The efficacy of Punica granatum extract gel in the treatment of symptomatic oral lichen planus in an Indian population: A clinical study.

INTRODUCTION: The autoimmune disorder, oral lichen planus (OLP), primarily affects oral mucous membranes. Current drug treatments are only palliative and have serious side effects. Pomegranate has been used as a potential herbal remedy for the treatment of OLP. MATERIALS AND METHODS: The study consisted of a sample size of 30 individuals who were diagnosed with symptomatic OLP based on both clinical and histological evidence and were equally assigned to Group A (4% topical Punica granatum seed extract gel, which has been customized for this particular study purpose only) and Group B (0.1% topical steroid). All patients were evaluated for the outcome criteria of pain, burning sensation, and lesion size. RESULTS: In the present study, results were highly statistically significant (P = 0.001) in intragroup observation for both Group A and Group B from baseline to the end of 30 days of follow-up for all three parameters. There was no statistically significant difference between groups for each week of follow-up. CONCLUSION: P. granatum has been used in very few studies, but this is one of the few where a gel made from P. granatum seed extract is used as an oral gel. In conclusion, it can be said that topical P. granatum extract gel is as good as topical corticosteroids at getting rid of the signs and symptoms of OLP, so it can be used as an alternative treatment.

Anatomical Variants of Condylar Process, Coronoid Process, and Sigmoid Notch in a Maharashtrian Population: A Radiographic Study.

Background The cornerstone of an individual's singularity is identification. Digital orthopantomography (OPG) helps to illustrate the varying condylar process, coronoid processes, and sigmoid notch found within a population to facilitate individual recognition. This study aims to assess the various shapes of the condylar process, coronoid process, and sigmoid notch found using OPG in a sample population of an Indian city. Methodology This retrospective, cross-sectional study was conducted using 1,000 good-quality digital OPG scans to evaluate the different shapes. The scans were evaluated by two experienced oral radiologists and tabulated for statistical analysis. Results The current investigation revealed varied morphological forms of the three entities, with the round shape being the most frequently observed condylar process, coronoid process, and sigmoid notch. Comparisons across sides and between sexes revealed differences in all three variables which were found to be statistically significant. We discovered a crooked finger condyle (58.56% on the left side and 41.44% on the right side), a beak-shaped coronoid process (50.0% on the left side and 50.0% on the right side), and a V-shaped sigmoid notch (41.35% on the left side and 58.65% on the right side) in this study. This is a unique finding not reported by other studies. Conclusions Analyzing the shape of the condylar process, coronoid process, and sigmoid notch found on an OPG scan can help with gender identification in forensic odontology and anthropology as these anatomical features show strong sexual dimorphism.

Mandibular Ramus: An Indicator for Gender Determination.

Background The goal of this study is to use digital orthopantomographs (OPGs) to find out the role the mandibular ramus plays in figuring out a person's gender. Methodology Six hundred digital OPGs of patients, aged 21 to 50 years of either gender, fulfilling the exclusion and inclusion criteria, were randomly selected from the department archives exclusively for this digital retrospective study. All the scans were anonymized before the analysis. A total of seven measurements (in mm) were performed on OPGs, namely, minimum and maximum widths of the ramus, minimum and maximum condylar heights, maximum height of the ramus and coronoid, gonial angle bilaterally, and bigonial width. The data obtained was statistically analyzed using IBM SPSS Statistics for Windows, Version 21.0. (IBM Corp., Armonk, NY, USA), by a stepwise discriminant functional analysis for gender determination. Results Linear measurements, including maximum and minimum widths of the ramus, maximum height of the condyle, height of the ramus, and coronoid and bigonial width, revealed more values in males than in females. However, the gonial angle showed higher average values in females than in males. Moreover, all seven parameters showed statistically insignificant age-related changes. Conclusions The mandibular ramus showed high sexual dimorphism, and its analysis on OPG can be a valuable aid in the determination of gender in the fields of forensic odontology and anthropology.

Prevalence of Anterior Loop and other Patterns of Mental Nerve in a Sample Population of an Indian City: A Retrospective Study.

