Evaluation of the Efficiency to Remove the Infected Dentin viaEnterococcus faecalis Bacterial Count and to Adequately Shape the Canal Using Hand Kedo-SH Files, Rotary Kedo-SG (Blue) and Pro AF Baby Gold Files in Primary Molars: An In Vitro Study.

Background: Premature loss of primary teeth results in space loss, thus affecting the integrity of the oral tissues. According to the American Academy of Pediatric Dentistry, the treatment for a carious primary molar with pulpal involvement is pulpectomy. The success of this procedure depends on the elimination of bacteria, the most common being Enterococcus faecalis (E. faecalis), by cleaning and shaping the root canals with rotary or hand instrumentation. Aims and objectives: Evaluating and comparing the cleaning efficacy and obturation quality using Kedo-SH hand files and rotary Kedo-SG (blue) and Pro AF Baby Gold files in primary molar teeth. Materials and methods: A total of 51 extracted primary molar teeth were selected and divided into three equal groups. Group I, the control group, was instrumented with Kedo-SH hand files. Groups II and III were instrumented with Kedo-SG (blue) and Pro AF Baby Gold files, respectively. Baseline data and postinstrumentation data were sent for microbiological analysis to check microbial levels of bacteria E. faecalis. Obturation quality was then scored using Barrieshi-Nusair criteria and the T-scoring system by Robia. Results: Associating obturating length between each group, maximum samples in group I showed adequate fill. Relating to density, maximum samples in group III showed no voids present in the obturation. Distribution of the T-scoring system shows maximum samples in group III having all three qualities of ideal obturation. On comparing microbiological analysis among the groups, group I showed higher colony counts of E. faecalis compared to groups II and III. Conclusion: In the present study, rotary instrumentation in the canals showed more consistent results than hand instrumentation. Among the rotary files, Pro AF Baby Gold files show a greater reduction in E. faecalis, with a good obturation quality. Thus, the use of nickel-titanium (Ni-Ti) files is a good option for root canal instrumentation in primary teeth. How to cite this article: Shanker K, Patil SB. Evaluation of the Efficiency to Remove the Infected Dentin viaEnterococcus faecalis Bacterial Count and to Adequately Shape the Canal Using Hand Kedo-SH Files, Rotary Kedo-SG (Blue) and Pro AF Baby Gold Files in Primary Molars: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-2):S142-S148.

Clinical, Radiological and Histological Features and Their Association with Extranodal Extension in Buccoalveolar Complex Squamous Cell Carcinoma.

Jeyashanth RijuObjectives The study was aimed to (1) evaluate the effectiveness of clinical examination, intraoperative finding, and contrast-enhanced computed tomography (CECT) to detect extranodal extension (ENE) in buccoalveolar complex squamous cell carcinoma (BAOSCC), (2) to know various factors influencing ENE, and (3) to evaluate survival outcome in patients with ENE. Materials and Methods This was a retrospective cohort study, which included 137 patients with BAOSCC who underwent curative treatment between May 2019 and April 2021. Collaborative findings suggestive of ENE were noted during preoperative clinical examination, CECT, and intraoperatively, and their efficacy was compared with postoperative histopathology. Also, the various factors associated with ENE were evaluated and compared. Statistical Analysis Univariate and multivariate analysis of parameters was done using multiple logistic regression analysis and significant correlation was determined using chi-square test between ENE positive and negative categories. Analysis of prognosis and survival was done by Kaplan-Meier curve plotting using regression analysis and its significance was compared. Results The overall prevalence of ENE was 18.98% and that of lymph node involvement was 40.88%. CECT (73.1%) was found to be more sensitive in detecting ENE compared to intraoperative examination (46.2%) and clinical examination (34.6%).In comparison with clinical examination (91.9%) or CECT (78.38%), intraoperative examination (93.7%) showed the highest specificity in detecting ENE. Clinical nodal size ≥ 3 cm ( p ≤ 0.001), fixity ( p ≤ 0.001), and clinical number of nodes ( p ≤ 0.001) had significant association with ENE. The presence of thick nodal walls on CECT increased the probability of predicting ENE 15 times ( p = 0.180, confidence interval: 0.3-765.4). After a mean follow-up of 18 months, subjects without nodal positivity had a survival advantage over patients with positive lymph nodes (86.4% vs. 53.3%) and those with ENE (86.4% vs. 23.2%), respectively. Conclusion The results demonstrated that clinical examination can be used as an adjuvant to radiological imaging for prediction of ENE preoperatively. Clinical finding suggesting size of node ≥ 3 cm and ≥ 2 nodes are strong predictor of ENE, in addition to other known predictors. Patients with ENE had an unfavorable prognosis when compared with subjects with metastatic nodes without ENE. Presence of ENE remains one of the strongest factors predicting recurrence and thus poor prognosis.

