Minimally traumatic extraction techniques in nonrestorable endodontically treated teeth: A comparative study.

Aim: The goal of this study was to assess the effectiveness of piezotome as compared to periotome extractions of nonrestorable endodontic treatment of teeth in terms of operational time, pain control, and postoperative bone loss considering the prosthetic rehabilitation in future. Materials and Methods: A double-blind, randomized controlled trial was conducted with 100 patients who wanted single-rooted teeth to be extracted (which failed endodontically). The participants have been randomized into two equal groups named as - (i) a periotome group (ii) and a piezotome group. Duration of the surgery, postoperative pain within 7 days, complications (if any) associated with the extraction process were performed as a part of clinical assessment. Bone loss has been analyzed 6 months after the surgery radiographically. The data have been recorded and analyzed using the version 22.0 of the SPSS software package. Results: All parameters in the periotome category (P < 0.05) were statistically significant except for bone loss and gingival laceration in comparison to piezotome group. In the piezotome group, a longer time was observed for surgery and delayed pain control was achieved. In our study, we found statistically significant more marginal bone loss in piezotome group in comparison with periotome group. Conclusion: The findings of this study indicate that for intraoperative and postoperative comfort periotome could be used as a safer and cheaper option for atraumatic extractions but piezosurgery may prove as a better choice soon for surgeries in the maxillofacial region to maintain soft-tissue integrity.

Iontophoresis and topical application of 8% arginine-calcium carbonate to treat dentinal hypersensitivity.

AIM AND OBJECTIVES: The aim and the objectives were. (1) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™), (2) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™) used in combination with iontophoresis, and (3) to compare the effectiveness of the above methods. SUBJECTS AND METHODS: Two groups of 40 patients each having dentinal hypersensitivity were treated using 8% proarginine and iontophoresis. The patients were recalled after 1, 2, and 4 weeks. The scores were tabulated and the results were analyzed using SPSS statistical software. RESULTS: Visual analog scale between the two groups showed a significant difference from the 1st week till the 4th week. ANOVA values showed the reduction in the dentinal hypersensitivity in Group 2 using the iontophoresis along with the 8.0% arginine-calcium carbonate toothpaste. The Cochran-Mantel-Haenszel correlation test of the Schiff's dentinal hypersensitivity cross-tabulation showed P < 0.001 which was statistically significant reduction after the 4th week following the application of 8.0% arginine-calcium carbonate along with iontophoresis. CONCLUSION: Iontophoresis, when used along with Colgate® Sensitive Pro-Relief™ toothpaste, can provide additional benefit as this provides a better sealing effect.

Implant Survival between Endo-osseous Dental Implants in Immediate Loading, Delayed Loading, and Basal Immediate Loading Dental Implants a 3-Year Follow-up.

INTRODUCTION: With introduction of the term "ossteointegration of dental implant" by Branemark, advancement in implantology from 1957 to 2017 has come a long way with modification in implant type and in loading time. This study aims to evaluate the survival of endo-osseous immediate loading (IL) implant and basal IL implants in atrophic jaws with objective to compare implant survival in atrophic jaws for full mouth rehabilitation between endo-osseous IL versus endo-osseous delayed loading (DL) versus basal IL during 3-year follow-up. MATERIALS AND METHODS: Fifty-two (34 endo-osseous and 18 basal) implants were placed in 4 patients requiring full mouth rehabilitation in atrophic jaws. Case 1: Endo-osseous DL implants in upper and lower arch, Case 2: Endo-osseous IL implants in upper and lower arch, Case 3: Basal IL implant in upper and lower arch, and Case 4: Endo-osseous DL in upper arch and basal IL implant in the lower arch. Intraoperative evaluation was done on the basis of pain (visual analog scale [VAS]), operative time, and initial primary implant stability. Postoperative evaluation was done on pain (VAS), infection, radiographically successful implant (orthopantomogram), and patient satisfaction (Grade 0-10). RESULTS: All cases showed satisfactory results but more amount of intra- and post-operative pain was felt with immediate basal implants. CONCLUSION: We believe that clinicians should comply with patient requests, and for this reason, we agree with some authors to use minimally invasive techniques and to avoid when possible esthetic or functional problems associated with the use of removable prosthesis after teeth extractions.

