modifications have been done to improve patients acceptance and to eliminate the discomfort caused due to clamps. AIM: Clinical evaluation of efficacy and postoperative outcome of metal clamps with customized cushions and standard metal clamps during rubber dam isolation procedures. MATERIALS AND METHODS: After institutional ethical approval and informed consent total 64 patients were randomly assigned in two groups. Group A - rubber dam metal clamp with customized cushees (n = 32), Group B - rubber dam with standard metal clamp (n = 32). After selection of appropriate clamp for Group A, Customized cushions were prepared and restoration was performed. The evaluation was done using self-designed assessment criteria which included postoperative pain, rubber dam slippage, trauma to gingival and adjacent tissues and sealing ability of both the groups. STATISTICAL ANALYSIS USED: Chi-square value was calculated with SPSS software version 18.0. RESULTS: There was statistically significant difference between postoperative pain, rubber dam slippage, trauma to gingival tissues (P < 0.001) with reduced postoperative pain. CONCLUSION: Cushions have played significant role in reducing postoperative pain, trauma to the gingival tissue and slippage of rubber dam clamp compared to standard metal clamps.

Ultrasound-guided autologous blood injection in patients with chronic recurrent temporomandibular joint dislocation.

OBJECTIVE: To evaluate the accuracy and effectiveness of ultrasound (US) guided autologous blood injection (ABI) for the treatment of chronic recurrent TMJ dislocation. DESIGN: Prospective cohort study. SETTING: Centre for medical education and research. PARTICIPANTS OR ANIMALS SPECIMENS CADAVERS: Ninteen patients with chronic recurrent TMJ dislocation (Fifteen bilateral and fourteen unilateral). INTERVENTIONS: Autologous blood injected, 2ml in superior joint space (SJS) and 1 ml in peri-capsular tissue (PT) under ultra sound guidance. MAIN OUTCOME MEASURES: Reduction in number of dislocation episodes, maximal mouth opening, pain (visual analogue scale) and TMJ sounds (present or absent) at the end of 2 weeks, 3 months, 6 months and 1 year. RESULTS: At 2 weeks post operatively 18 patients (95%) were asymptomatic only one patient (5%) complained of Recurrence of dislocation and was treated successfully by a 2nd injection. At subsequent follow up visits none reported dislocation. CONCLUSIONS: US guided ABI for patients with chronic recurrent TMJ dislocations serves as an alternative, minimally invasive, highly effective and accurate modality of treatment since it includes exposure without radiation, real-time visualization of soft tissues, visualization of the needle tip advancement, local anesthetic spread relevant to the surrounding structures which can be performed on an outpatient basis.

Three-dimensional printing: A revealing pathway to an unpredictable maze.

Three-dimensional (3D) technology has gained wide acceptance in dentistry. It has been used for treatment planning and surgical guidance. This case report presented a novel treatment approach to remove and preserve the cortical bone and root-end resection during periapical surgery with the help of cone-beam computed tomography (CBCT), computer-aided design, and 3D printing technology. A 22-year-old male patient presented with a large periapical lesion in the right maxillary central and lateral incisors was referred for endodontic surgery. The data acquired from a preoperative diagnostic CBCT scan and an intraoral scan were uploaded into surgical planning software and matched. A template that could be used to locate root ends and lesion areas was virtually designed based on the data and was fabricated using a 3D printer. With the guidance of the template, the overlying cortical bone was precisely removed and preserved, and apicectomy was performed. The patient was clinically asymptomatic at a 6-month follow-up review. Six months after the surgery, the lesion was healing well, and no periapical radiolucency was observed on radiographic examination. The digitally designed directional template worked in all aspects to facilitate the periapical surgery as anticipated. The root ends were accurately located and resected. The surgical procedure was simplified, and the treatment efficiency was improved. This technique minimized the damage and reduced iatrogenic injury.

A 5 years' follow-up of root anatomy-based maturogenesis achieved in infected immature molars using regenerative techniques - A case series.