Worst Pattern of Invasion as an Independent Predictor of Lymph node Metastasis and Prognosis in oral Cavity Squamous cell carcinoma - A Retrospective Cohort Study.

Although Worst pattern of invasion (WPOI) is one of the histopathological (HP) markers that has been utilized in risk stratification of oral squamous cell carcinoma (OSCC) patients, its potential as an independent predictive factor for lymph node metastasis (LNM) and prognosis is least analyzed. Aim of the study is to analyze the relationship of various HP parameters to WPOI, their propensity for lymph node metastasis and prognostic value. This retrospective study included 140 patients diagnosed with resectable OSCC who underwent definitive surgery. Multiparametric HP risk assessment was done on the postoperative specimen and patients were categorized as low-risk WPOI (Type 1-3), and high-risk group (type 4 and 5). After categorization, 36.1% patients had low-risk WPOI and 63.9% had high-risk WPOI. Significant association was noted between WPOI and patient's age (p = 0.001), nodal stage (p = 0.001), lymphovascular invasion (LVI) (p = 0.006) and neural invasion (p = 0.001). 87% patients with nodal metastasis had high risk WPOI. LVI (p = 0.014) and WPOI (p < 0.001) had significant predictive role in LNM. High-risk WPOI and bone involvement were found to be predictive factors for overall survival, and only high risk WPOI had strong correlation with disease free survival having significant poor prognosis. Analyzing WPOI is essential in reporting HP specimens in OSCC. High-risk WPOI can act as an independent predictor for LNM, early recurrence and poor prognosis. Incorporation of WPOI into TNM staging is recommended to improve clinician's ability to prognosticate and individualize treatment strategies.

Analysis of Early Impact of COVID-19 on Presentation and Management of Oral Cancers - an Experience from a Tertiary Care Hospital in South India.

Oral cancers are the leading cause of cancer-related death in Indian men. Currently steps to contain the transmission and treatment of COVID-19 pandemic have crippled the entire health care system. With hospitals running short of resources, the oncological practice became standstill, especially during the initial phase. This is a retrospective study among patients who presented to our tertiary care hospital in early 3 months of COVID-19 era(ECE) with respect to pre-COVID-19 era(PCE). The study includes patients discussed in multidisciplinary tumor board(MDT)(421 in ECE Vs 31 in PCE) and those who underwent surgery(192 in ECE Vs 26 in PCE). The presentation and outcomes of oral carcinoma were compared between the two eras. There was a significant drop in the number of patients who presented during ECE. Though mean age and gender remained comparable between groups, there was a statistical difference in relation to demographic profile of patient (p value < 0.001). Among operated during ECE, 80% had a significantly advanced tumor stage (p value < 0.034) and advanced composite stage (p value < 0.049). Among patients discussed in MDT during ECE, 38.7% were deemed inoperable which is double the number when compared with PCE (p value < 0.009). Results of our study showed a higher incidence of advanced stage disease during ECE, with many patient turning inoperable. Thus, the survival of newly diagnosed oral carcinoma patients will be worser. In the management of oral cancer both early stage and advanced stage should have the same priority. Immediate resumption of safe oncology services is mandatory to curtail the current issues.

Evaluation and comparison between smartphone and photomicrography based whole slide imaging.