Introduction: The final portion of the inferior alveolar nerve (IAN), the mental nerve (MN), is a general somatic afferent nerve that provides sensation to the lip, chin, and gingival tissue. Three patterns of MN have been observed - straight, perpendicular or vertical, and anterior loop (AL) of MN. The interforaminal region of the mandible possesses a MN with a path that creates an AL before entering the mental foramina. The aim of the study is to evaluate the presence of AL of MN using cone-beam computed tomography (CBCT) and to measure the length of the AL of MN, if present, also to evaluate the prevalence of other anatomical patterns of MN - straight and vertical patterns. Materials and Methods: Mandible CBCT of 400 patients with the age of 20 years onward was included in the study. The images obtained were assessed for the different patterns of MN - straight, vertical, and ALs. The statistical analysis was done using the Chi-square test, paired t-test, and sample t-test. Results: Out of 400 CBCT scans comprising 800 hemimandibles, straight pattern was observed in 67.1%, vertical pattern in 26%, and Anterior Loop in 6.9%. The prevalence of AL pattern was 6.9%. AL length was found to be in a range of 2.4-6.6 mm. Discussion: Surgical trauma or injury to the AL of MN is possible during implant surgery in the interforaminal area of the mandible if AL is not assessed preoperatively.

Odontogenic Keratocyst with Diverse Variations: A Rare Case Report.

Rationale: An odontogenic keratocyst (OKC) is a developmental odontogenic cyst lined by squamous epithelium having intrinsic growth potential. Hence, metaplastic changes such as the formation of mucous cells, ciliated cells, and hyaline bodies with ortho/para keratinisation have been known to create unusual histopathological variations. Patient Concerns: A 34-year-old male patient reported with swelling on the lower right side of the face and numbness on the overlying skin. Diagnosis: Based upon the histopathological findings, a final diagnosis of glandular odontogenic cyst with OKC was confirmed presenting mixed features of basal layer palisading squamous epithelium with goblet cells and satellite cysts appeared to be entrapped in the connective tissue wall. Treatment: Surgical enucleation of the cyst was done. Outcomes: No recurrence was reported in 1 year of follow-up. Take-away Lessons: Diverse variations appear within odontogenic cysts and tumours. The high recurrence rate and aggressive nature of the cyst, divulges appropriate treatment and long-term follow-up.

Intraoral plasmablastic lymphoma as a primary oral manifestation: A case report and review of literature.

Plasmablastic lymphoma (PBL) is an aggressive type of large B-cell lymphoma as stated in the WHO classification of 2008. It is a rare form of non-Hodgkin's lymphoma, generally seen in human immunodeficiency virus (HIV)-acquired immunodeficiency syndrome affected individuals. A case of a 42-year-old female patient is presented here. The patient complained of swelling in the lower right back tooth region and presented with a history of extraction of molars. The underlying HIV status was detected after the oral examination. The diagnosis of PBL was confirmed with immunohistochemical analysis.

Assessment of efficacy of ultrasonography in cervical lymphadenopathy in oral malignancies.

AIMS AND OBJECTIVES: To substantiate the use of ultrasonography in diagnosis of cervical lymphadenopathy in oral malignancies and to assess if ultrasonographic examination done prior to lymph node (LN) biopsy can yield important information regarding the diagnosis. MATERIALS AND METHODS: Twenty subjects with histopathologically confirmed oral malignant lesions with clinically palpable and untreated cervical LNs included into study. These patients were subjected to clinical examination (number of LNs, shape, size, location, overlying temperature, overlying skin, tenderness, consistency, and fixity to the underlying structures), and ultrasonographic evaluation (number of LNs, shape, size (mm), location, borders, matting, peripheral halo, hilum, calcification, necrosis, reticulation, and echogenicity) of the LNs, and finally, histological assessment was done after surgical excision during the course of treatment. RESULTS: Predominantly male (65%) patients were having with malignant LN involvement with age group of 60-69 years, i.e., 35%. Ultrasonogram is superior to clinical examination as it detected additional 49 nodes. Malignant nodes tend to have longest axial diameter (17 mm with standard deviation of 8.7 mm). Over all 52 malignant nodes were round, whereas 35 nodes were oval in shape. Most of the nodes were detected in submandibular region. Around 61 (70.9%) nodes had sharp borders and 26 (29.9%) had smooth borders. Loss of echogenic hilus is a common feature of malignancy showing 70% sensitivity and 67% specificity. Most of malignant nodes were hypoechoic. Around 51 (58.6%) of nodes showed intranodal necrosis, whereas it was absent in 36 (41.4%) nodes. Matting and edema were present 25 (28.7%) nodes. Intranodal calcification was present in 37 nodes. Sensitivity of USG was 90%, whereas specificity was 100%. CONCLUSION: Ultrasonographic examination of cervical LNs can yield important information regarding the diagnosis. Ultrasound examination should be done prior to FNAC and ideally an ultrasound-guided FNAC.

