Outcome of novel pulp capping modalities after full pulpotomy in teeth diagnosed with irreversible pulpitis: A prospective randomized clinical trial.

Objective: The study aimed to compare and evaluate the effect of biodentine (BD) alone, BD along with Lyophilised freeze dried platelet rich concentrate (LPC + BD), and BD along with low-level laser therapy (BD + LLLT) after pulpotomy in mature permanent molars with irreversible pulpitis. Materials and Methods: The study was designed as a randomized, pragmatic, parallel, double-blinded clinical trial registered under the Clinical Trial Registry-India (CTRI/2020/02/023245). 120 permanent molars fulfilling the inclusion and exclusion criteria with symptoms of irreversible pulpitis were randomized after performing pulpotomy into three pulp capping groups: Group 1, BD; Group 2, lyophilized freeze-dried platelet-rich concentrate + BD (LPC + BD); and Group 3, Low level laser therapy + BD Group 3, LLLT + BD. The intergroup comparison was done using one-way analysis of variance followed by the Bonferroni test. The level of significance and confidence interval were 5% and 95%, respectively. Interobserver reliability was measured using Cohen's kappa analysis. Results: At 1 week, there was a significant difference (P < 0.005) observed in the mean postoperative pain levels between the three groups with Group 1 (BD) exhibiting the highest postoperative pain followed by Group 2 (LPC + BD) and least pain was exhibited by Group 3 (LLLT + BD). A similar pattern was observed regarding the analgesic intake with maximum frequency in Group 1 (BD) and least with Group 3 (LLLT + BD). No significant difference in success rates was reported among the groups. Conclusion: Pulpotomy as a treatment option for mandibular molars with irreversible pulpitis has an acceptable clinical success rate; however, long-term overall success rate remains questionable. The outcomes of incorporating adjunctive modalities with BD are remarkable and show tremendous potential for continued development and research.

Mandibular Teeth as Predictors in Forensic Age Estimation: A Cone-Beam Computed Tomography-Based Pulp Volume Regression Study.

Background: Age estimation is integral to science of forensic odontology and plays an important role in human identification. Pulp volume estimation using cone-beam computed tomography (CBCT) to derive age can be very useful as it is noninvasive and can be applied on individuals of all ages. Aims and Objectives: The study aimed to estimate the chronological age-based pulp and tooth volume (PTV) ratios in adults from Uttar Pradesh, India, using CBCT and voxel counting dental software. Materials and Methods: Thirty-six CBCT scans were allocated into three Groups, I, II, and III (12 in each group) randomly to study the pulp volume of lateral incisor, canine, and first premolar, respectively. PTV was calculated by image segmentation method using Xelis Dental software. A correlation between chronological age with PTV was established using derived regression equations. Statistical Analysis: All the data were subjected to statistical analysis using Statistical Package for Social Sciences version 16.0. Results: Estimated age and standard error were determined. Standard errors of estimates were 11.24 years (LI), 7.78 years (C), 9.89 years (PM) group, lowest being for canines. The estimated age was compared with the chronological age. The difference between the chronological age and the estimated age by the derived equation for the present study was statistically nonsignificant (P = 1.00). Conclusions: The results of the study show the feasibility of calculation of PTV ratios on CBCT to estimate the age for the set population with canine as the best predictor of age for the present study population.

3-D assessment of skeletal and dentoalveolar bilateral dimensions in unilateral impacted palatal canine cases - A CBCT study.

Background: The aim of this study was to compare skeletal and dentoalveolar dimensions in subjects with maxillary unilateral impacted palatal canines versus the unaffected contralateral side using CBCT. Material and Methods: Skeletal and dentoalveolar variables (Anterior alveolar ridge height, Anterior dentoalveolar height , nasal cavity width, basal nasal width, Lateral angulation of long axis of the incisors and canines with respect to the nasal horizontal plane, premolar to median raphe width, dimensions of lateral incisor and canine, root resorption of lateral incisors, crown-root angulation of lateral incisor, and sector classification of canine) were compared between the impacted and the contralateral sides. As the data had normal distribution, means were compared using students t test. The significance was set at p<0.05. The root resorption in lateral incisor was compared using Chi square test. Results: Lateral angulation of long axis of canines, nasal cavity width, basal lateral width, and premolar to median raphe width were found to be significantly different. Maximum number fell in sector 4 (n = 23, 38.3%) in sector classification. Root resorption of lateral incisor on impacted side was insignificant. Conclusions: Skeletal and dento-alveolar dimensions vary between the impacted and non-impacted sides in unilateral palatal canine impaction cases. Canines on the impacted side were more mesially angulated compared to the non-impacted side. The nasal cavity width, basal lateral width and premolar to median raphe width were significantly less on the impacted side compared to the non- impacted side. Key words:Impacted canine, CBCT, skeletal dimensions, diagnosis, orthodontic treatment.

Questionable accuracy of CBCT in determining bone density: A comparative CBCT-CT in vitro study.