CONTEXT: In recent years, a new concept has emerged at the forefront of slide-based diagnosis and telepathology. This is the concept of whole slide imaging. This has very recently also been tried with smartphones using complex software for photo analysis and stitching. This study is aimed to evaluate and compare the use of Jenoptik photomicrograph camera and smartphone camera-based whole slide imaging (WSI) for various microscopic preparations and slides. The study also uses a commonly available IOS smartphone device, a commonly available phone to microscope attachment, and the most commonly used Adobe Photoshop software for all stitching purposes. AIM: To evaluate and compare smartphone and photomicrography-based whole slide imaging. SUBJECTS AND METHODS: The study was conducted at the Department of Oral Pathology and Microbiology in Bapuji Dental College and Hospital, Davangere. The samples included in this study are 10 slides of routine hematoxylin and eosin stain slides and 10 ground section slides of teeth and bone samples. Continuous photographs of the entire slide were captured using an IOS device and a Jenoptik camera attached research microscope at 10× magnification. The photographs were stitched using Adobe Photoshop 2017 software to obtain a whole slide image. Then, two observers analyzed the whole slide image for a possible diagnosis and thus compared the efficiency of both the methods. STATISTICAL ANALYSIS USED: The statistical Chi-square test and analysis of variance (ANOVA) H test were done using Statistical Package for the Social Sciences (SPSS) 2010 Software. RESULTS: Percentage of measure of agreement was 79.5%, 83.7% and 86.3%, 89.1% for the whole slide images taken in the smartphone and photomicrograph and analyzed by Observer 1 and Observer 2, respectively. CONCLUSIONS: In this study, it can be seen that the WSI by research microscopes is better than that with a smartphone and a compound microscope but still both the methods are equally good and can be followed with accurate results.

Desmoplastic ameloblastoma: A case report.

Desmoplastic ameloblastoma (DA) is a rare variant of ameloblastoma, accounting for approximately 4 to 13% of ameloblastomas. It is uncommon, aggressive in nature, and there are high chances of misdiagnosis. Clinical and radiographical features are similar to fibro-osseous lesions of jaw. We reported a case of 35-year-old male patient of DA.

Mixed odontogenic tumour with dentinoid and ghost cells.

Ameloblastomas do not generally show evidence of induction, however, rare cases associated with odontome have been reported and are referred to as odontoameloblastomas. We report an unusual case of an ameloblastoma with features of an adenomatoid odontogenic tumour, showing evidence of induction of dentinoid by tumour cells--but without concomitant formation of enamel--and with features of ghost cells. The lesion occurred on the left side of the maxilla in a 31-year-old woman.

Metastatic small cell carcinoma of the cervix to the oral cavity: A rare case report and an insight into pathogenesis of metastasis.

The oral cavity is an uncommon site for metastatic tumor cell colonization and is usually evidence of a widespread disease, with an incidence of about 1% of all oral cancers. The jawbones, particularly the mandible, are more frequently affected than the oral soft tissues (2:1). Small cell carcinoma (SCC) of the uterine cervix is a rare tumor characterized by a highly aggressive clinical course and poor prognosis. The purpose of this report is two-fold: To present a case of metastatic SCC of the uterine cervix to post extraction site in oral cavity, which is the first reported case in the literature, as per our knowledge and to analyze the possible mechanism of metastasis from the lower part of the abdomen to the post-extraction site and to gain additional knowledge in this phenomenon.

The Solitary Variant of Mandibular Intraosseous Neurofibroma: Report of a Rare Entity.

Neurofibroma (NF) is a benign neoplasm derived from peripheral nerve cells. NF may extend either as a solitary lesion or as part of a generalized syndrome of neurofibromatosis. Intraorally, the intraosseous variant of neurofibroma is a very rare tumor. The literature provides only few cases of solitary intraosseous neurofibroma of the mandible. We report a case of 28-year-old female who was diagnosed with a solitary intraosseous neurofibroma involving the lower left quadrant of the mandible. The present case is rare in regard to its dimensions and its location.

Estimation of age by Kvaal's technique in sample Indian population to establish the need for local Indian-based formulae.

CONTEXT: Age estimation using radiographs by Kvaal and coauthors has shown to be reliable method, possible variation in ethnicity restricts its use in sample Indian population. AIMS: Thus this study was aimed at evaluating the accuracy of age estimation formula of Kvaal and coauthors developed for Norwegian population. MATERIALS AND METHODS: From the subjects (1-100) between the age group 20 and 50 years digitized intraoral periapical (IOPA) radiograph of maxillary central incisors was taken and length and width of the teeth were measured and their ratios were calculated and applied to Kvaal and coauthors formula. The estimated age and chronological age were compared, less accurate results were found in sample Indian population. Modified Kvaal's formula was then developed by using regression analysis of the ratios and to evaluate the accuracy of this formula, the study was repeated using same criteria and methodology on another subjects (101-200). RESULTS: Using Kvaal's formula standard error of estimated age was more in sample Indian population when compared with Norwegian population. Then modified Kvaal's formula was developed and applied to sample Indian population, which showed accurate results. CONCLUSION: This study concludes that formula which was derived from Norwegian population is not applicable to sample Indian population.