Correlation of ultrasonographic measurements, histopathological grading, and clinical staging in oral submucous fibrosis.

AIMS AND OBJECTIVES: To evaluate the presence and thickness of submucosal fibrosis in oral submucous fibrosis (OSMF) patients ultrasonographically and to correlate these findings with the clinical stage and histological grade of OSMF. MATERIALS AND METHODS: Forty participants (twenty cases and twenty controls) were included in the study. The patients diagnosed clinically as having OSMF and consented for biopsy were included in the cases, and completely healthy individuals with no habit history or oral lesions were included in the control group after matching the body mass index. After clinically staging, the patients' transcutaneous ultrasonography (USG) was performed and after that punch biopsy was taken and the specimen was graded histopathologically. RESULTS: The data were statistically analyzed using Mann-Whitney test and Spearman's rank correlation. The cases showed increased submucosal thickness as compared to the controls. The USG measurements statistically correlated with the clinical stage and histopathological grade of OSMF. CONCLUSION: USG proves to be a valuable adjunctive modality in diagnosing, staging and also evaluating the prognosis of OSMF.

Age estimation in Indian adults by the coronal pulp cavity index.

BACKGROUND: Age estimation from tooth coronal index (TCI) using intraoral periapical radiographs by paralleling technique based on a reduction in the size of the dental pulp cavity with advancing age as a result of secondary dentin deposition. AIM AND OBJECTIVES: The aim of this study is to estimate age for Indian adults using radiographs of mandibular first molar and second premolar teeth using coronal pulp cavity index. MATERIALS AND METHODS: The study material consists of 400 intraoral periapical radiographs of mandibular second premolar and mandibular first molar from enrolled participants of either gender in the age group of 20-60 years. STATISTICAL ANALYSIS: Data analysis was done using SPSS (Statistical Package for Social Sciences), and Pearson's correlation coefficient (r) was used to find the correlation between age (years) and TCI. RESULTS: TCI was computed for each tooth and regressed on the real age of the sample. The correlation coefficient "r" was -0.865 (for premolar combined sample) and -0.850 (for molar combined sample). The obtained equations were tested on test sample of fifty teeth and age was determined. The absolute mean error between actual and predicted age for premolars was 6.72 months and for molars, it was 9 months. CONCLUSION: Age estimation using TCI is a precise, noninvasive, less time-consuming, and an inexpensive method.

Evaluation of Osseointegration in Implants using Digital Orthopantomogram and Cone Beam Computed Tomography.

INTRODUCTION: Accurate assessment of osseointegration in dental implants requires precise radiographic visualization of pathologic conditions as well as anatomical structures. The present study aimed to evaluate the formation of bony tissue (osseointegration) using digital orthopantomogram (OPG) and cone beam computed tomography (CBCT) immediately after implant insertion (within 7 days) and 3 months postinsertion. MATERIALS AND METHODS: Twenty single-implant sites on mandi-bular posterior regions were selected on patients irrespective of their gender. Both digital OPG and CBCT were done within a week and again after 3 months of implant insertion surgery, using the same exposure parameters. RESULTS: Three of the 20 implants were submerged and were excluded as the crestal bone height could not be measured. The participants were recalled for radiographic measurements after 3 months of implant placement. On an average, there was 0.03 mm of osseointegration at the apical portion after 3 months of implant insertion on digital OPG; 0.04 mm of osseointegration at the crestal bone height after 3 months on digital OPG; and 0.01 mm of osseointegration at the apical portion after 3 months on CBCT. No change or ≤0.02 mm of osseointegration at crestal bone height after 3 months on CBCT. CONCLUSION: Both digital OPG and CBCT are significant for the assessment of osseointegration in implants, and hence, endow definite benefit for accurate assessment in terms of the success of the implant placement. CLINICAL SIGNIFICANCE: However, CBCT is a better mode of evaluating dental implants but one should keep in mind that radiographic examination must be conducted to the benefit of the patient by application of the lowest achievable dose.