Periotome as an Aid to Atraumatic Extraction: A Comparative Double Blind Randomized Controlled Trial.

AIM: The aim of this study was to evaluate the efficacy of periotomes in single rooted nonsurgical tooth extractions. MATERIALS AND METHODS: A double blind, randomized controlled clinical trial of 100 patients requiring nonsurgical single rooted tooth extractions was performed. The subjects were randomized into the experimental group (underwent extractions with periotome and conventional extraction forceps) or into the control group (subjects underwent extractions using periosteal elevator and conventional extraction forceps). Pain was assessed using visual analogue scale all throughout 7 days postoperatively. Gingival laceration, duration of surgery, number and frequency of analgesics consumed and complications (if present) were also noted. RESULTS: On inter-group comparison, all the parameters were statistically significant in control group (p < 0.05). Also on pre and post-operative inter-group comparison, statistically significant pain reduction was noted in experimental group (52.8 %) whereas pain increased in control group (65 %). CONCLUSION: The results of this study suggest that use of periotome may be helpful in reducing post extraction discomfort.

"Are we similar to caucasians": orthognathic surgery for north indians.

PRIMARY AIM: To establish the cephalometric standards for hard and soft tissues of the facial skeleton for north Indian population. METHODS: The sample comprised of lateral cephalograms taken in natural head position of 100 participants (50 men, 50 women). The cephalograms were traced, analyzed and interpreted using the landmarks and values given by Burstone's analysis for hard tissue and Legan and Burstone analysis for soft tissue respectively. The Student's t test, standard deviation and mean deviation were calculated to compare between the groups. RESULTS: Statistically significant results were found in various parameters between intra and inter group comparison. CONCLUSION: The results obtained in the north Indian population can be used as cephalometric norms for orthognathic surgery.

Posterior superior alveolar nerve blocks: a randomised controlled, double blind trial.

BACKGROUND: Local anesthesia has been a boon for dentistry to allay the most common fear of pain among dental patients. Several techniques to achieve anesthesia for posterior maxillae have been advocated albeit with minor differences. We compared two techniques of posterior superior alveolar nerve block (PSANB), the one claimed to be "most accurate" to the one "most commonly used." AIM: This study was conducted to assess and compare the efficacy as well as complications of "the straight needle technique" to that of "the bent needle technique" for PSANB. PATIENTS AND METHODS: We conducted a prospective, randomised, double blind study on 120 patients divided into two groups, using a 26-gauge, 38 mm long needle with 2 ml of 2 % lignocaine hydrochloride with 1:200,000 adrenaline solution. Objective symptoms were evaluated by a single investigator. Cold test using ice was used to evaluate the status of pulpal anesthesia. Data thus obtained was subjected to statistical analysis. RESULTS: Out of the 120 blocks, 19 blocks failed. Statistical analysis found straight needle technique to be more successful than the bent needle technique (p = 0.002). Both the techniques were equally effective for the first molar region on both right and left side (p = 0.66 on right side and p = 0.20 on left side). However, in the second and third molar region technique A was more effective than B (p = 0.01) on right side only. On Left side, both techniques were equally effective (p = 0.08). Sensitivity of the cold test was 82 % which is quite high but the specificity was 68 % which seems to be falling in the above average range only. Positive predictive value of 75 and negative predictive value of 76 was observed. We did not encounter any complications in this study. CONCLUSION: To the best of our knowledge, this is the first randomised controlled clinical study on PSANB techniques. This study suggests that the PSANB using the straight needle technique as advocated by Malamed [1] can be routinely and safely used to achieve anesthesia in the maxillary molar region and to great efficacy, with normal precautions.

Biomechanics of cranio-maxillofacial trauma.

