A Novel Method to Fix Paediatric Mandibular Fracture using 2-0 Polyglactin Suture: A Technical Note.

BACKGROUND: Reduction and stabilisation of fractures at the earliest is valuable in the paediatric age groups. This novel technique focuses on stabilisation of the fracture fragments using vicryl, which has an added advantage to conventional plating and wiring. This study aimed on a novel cost-effective technique of stabilising the paediatric mandibular fracture using 2-0 resorbable polyglactin 910 suture with minimal trauma to tooth buds and bone and adequate stability. TECHNIQUE: After raising a full-thickness mucoperiosteal flap, the fracture segments are identified and reduced. 1.6mm drill bit is used to make holes through the buccal cortex on either side of the fractured segment in an anteroposterior direction. The patency of holes is checked by passing a long 26-gauge wire. The proximal end of the wire is bent into a loop, a 2-0 resorbable polyglactin suture (vicryl) is passed through this loop and the loop is pressed in place to lock the suture. The wire with the attached suture is pulled through the distal end. Once the suture is secure in place, the 26G wire is cut, and the two ends of sutures are knotted and stabilised. The mucoperiosteal flap is then closed. CONCLUSION: A novel method of stabilisation of paediatric fracture without hampering the tooth and jaw growth, especially in the financially unstable population. 2-0 polyglactin 910 suture is cost-effective, $2 US, compared to resorbable plates costing about $150 US, and easily available. Polyglactin 910 takes 40-60 days for resorption, and half-life tensile strength is 2 weeks; thus, it gives adequate stability and time for callus formation and does not damage the tooth buds or bone by cutting through them.

Gorlin-Goltz Syndrome - A Concatenation of Six Case Reports.

Rationale: Gorlin-Goltz syndrome (GGS) has a wide range of expressivity, with a majority of cases being first diagnosed from the oral findings. Early intervention can reduce its severity. Patient Concerns: The primary complaints of all the patients were pain and swelling. Clinical examination with radiological and histopathological evaluation confirmed the diagnosis. Diagnosis: This series presents the six cases of GGS treated over a time frame of five years (2018-2022). Treatment: The treatments range from enucleation, chemical cauterisation and peripheral ostectomy to aggressive modalities such as resection and reconstruction. Outcomes: This series comprises of six patients with ages ranging from 12 to 42 years, four of which were female and two were male presenting minimal expression to highly aggressive forms and its unpredictable frequent manifestation. Take-Away Lessons: This emphasises the significance of long-term periodic follow-up and genetic screening for early detection, thereby reducing the intensity and aggressiveness of the disease.

A Clinical Study for Removal of Impacted Mandibular Third Molar under Local Anaesthesia, with and without Ketamine - A Split Mouth Comparative Study.

Introduction: Disimpaction is one of the most common operations done by oral and maxillofacial surgeons around the world. Ketamine is a well-known general anaesthetic and short-acting intraoperative analgesic. The aim of this study was to measure the efficacy of anaesthesia using combined treatment with local anaesthetic plus a subanaesthetic dose of ketamine and local anaesthetic alone in bilaterally impacted mandibular third molar surgery. Methods and Materials: A total of 24 patients who consented were taken up for a split-mouth study. In the control group, surgical extraction of the impacted lower third molar was done using local anaesthesia (lignocaine 2% with 1:80,000 adrenaline) only, and in the study group, local anaesthesia with ketamine extraction was done using ketamine (0.2 mg/kg) along with local anaesthesia (LA). The time of onset and the duration of anaesthesia intraoperatively were recorded using a digital stopwatch. The depth of anaesthesia was noted on the 10th, 30th and 60th min. After extraction, the post-operative pain on the first, fourth, eighth and 12th hour was evaluated using a Visual Analogue Scale (VAS) score rating of 1-10. The pulse was also noted and compared for any differences in either of the groups. Results: A statistically significant (P < 0.005) difference in result was obtained for the onset, duration, depth and pain score after surgical extraction in both the evaluated groups. The pain index score by the ketamine group was significantly low as compared to the local anaesthesia-only group. Intraoperative onset, duration and depth of anaesthesia obtained had a significant difference. Discussion: Ketamine can be used as a viable option for surgical third molar extractions with reduced discomfort and post-operative pain.

Evaluation of Efficacy of Low-Intensity Pulsed Ultrasound on Comorbidities Following Mandibular Impacted Third Molar Surgery: A Prospective Study.