Evaluation of the Position of Mental Foramen for Clinical and Forensic Significance in terms of Gender in Dentate Subjects by Digital Panoramic Radiographs.

INTRODUCTION: Evaluation of the position of mental foramen aids in forensic, surgical, endodontic, as well as diagnostic procedures. Thus, in view of this, the present study was conducted among the population of Pune, a central part of India, to determine the most regular location of the mental foramen and to estimate difference in position of mental foramen based on gender. MATERIALS AND METHODS: The present retrospective study was commenced on 200 digital panoramic radiographs of dentate patients. The location of the representation of the mental foramen was traced. Measurements for evaluating distance of superior and inferior borders of the foramen in relation to the lower border of the mandible were made using the reference lines drawn from anatomical landmarks. The data so obtained were statistically analyzed using chi-square test. RESULTS: The most common position of mental foramen among Pune population in horizontal plane in both male and female patients was in line with second premolar followed by position in between first and second premolar, whereas in the vertical plane, most common position was at or in line with apex of second premolar followed by in between apex of first and second premolar. The variation in length of superior and inferior border of the foramen in relation to lower border of the mandible with respect to gender was found to be significant, with p-value <0.05. CONCLUSION: There was no difference in position of mental foramen in horizontal and vertical planes based on gender. CLINICAL SIGNIFICANCE: The stability of location of mental foramen and significant difference in length of superior and inferior border of the foramen in relation to lower border of the mandible with respect to gender offer its application in forensic identification of gender.

Effectiveness of Aloe Vera and Antioxidant along with Physiotherapy in the Management of Oral Submucous Fibrosis.

BACKGROUND: Oral submucous fibrosis (OSMF) is a well-established precancerous condition affecting the oral mucosa. It is a disease that causes significant morbidity (in terms of loss of mouth function as tissues become rigid and mouth opening becomes difficult) and mortality (when transformation into squamous cell carcinoma occurs). AIM: The aim of the study is to compare the efficacy of Aloe vera with antioxidant when given along with physiotherapy in the management of OSMF. MATERIALS AND METHODS: Forty patients presenting with clinical signs and symptoms of OSMF were included for the study after informed consent. Group A included 20 patients who received Aloe vera gel (forever living gel) along with physiotherapy. Group B included 20 patients who received antioxidant capsules twice daily for 3 months along with physiotherapy exercises four times in a day. The following parameters, that is, burning sensation, mouth opening, tongue protrusion and cheek flexibility were recorded at each visit. RESULTS: Majority of the participant enrolled were in the age range of 30 to 35 years. Improvement in all the parameters was seen with the individuals receiving Aloe vera gel in comparison to antioxidants. CONCLUSION: So, Aloe vera being a soothing, simple and safe mode of treatment along with proper habit restriction can be considered to be an effectual protocol in the management of OSMF. The analgesic effects of Aloe vera with the physiotherapy exercises provide better results in reducing burning sensation and improving mouth opening, tongue protrusion and cheek flexibility in comparison to antioxidants.

An Atypical Presentation of Multiple Central Osteomas Mimicking Craniofacial Fibrous Dysplasia - A Pictorial Essay.

Osteoma is benign neoplasm with slow growth characterized by deposition of compact lamellar cortical or cancellous bone creating a tumour mass. It is still unclear whether osteomas are benign neoplasms or hamartomas. They have typical clinical presentations and are easily diagnosed with the help of radiographs. We present a rare case of non-syndromic multiple osteomas in the craniofacial region which are typically restricted to the midline and presents radiographically as craniofacial fibrous dysplasia causing a diagnostic dilemma.