The forces to the cranium and facial skeleton can be applied from an anteroposterior, superior, inferior and lateral directions. These forces with level and location of point of impact will determine the pattern of injury. Fractures of the cranium rarely extend into the region of facial skeleton. On the other hand, fractures originating in the facial skeleton can extend into the cranium. This has got implications as facial fractures are associated with head injury. Understanding the biomechanics of craniomaxillofacial trauma gives an insight in understanding the pattern of injury. We have briefly reviewed the literature and discussed biomechanics of craniofacial trauma, and how it influences head injury.

Microflora in maxillofacial infections--a changing scenario?

PURPOSE: Advances in isolation and culturing techniques have brought the role of anaerobic bacteria-causing maxillofacial infections to the fore. Recent literature also favors the role of anaerobes in maxillofacial infections. A prospective clinical and microbiological study was designed to check the validity of such claims. PATIENTS AND METHODS: This study included 88 patients who fulfilled the inclusion criteria. Pus was obtained by aspirating the involved spaces and culture and sensitivity tests were performed to determine the microbes involved and their sensitivity to various antibiotics. RESULTS: Upon isolating the various organisms causing infection, it was found that 68.2% were aerobes, 13.6% were mixed infections, and 9.1% were anaerobes. Streptococcus and Peptostreptococcus species were the most common among aerobes and anaerobes, respectively. On determining sensitivity to penicillin, 81.3% were sensitive and 18.8% were resistant. Coagulase-negative Staphylococcus and Staphylococcus aureus were predominantly resistant to penicillin. CONCLUSION: Analysis of the results indicated no change in microflora-causing infections in the maxillofacial region and penicillin remains the drug of choice in treating these infections.

Antibiotic prophylaxis in third molar surgery.

AIMS AND OBJECTIVES: To evaluate the role of prophylactic antibiotics, if any, in the removal of mandibular impacted third molars. PATIENTS AND METHODS: A total of 89 patients were randomly allocated in 3 groups (group 1, placebo; group 2, amoxicillin 1 g orally 1 h before surgery; and group 3, metronidazole 800 mg orally 1 h before surgery). RESULTS: Of the 89 patients, 5 had surgical wound infection (3 [10.33%] in group 1, 2 [6.45%] in group 2, and none [0%] in group 3), leading to an overall infection rate of 5.61%. There was no statistically significant difference found in surgical wound infection between the groups. CONCLUSIONS: Our study failed to show any advantage in the routine use of prophylactic antibiotics because we found no statistically significant difference between the groups.

Prospective analysis of frequency and contributing factors of nerve injuries following third-molar surgery.

The objective of this prospective study was to determine the incidence of injury to the inferior alveolar and lingual nerves following surgical removal of impacted mandibular third molars and to evaluate the various factors contributing to the same. A total of 119 patients underwent mandibular third-molar removal during the period of 11 months. Of 119, 3 inferior alveolar nerve and 5 lingual nerve injuries were encountered. Various factors such as lingual retraction, surgical time, operator experience, radiologic findings contributing to the injury were correlated and analyzed.

Prophylactic antiemetics in oral and maxillofacial surgery: a requiem?

PURPOSE: To determine the incidence of postoperative nausea and vomiting (PONV) after oral and maxillofacial surgical procedures and to evaluate the rationale behind prophylactic antiemetic medications. MATERIALS AND METHODS: A total of 167 patients, irrespective of age and gender, undergoing oral and maxillofacial surgical procedures under general anesthesia/dissociative anesthesia, were included. Risk factors associated with PONV such as gender, type of anesthetic agent used, nature of surgical procedure, surgical approach used, and duration of surgery and postoperative use of opioids were assessed. A "watch and wait" policy was adopted in all cases of recorded PONV with gastric lavage (GL) to be performed in patients with more than 2 episodes of PONV in the 6-hour postoperative period. The efficacy of such an intervention was also assessed. Antiemetic medications were given in only those cases which did not respond favorably to GL. A chi(2) test was performed using SPSS software (Chicago, IL) to determine statistical significance. RESULTS: Of the 167 patients included, 19 patients experienced episodes of PONV. GL was performed in 3 patients, and all showed cessation of emesis after this intervention. No antiemetic medications were administered. A significant association was observed between PONV and female gender, duration of surgery, type of anesthetic agent used, and specific surgical procedures such as oncologic and temporomandibular joint surgeries. The role of surgical approach and the use of opioids in the postoperative period on the incidence of PONV were found to be insignificant. CONCLUSIONS: Information regarding the incidence of PONV after oral and maxillofacial surgical procedures remains scanty. We conclude that there does not appear to be a rationale for the prophylactic administration of antiemetic drugs in such surgical procedures. A watch-and-wait policy and simple GL may provide significant relief. Antiemetic medications are to be considered only in case of non-responders and intractable PONV.