Prevalence and characteristics of supernumerary teeth in a non-syndromic South Indian pediatric population.

BACKGROUND: Supernumerary teeth are one of the most widely reported and significant anomaly in patients affecting the primary and early mixed dentition. AIM: To describe the distribution and characteristics of the supernumerary teeth in South Indian population of paediatric patients. DESIGN: In a 12 year retrospective study, a total of 63,569 patients up to the age of 14 years who visited our department between June 2003 and May 2013 were revised.790 cases of supernumerary teeth were found. Patients were evaluated for age, sex, site, status of dentition, number, position, orientation and type of supernumerary teeth. Statistical analysis was carried out using chi square test. RESULTS: 790 subjects with supernumerary teeth (481 males and 309 females) were detected, revealing male-female ratio of 1.55:1.The most common supernumerary teeth were mesiodens (82.28%), the most common site was the anterior maxilla (92.53%)region. Majority of patients had a single erupted supernumerary oriented straight in the arch. Patients in mixed dentition stage reported with maximum number of supernumerary teeth. CONCLUSIONS: The prevalence of supernumerary teeth in non syndromic South Indian paediatric population is 1.24% with slight male predilection and conical mesiodens being the commonest.

A comparative microbiological study to assess caries excavation by conventional rotary method and a chemo-mechanical method.

AIMS: This study was aimed to determine the effectiveness of Papacárie(®) for caries removal as compared to the conventional method with respect to microbial flora, time, the amount of tissue removal, child's behavior, pain perception, and preference of treatment. MATERIALS AND METHODS: Sixty primary molars of 30 children of age 4-9 years were selected randomly and divided into two groups of 30 teeth each: Group A treated by conventional method and group B with Papacárie(®) method. RESULTS: Comparatively, no statistical difference was seen in microbial growth, total bacterial count, and lactobacilli count in both the groups (P = 0.36). The mean cavity entrance size with group A was 0.98133 mm and group B was 0.26083 mm (P < 0.001). The mean preparation time for group A was 4.7 Mins (minutes) and group B was 17.96 min s (P < 0.001). Majority of kids of both group A and B scored 3 (Frankl Behavior Rating Scale) before and after the treatment showing no statistical difference in their behavioral score (P = 1). In group A 50% of children experienced no pain as compared to 86.7% in group B (P = 0.01). There was no statistical difference in the preference of treatment (P = 0.12). CONCLUSION: Thus, the Chemo mechanical caries removal method can be considered as an effective method to control pain and preserve sound tooth structure during caries excavation.

Adenomatoid odontogenic tumor: an uncommon location.

Adenomatoid odontogenic tumor is an uncommon tumor of odontogenic origin. It is usually located in the anterior region of the maxilla associated with impacted canines. The purpose of this paper was to present a case of adenomatoid odontogenic tumor in a 14-year-old girl with unusual clinical manifestations involving an impacted mandibular lateral incisor as well as its treatment follow-up.

Pediatric Dental Trauma:Wide Horizon of Ignored Etiological Factors.

Trauma of the oral and peroral structures are one of the most common and frequent complaints after dental caries with which a child is being referred to a dental clinic. As an emergency, we tend to treat the injuries without understanding or neglecting the cause of trauma. The different possible etiological factors are unnoticed, not revealed or not noted while taking the history of the patient. Sometimes negligence of the etiology by the dentist himself or the accompanying person could influence the prognosis and prevention. Thus, this paper is an effort towards exploring the common yet unnoticed etiological factors of pediatric dental trauma which we tend to knowingly ignore.

Double dens invaginatus in an impacted molariform supernumerary tooth: a unique case.

Dens invaginatus is a relatively rare developmental anomaly affecting usually the permanent maxillary lateral incisor. Various factors have been put forward regarding its pathogenesis. Involvement of crown/root has been reported as the coronal and radicular variety of dens invaginatus. One of the rarest variant is the Double dens invaginatus and only a few cases have been reported in the literature.This article focuses on a case of double dens invaginatus in an impacted maxillary anterior supernumerary tooth, the associated complications and its management.