Bilateral Calcifying Cystic Odontogenic Tumour of Mandible: A Rare Case Report and Review of Literature.

Calcifying cystic odontogenic tumour (CCOT) is a relatively rare lesion of oral and maxillofacial region and forms only 2% of all odontogenic tumours. It was previously known as Calcifying odontogenic cyst and only recently has been classified as a tumour by WHO. The controversy regarding its origin can be owed to its diverse clinical and histopathological presentation and variation in reported malignant potential. It was first reported by Gorlin in 1962 and since then conundrum regarding its true nature has persisted. It is seen in association with other lesions like odontoma, ameloblastoma and ameloblastic fibroma. Both intra-osseous and extra-osseous forms of CCOT have been reported. It commnoly occurs in anterior region with equal preponderance in maxilla and mandible. Here we present a rare case of bilateral CCOT in the posterior mandible of a 16-year-old male patient which was discovered incidentally during a radiographic examination.

Detection of Acid Fast Bacilli in Saliva using Papanicolaou Stain Induced Fluorescence Method Versus Fluorochrome Staining: An Evaluative Study.

BACKGROUND: Fifty years after effective chemotherapy, tuberculosis (TB) still remains leading infectious cause of adult mortality. The aim of present study was to evaluate diagnostic utility of papanicolaou (Pap) stain induced fluorescence microscopic examination of salivary smears in the diagnosis of pulmonary TB. MATERIALS AND METHODS: Cross-sectional study of 100 individuals clinically suspected of suffering from active pulmonary TB. Control group - 50 individuals are suffering from any pulmonary disease other than TB such as pneumonia or bronchiogenic carcinoma. Fluorescence microscopic examination of two salivary smears stained by Pap stain and auramine-rhodamine (A-R) stain respectively for each patient. Ziehl-Neelsen stained sputum smear examined under the light microscope for each patient. Culture was done in all the patients for microbiological confirmation. McNemar's Chi-square analysis, Kappa test, and Z-test. RESULTS: The sensitivities of the three staining methods using culture as a reference method were 93.02%, 88.37% and 87.20% for Pap, A-R and Ziehl-Neelson respectively. CONCLUSION: Pap-induced fluorescence of salivary smears is a safe, reliable and rapid method, which can prove as a valuable diagnostic tool for diagnosis of TB.

Verrucous hemangioma of the oral cavity: A rare diagnostic dilemma.

Verrucous hemangioma (VH) is an uncommon, congenital, vascular malformation that involves dermis and subcutaneous connective tissue of skin. VH lesions are initially present at birth, and therefore, the diagnosis in the elderly may be difficult. Review of literature reveals that VH lesions are commonly located unilaterally on the lower extremities. VH may clinically present as keratotic, papular, nodular, or plaque-like lesions that are reddish-blue in color. VH does not resolve spontaneously and has a tendency to relapse. The diagnosis of VH is generally done on the basis of histopathology. Early diagnosis is important to get a better cosmetic result. VH requires a large, deep excision to avoid recurrence because of frequent extension into subcutaneous fat planes. Intra-oral lesions of VH have rarely been reported in the literature. We present an extremely rare case of VH occurring in the retromolar triangle area of oral cavity.

Intra-oral malignant melanoma--a case report and review of the literature.

Malignant melanomas represent one of the most life-threatening forms of cancer. Arising from melanocyte precursors, they have the ability to invade or readily metastasise to any organ. Intra-oral melanomas represent 1-2% of all oral malignancies, and 0.2-8% of all melanomas. Prognoses and eight-year survival rates for intra-oral malignant melanomas are poorer than for cutaneous malignant melanomas (20% and 60% survival, respectively) because of: the absence of symptoms in the early stage of the disease delaying diagnosis; difficulty in determining the width of the radical surgical excision due to anatomic limitations; and the rich blood supply to the region, which may facilitate haematogenic propagation. We report a case of a 65-year-old man with malignant melanoma of the anterior maxillary gingiva. Considering the poor prognosis associated with oral melanomas, it also emphasises the fact that suspicious pigmented lesions should be surgically removed and investigated further.