Students' perceptions regarding educational environment in an Indian dental school.

BACKGROUND: As one of India's premier dental schools, the Manipal College of Dental Sciences, Manipal, has striven to be in the forefront of dental education ever since its inception in 1965. But one of our main drawbacks has been the lack of students' perceptions about the educational atmosphere in our institution. AIM: (1) To understand the students' perceptions of the educational environment. (2) To compare the results with those of other dental/medical schools. METHODS: Dundee Ready Education Environment Measure (DREEM) was used to gather information about the environment in our institution. The same was administered to first year and final year students (63 each). RESULTS: The main area of convergence of both groups was that the social atmosphere was not very congenial. But the thought-provoking finding was that both groups felt that the teachers were authoritarian. CONCLUSION: The lack of congenial atmosphere in our institution seems to be due to the attitude of the course organizers.A need for makeover in attitudes and approach on the part of the teachers to make the learning experience more pleasant for the students was made obvious by this study.

The need of postoperative radiographs in maxillofacial fractures--a prospective multicentric study.

There is still debate about the appropriateness of taking postoperative radiographs in the management of maxillofacial fractures. We did a prospective, multicentre study with predefined inclusion and exclusion criteria involving seven centres with a minimum sample size of 50 patients from each (total n=431). A standard data sheet was given to operators to record clinical and radiological variables before and after operation. The information obtained was analysed to evaluate the need for routine postoperative radiographs in the management of maxillofacial fractures. Patients were followed up for one month postoperatively. The parasymphyseal (n=240) was the most commonly encountered fracture site. The orthopantograph was the most commonly used radiograph, being recorded in 421 cases (98%) before, and all 305 cases in which it was recommended after, the operation. Assessment of the reduction after fixation was the most common reason (n=237, 78%)) for advising postoperative radiographs. Intraoperative reduction and immediate postoperative occlusion were better indicators (p=0.02 and 0.01) of reduction, fixation, and clinical outcome than immediate postoperative radiographs. The practice of advising postoperative radiographs routinely should be discouraged as it has no significant role in the management of maxillofacial fractures.

Exodontia and antiplatelet therapy.

PURPOSE: The fear of excessive bleeding often prompts the physician to stop long-term, low-dose antiplatelet therapy before any surgical procedure. This may put the patient at risk of an adverse thromboembolic event. We undertook an assessment of the incidence of prolonged postoperative bleeding after dental extractions among patients on uninterrupted antiplatelet therapy, and evaluated the need to stop such medications before dental extractions. PATIENTS AND METHODS: Eighty-two patients requiring dental extractions were included in this study, of whom 57 were on antiplatelet therapy (aspirin). Patients were divided into 3 groups. Group 1 consisted of patients in whom antiplatelet therapy was interrupted (n = 25), group 2 consisted of those continuing their medication (n = 32), and group 3 comprised healthy patients not on antiplatelet therapy (n = 25). Preoperative bleeding time and clotting time were determined in all patients. The surgical procedure involved single or multiple teeth extractions under local anesthesia with a vasoconstrictor. All patient groups were similar regarding age, gender distribution, dosage of antiplatelet drug, and medical condition for which the drug was prescribed. Events of single or multiple teeth extractions were also comparable among the 3 groups. Pressure packing was performed in all cases as in routine dental extractions. One-way analysis of variance was performed to determine the significance of prolonged bleeding among groups. RESULTS: The mean bleeding times in groups 1, 2, and 3 were 3 minutes, 2 minutes and 45 seconds, and 1 minute and 49 seconds, respectively. The mean clotting times in groups 1, 2, and 3 were 5 minutes and 4 seconds, 4 minutes and 52 seconds, and 3 minutes and 42 seconds, respectively. No patient in any group had any episode of prolonged or significant bleeding from the extraction sites. Local hemostasis had been satisfactorily obtained in all cases with the use of a pressure pack for 30 minutes. CONCLUSIONS: Routine dental extractions can be safely performed in patients on long-term antiplatelet medication, with no interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding.