Introduction: Despite several in vitro and in vivo applications of low-intensity pulsed ultrasound (LIPUS), it remains an under-studied feature of the oral and maxillofacial region. The goal of this in vivo study was to objectively investigate the efficacy of low-intensity pulsed ultrasound on wound healing and related morbidities following surgical removal of an impacted third molar. Materials and Methods: The following in vivo prospective, comparative, randomised controlled clinical study was carried out amongst 56 patients who reported to the Department of Oral and Maxillofacial Surgery fulfilling the inclusion criteria. Group A received sham ultrasound, whereas Group B received LIPUS therapy. Based on the group allocated LIPUS 1 MHz, pulsed 20% and dose 1.0 watts/square centimetre (W/cm2)/sham, ultrasound therapy was given on 1st, 2nd and 3rd post-operative days. The assessment of post-operative pain, oedema, trismus and wound healing on preoperative, first, third and seventh postoperative days. Results: The quantitative variables of the study were assessed using independent sample t-test, and qualitative variables were assessed using the Chi-square test. The P < 0.05 on third and seventh post-op days for pain, trismus and wound healing in the LIPUS group compared to control group making it statistically significant. There was no statistically significant difference in the reduction of oedema amongst the two groups. Discussion: Post-LIPUS application in the patients, postoperative pain was significantly reduced, trismus was noticeably improved and wound healing was satisfactory and can be employed as a complementary technique.

A Double Barrier Technique in Surgical Closure of Oroantral Communication.

Routine minor surgical procedures in the maxillary premolar or molar region often heal without any repercussions; however, some may culminate in an unintentional opening into the maxillary sinus, leading to the formation of oroantral communication. It is, therefore, imperative for a surgeon to recognize it and treat it sequentially to avoid long-term complications. This case report highlights a flapless double membrane closure of oroantral communication (OAC) with platelet-rich fibrin (PRF) and guided tissue regeneration (GTR) membranes and its edge over conventional methods.

The Efficacy of Commercially Available Herbal Dentifrices in Comparison with Conventional Dentifrices against Two Common Oral Microbes: An In vitro Study.

BACKGROUND: Mechanical plaque removal is considered the gold standard for controlling and prevention of plaque and gingivitis. The present study was conducted to evaluate the efficacy of commercially available herbal dentifrices in comparison with conventional dentifrices against two of the common oral microbes, namely Streptococcus mutans and Candida albicans. MATERIALS AND METHODS: To determine the antimicrobial properties of individual dentifrices, the zone of inhibition on the blood agar plates was measured and also disc diffusion method was used for testing the antibacterial properties for which a thin paper disc containing the antimicrobial agent was applied on a culture of bacteria grown on agar media. Each dentifrice was tested in 50% concentration (1:1 dilution [50% w/w] using sterile deionized distilled water/half strength) and 100% concentration (full strength). The blood agar plates were then incubated aerobically at 37°C. The measurement of zone of inhibition was done after 24-48 and 72 h on the underside of the Petri dishes using Vernier calipers. RESULTS: At 50% concentration, Regimen B2 showed the maximum zone of inhibition which was closely followed by Regimen A1 for S. mutans, whereas at 100% concentration, Regimen A1 showed better effects. For C. albicans, it was observed that Dabur red toothpaste showed the significantly higher zone of inhibition at 50% concentration when the concentration was made 100% and also Dabur red toothpaste showed the maximum zone of inhibition. CONCLUSION: This concluded that the herbal dentifrices are equally and sometimes better than the conventional ones.

A comparative microbiological study of polyglycolic acid and silk sutures in oral surgical procedures.

BACKGROUND: Bacterial adherence to silk and polyglycolic acid suture is similar. Literature has shown bacterial adhesion is lower degree in polyglycolic acid suture compared to silk, but tissue reaction was more in the polyglycolic acid suture. The aim of the study was to compare the bacteria adhered on the silk and polyglycolic acid sutures. METHODS: Sixty-two patients who fulfilled the inclusion criteria were included in the study and were divided equally into group A and group B. After intraoral surgical procedures the operated site was sutured either with 3-0 black silk or 3-0 polyglycolic acid sutures in group A and B respectively. On seventh day after irrigation with normal saline sutures were removed and one suture strand was transported to the Department of Microbiology to inoculate and identify the bacteria. RESULTS: 3-0 black silk exhibited a high degree of aerobic bacteria. The bacteria identified on the suture were Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus viridians, Enterobacter, Escherichia coli, Citrobacter and Klebsiella. In 3-0 polyglycolic acid suture Pseudomonas aeruginosa, E. coli, Streptococcus viridians bacteria were identified. CONCLUSIONS: PGA showed fewer bacterial adherences compared to black silk. Fewer bacterial adherence and resorbable PGA makes a better choice for intra oral surgical procedures.

Circum-zygomatic suspension wiring using lumbar puncture needle: A technical note.

In the treatment of mid-facial fractures circum-zygomatic suspension wiring is one of the treatment modality. Earlier zygomatic awls were used to pass wire, which used to cause conspicuous trauma. In the present case we have used 16 gauge lumbar puncture needle for the suspension wiring for Lefort 1 fracture, which is inconspicuous as compared to an awl. The needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue, and the wire was twisted around the maxillary arch bar. The fragments were stable and occlusion was maintained. Six weeks post-operatively the bone healing was satisfactory, and the wires and arch bar were removed.