Infected immature molars are commonly encountered but seldom are they treated using principles of regenerative endodontics. The case series describes a feasible technique for attempting maturogenesis based on molar tooth anatomy. A total of 9 infected immature molars in the patients between 6 and 18 years of age were treated as part of this case series. All the canals were disinfected using 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid following minimal instrumentation. After using triple antibiotic paste for 3 weeks, bleeding was induced in mesial or constricted canals and platelet-rich fibrin was placed in distal or open wide canals till the orifice level. Coronal seal was obtained using mineral trioxide aggregate. Outcome was evaluated clinically and radiographically at the periods of 3, 6, 12, 24, 36, and 60 months. All the teeth showed continued root development and maintained functionality but none responded to vitality testing. Anatomical aspects of individual roots within a tooth can be utilized as a guide to decide the appropriate approach for attempting maturogenesis in a molar. Root changes can be expected even if the pulp vitality is not restored.

Radiographical and histological evaluation of bioactive synthetic bone graft putty in sinus floor augmentation: A pre- and post-intervention study.

OBJECTIVE: The main objective is to evaluate the quantity and quality of bone formed after use of bioactive synthetic bone graft putty in sinus augmentation and to radiographically and histologically evaluate increase in alveolar bone height in augmented sinus. MATERIALS AND METHODS: It is a pre- and post-intervention study of 15 patients (present at both baseline and at 6 months) with 80% power and 95% confidence level. RESULTS: The mean increase in alveolar bone height is 7.08 ± 1.42 mm ranging from 5.6 mm to 10.7 mm. It is evident from the data that there has been increase in alveolar bone height postbone graft augmentation. P < 0.001 shows that increase in alveolar bone height is highly significant as compared to preoperative bone height. The mean postoperative density is 525.43 ± 104.18 hounsfield unit ranging from 649 HU to 350 HU. This is also a D3 quality bone as per Misch classification. The mean difference in alveolar bone density is 104 ± 125.16 HU. P = 0.0053 shows that increase in alveolar bone density is significant as compared to preoperative bone density. CONCLUSION: Bioactive synthetic bone graft putty yields sufficient quantity of mineralized tissue for implant placement in patients with 2-6 mm of alveolar bone height before grafting. Histologically, it has shown that it has good osteoconductive properties and good quality of bone is formed within 6 months of its augmentation.

Piezoelectric harvest of osteo-odonto-lamina in modified osteo-odonto keratoprosthesis: A maxillofacial perspective.

PURPOSE: We describe the piezo-osteotomy feasibility in rehabilitation and harvesting of osteo-odonto lamina in modified osteo-odonto keratoprosthesis (MOOKP) surgery. Surgery was evaluated regarding operative technique and success of the keratoprosthesis (KPros) in terms of perception to light (+ve) to finger counting (+ve). MATERIALS AND METHODS: This retrospective cohort study included 12 patients undergone MOOKP surgery procedures. Harvesting of osteo-odonto-lamina was performed using piezosurgical osteotomy during 2007-2012. RESULTS: The mean follow up was 34 months (range 24-48 months). Of the 12 patients six patients had vision ≥6/12, four patients had vision <6/12, but >6/60 and one patients had vision ≤6/60. KPros was retained and functional in all the eyes after a minimum follow up of 24 months. There was mucosal overgrowth over the optical cylinder occurred in two cases over 4 years follow up which was corrected with trimming. Postoperative complication at donor site was seen in three cases, two cases with exposure of root of adjacent teeth and oro antral fistula in one. CONCLUSIONS: This study suggests that piezoelectric harvest of osteo-odonto-lamina is a valuable surgical option in patients undergoing MOOKP surgery, resulting in high success rate with less complication.

Ultrasound-Guided Taylor's Approach in Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine which leads to ossification and formation of a classical bamboo spine. This poses a challenge to the anesthetist both in terms of administering general and regional anesthesia due to the limited mobility of the spine. With the advent of ultrasound as an aid in regional anesthesia, it has been relatively easy to perform a central neuraxial blockade in such patients though the skill requires some degree of expertise. Here, we have described the use of ultrasound as a guide for administering regional anesthesia to a patient with AS after initially attempting a blind approach which had failed due to difficult anatomy.