Diabetes mellitus and odontogenic infections--an exaggerated risk?

INTRODUCTION: The diabetic host is considered to be at an increased risk for the development of odontogenic infections due to his medically compromised state. This perceived risk of higher infections often results in dentists delaying much-needed surgical treatment in this patient population. DISCUSSION: A critical examination of literature does not seem to support the role of diabetes mellitus as a definitive risk factor for odontogenic infections. A simplistic extrapolation of infection rates observed in other sites may not be justified in the orofacial region.

Correlating facial fractures and cranial injuries.

PURPOSE: This study retrospectively evaluated individuals with traumatic injuries from different mechanisms and tried to determine if there is any relationship between various isolated or combined fractures of facial skeleton and cranial injuries. MATERIALS AND METHODS: We retrospectively studied hospital charts of all patients who reported to the trauma center at Kasturba Hospital in Manipal with facial fractures and suspected cranial injuries during a 5-year period (January 1, 1995 to December 31, 1999). These patients were admitted to the Department of Neurosurgery or the Maxillofacial Unit of Kasturba Hospital, Manipal. The complete medical record of each patient was reviewed, recording the following in a standard format: age, gender, cause of injury, type of facial fractures, type of cranial bone fracture, concussion, intracranial injury, cerebrospinal fluid (CSF) rhinorrhea, CSF otorrhea, and the Glasgow coma scale. RESULTS: The study data were collected as part of retrospective analysis. A total of 12,329 patients reported to the trauma center of the study hospital during a 5-year period with various injuries. A total of 772 patients had facial fractures (6%). A total of 108 patients with a combination of cranial injuries and facial fractures were identified within this group (14%). Gender predilection was seen to favor males (90%) more than females (10%). The ratio was seen to be nearly 9:1. The ages of the patients ranged from 7 to 70 years with mean age being 32 years (standard deviation [SD] = +/-12). Central midfacial bone involvement was found to be more commonly associated with head injury. CONCLUSIONS: There is a correlation between midfacial injuries and CNS trauma. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of head injuries associated with facial fractures.

Osteoradionecrosis (ORN) of the mandible: a laser Raman spectroscopic study.

Laser Raman spectroscopy has been used in this study to characterize mandibular bone samples from patients who had undergone radiation therapy for oral cancer. The paper discusses spectral changes resulting in osteoradionecrosis (ORN) of the mandibular bone, a serious complication that may occur after radiation therapy. Histopathological studies normally reveal the radiation damage on vascular canals and loss in bone cells, but will not reveal any structural or biochemical changes. All radiation-induced side effects are attributed to this hypovascularity and hypocellularity caused by early- and/or late-delayed effects. Our Raman studies on normal and ORN bone and on bone exposed to radiation, but not in the ORN state, show that irradiation produces immediate structural changes in the inorganic bone matrix with a slight loss in cells. ORN bone, in addition to the structural changes that had already occurred on radiation exposure, shows almost complete loss of cellular components. Since bone tissue is continuously being remodeled (dissolved and rebuilt) under normal conditions, our results suggest that the immediate structural changes in the calcium hydroxy apatite mineral part is not repaired in ORN, due to loss of the highly transient osteoblasts and osteoclasts resulting from destruction of stem cells. The spectral studies also show changes in the organic matrix, which is mostly type I collagen.