BACKGROUND: The accuracy of the estimation of radiological bone density with the use of the cone-beam computed tomography (CBCT) grayscale is still questionable. Standardization and correlation with the gold standard computed tomography (CT) Hounsfield units (HU) is required prior to clinical application. OBJECTIVES: The objective of the present study was to evaluate the reliability of the grayscale for the estimation of bone density, using samples with intact soft tissue in order to substantiate the clinical use of the scale. MATERIAL AND METHODS: A total of 240 sites in 20 goat heads were scanned to obtain radiological bone mineral density via Hounsfield units in CT and the grayscale in CBCT. The anatomical architecture of soft tissues was preserved for all samples. Two observers obtained the data, which consisted of 3 variables (mean, minimum and maximum) for both scales. The statistical analysis of the data was conducted using Cronbach's alpha, Pearson's correlation coefficients, the independent samples t tests, and regression analysis. RESULTS: Differences in the means of the mean, minimum and maximum values between the 2 scales were statistically highly significant (p = 0.000). The correlation coefficients for the mean, minimum and maximum values of the 2 scales were 0.496, 0.037 and 0.396, respectively. Regression analysis revealed that the R2 values for the mean, minimum and maximum values were 29.79%, 21.05% and 19.45%, respectively. CONCLUSIONS: The positive but weak correlation between the 2 scales and the low predictive reliability of the grayscale reveals its questionable applicability for the estimation of density in comparison with the standard HU.

Occult prostate carcinoma with metastasis to the mandible presenting as numb chin syndrome.

Prostate cancer is one of the leading causes of death due to malignancy in men. Occult malignancy presenting with no primary symptoms could be a challenge to the diagnostician. Metastasis of prostate carcinoma to the mandible is rare and usually presents with non-specific symptoms. Only 1% of oral cancers account for lesions which present as metastasis of other primary malignancies. We report a rare case of prostate carcinoma being diagnosed as metastasis to the mandible with the patient presenting with numb chin syndrome.

Association of temporomandibular joint morphology in patients with and without temporomandibular joint dysfunction: A cone-beam computed tomography based study.

BACKGROUND: The etiology of temporomandibular disorders (TMDs) is complex and associated with multiple predisposing and initiating factors. Articular eminence morphology and steep eminence inclination have been postulated as the etiological factors, but there has been no clear evidence of association of morphology of the temporomandibular joints (TMJ) complex as a probable predisposing factor in the pathogenesis of TMDs. MATERIALS AND METHODS: This was a cross-sectional, case-control study, and cone-beam computed tomography scans, and the evaluation was performed for 60 joints in 30 patients with symptomatic TMDs and for 40 healthy joints of 20 age-matched patients. One-way ANOVA, post hoc, unpaired t-test, Chi-square, and intra-class correlation coefficient test were used to determine the correlation between the TMJ articular eminence inclination, height, condylar bone changes, condyle, and fossa shapes with symptomatic TMDs. The P < 0.05 were considered statistically significant. RESULTS: There was a statistically significant difference of articular eminence inclination and height with a steeper eminence inclination in the control group (P = 0.044*, and 0.035*). The condylar bone changes were found to be significantly more in the TMJ disorder group (P = 0.001*). There was no significant association of condyle and fossa shapes (P = 0.482 and 0.689) and of articular eminence inclination and height with condylar bone changes (P = 0.695, 0.498, 0.192, and 0.823) and condyle shapes (P = 0.389, 0.521, 0.260, and 0.387). The eminence inclination was not associated with fossa shapes (P = 0.471 and 0.086), but eminence height was associated with fossa shapes in the TMJ disorder group (P = 0.043* and 0.111). CONCLUSION: The results depicted that there was no significant association between TMJ complex anatomy and TMJ disorders in the present study population.

A Clinical Study on Comparative Evaluation of the Effectiveness of Carbamazepine and Combination of Carbamazepine with Baclofen or Capsaicin in the Management of Trigeminal Neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Various medicinal and surgical procedures have been utilized for the treatment of TN. Over the time, several drugs other than carbamazepine have been used but none of them have shown satisfying results. OBJECTIVE: The objective of the study is to evaluate the effectiveness of carbamazepine and combination of carbamazepine with baclofen or capsaicin in the management of TN. MATERIALS AND METHODS: A total of 45 patients diagnosed with TN were randomly divided into three groups. The patients were prescribed carbamazepine in Group 1, carbamazepine and baclofen in Group 2, and carbamazepine and capsaicin in Group 3. All the patients were followed on the 7th day, 15th day, and 1-month period to evaluate the response to the drugs. Data were subjected to statistics. RESULTS: The results are composed of a total of 45 patients (15 in each group). The mean visual analogue scale scores were calculated for each group at day 0, 7th day, 15th day, and 30 days, and it was found that there was statistically significant reduction of pain (P < 0.001) in all the three groups at different intervals. At day 7, comparative percentage reduction of pain in both groups was not statistically significant. At 15-days and 30 days, percentage change in pain reduction in Group 1 was 42.3% and 48.0% respectively and in Group 2 it was found to be 60.3% and 83.4%, respectively. The reduction in pain percentage was found to be statistically significant. Similarly, Group 1 was compared to Group 3, significant reduction of pain was found for carbamazepine-capsaicin combination at 30-day interval but the comparative reduction of pain at 7th day and 15th day was not statistically significant. CONCLUSION: Carbamazepine in combination with baclofen is more efficient and effective in reducing pain in TN patients, followed by carbamazepine-capsaicin combination compared to carbamazepine alone.