Comparative Analysis of Peak Air Pressure and Oxygen Flow between Conventional and Modified Endotracheal Tube for Retromolar Intubation (PUNTUBE)- An In Vitro Study.

Introduction: In conventional practice for retromolar intubation, endotracheal tube (ET) is bent. This leads to compression of the inner diameter of the tube which in turn reduces airflow. Furthermore, conventionally ETs are stabilised in position using inflated tracheal cuff. Elastic sticky tapes around the exit pose hindrance for surgical procedures on the face. Surgical manipulation and maxillomandibular fixation may lead to compression, damage or accidental extubation of ET. We have developed a modified ET dedicated to retromolar intubation with innovative means for tube stabilisation to solve these problems. Materials and Methods: To study the efficacy of the tube, a comparative in vitro study was done on mannequins. Null hypothesis of no change in air pressure and oxygen concentration in bent conventional ET versus modified ET was formulated. Comparison was done on the basis of the peak air pressure (PEP) and oxygen concentration, which was checked using air-gas monitor. Results: The mean PEP was found to be 24.29 psi with standard deviation (SD) of 9.54 in sequentially bent conventional tube. This was found to be only 10.35 psi with SD of 3.22 in modified ET. Oxygen delivery was found to be 3.96 L/min in bent conventional tube, which was 5.22 L/min in modified tube. Both the findings were statistically significant. Discussion: Modified retromolar tube (PUNTUBE) has been found to be efficient in maintaining low PEP while delivering more oxygen as compared to bent conventional tube. Novel mode of tube stabilisation in the form of PUNSTAB is an easy and effective way of tube stabilisation.

A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars.

INTRODUCTION: Dexmedetomidine is a selective alpha-2 adrenoceptor agonist. It is conventionally used as a sedative in the intensive care unit. However, recently, the application of dexmedetomidine as an adjuvant to a local anesthetic agent has been studied. The present study intends to evaluate the effectiveness of dexmedetomidine as an adjuvant to 2% plain lignocaine for surgical removal of impacted mandibular third molar and to compare the efficacy of dexmedetomidine with 2% plain lignocaine with 2% lignocaine and 1:200000 adrenaline. MATERIALS AND METHODS: A total of 80 patients who required surgical removal of impacted mandibular third molar extraction were included in the study. Patients were randomly divided into two groups using a computer-generated table. Patients in the study group received 2% plain lignocaine with 1 mcg/ml dexmedetomidine. Patients in the control group received 2% lignocaine with 1:200000 adrenaline. The parameters evaluated were onset and duration of action, pulse rate, blood pressure, oxygen saturation, and blood loss. RESULTS: Onset of action was faster and the duration of action was longer when dexmedetomidine was used with lignocaine as a local anesthetic agent. The vital parameters in both the groups were stable. Bleeding at the surgical site was less in the dexmedetomidine group. CONCLUSION: The study concluded that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine when injected for nerve blocks.

Cementum Malformations-Diagnostic Dilemma: Study in Western Maharashtra Population.

AIM: The present study was study to observe incidence of cemental malformations related to mandibular molar roots. MATERIALS AND METHODS: All cases requiring radiographs of mandibular molars reporting to author during 2011-2019 were included in this study. Mandibular molars had been observed for any radiographic malformations. Any such alterations were noted. RESULTS: Author has screened about 522 intraoral periapical radiographs in this study. A total of 63 cases of root malformations reported with two cases of cementoma were observed in this study. Both these cases were diagnosed as benign cementoblastoma (BC) on excisional biopsy. CONCLUSION: In this study, we have observed that incidence of cemental malformations is 1.2% and of BC is 0.38% as compared to overall incidence of 1%-6% in Western Maharashtra.

Stress Distribution in Cortical Bone around the Basal Implant - A Finite Element Analysis.

AIM: The aim of the study was to develop a model that represents a basal implant with stress distribution in the cortical bone on application of loads emulating masticatory forces. MATERIALS AND METHODS: In this study, the stress distribution in the bone and the implant is evaluated by applying various loads that emulate the masticatory forces. The geometric models of cortical bone representing the premolar area and a basal implant model of the following specifications, longitudinal oval threaded pin (1.95 mm × 2.1/2.3 mm ø), height of the implant head (7.2 mm), and width of the implant head (3.5 mm) (BOI BS, IDHEDENTAL), were generated with Ansys software, and both the implant model and the bone model are superimposed to mimic the bone implant system as a unit. RESULTS: Overall comparison of stress distribution on both implant shaft and implant neck showed that maximum stresses are located at implant neck irrespective of forces applied and minimum stresses are located at implant shaft. On overall comparison of stresses seen within the bone and the implant, it was observed that the maximum stresses were seen in the implant neck followed by the implant shaft followed by the bone interface. CONCLUSION: The present study concluded that the stress transmission is greatest during application of oblique load (70 N) followed by horizontal load (10 N) and the least by vertical load (35 N).

Central ossifying fibroma of mandible.

Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.

Extraction socket preservation using a collagen plug combined with platelet-rich plasma (PRP): A comparative clinico-radiographic study.

Background. Alveolar bone remodeling after tooth loss results in reduced ridge dimensions in horizontal and vertical planes. To prevent this, various authors have proposed different ridge preservation techniques. A collagen plug is a novel material that has shown promising results in preserving the alveolar bone. PRP has also yielded favorable outcomes in wound healing and promoted osteoinduction and osteoconduction Methods. Thirty patients of both sexes with an age range of 30-18 years requiring bilateral extraction of teeth with similar tooth root anatomy in the maxilla or mandible were included in the study. The extraction of teeth was carried out atraumatically. The patients' arches were randomly divided and labeled as the test or control sides. Bone width was measured on both sides. A collagen plug, with PRP, was placed, and the extraction socket was sutured on the test side. The control side was just sutured. A baseline RVG was taken to record the apico-coronal height. The patients were recalled after 10 days for suture removal and evaluation of wound healing. Parameters were re-evaluated at three and six months postoperatively. The data were subjected to t-test and one-way ANOVA. Results. The height of the crestal bone on the grafted side was more when compared to the non-grafted side three and six months after tooth extractions, and the difference was statically significant (P<0.001). No statistically significant difference was seen in the width of the alveolar bone three and six months after tooth extraction (P>0.05). Conclusion. Collagen and PRP provided reasonable socket preservation as simple and inexpensive options as compared to other materials.

Craniofacial Fibrous Dysplasia of Zygomaticomaxillary Complex.

Fibrous dysplasia is a benign bone disease first described by Lichtenstein in 1938. It is characterized by progressive replacement of normal bone with fibro-osseous connective tissue. When the disease involves craniofacial skeleton, it results in significant disfigurement and other functional problems. This paper reports a case of large craniofacial fibrous dysplasia involving zygomaticomaxillary complex in a 24-year old male patient. Clinical presentation and imaging characteristics of the pathology is discussed in detail. The disease caused significant facial asymmetry which was satisfactorily managed by surgical recontouring.

Noninvasive Technique for Estimating Blood Glucose Levels among Diabetic Patients.

AIM: The present study was aimed to assess the fasting and postprandial gingival crevicular blood (GCB) glucose and finger stick blood glucose measurements using a glucometer. MATERIALS AND METHODS: A total of 30 subjects with periodontitis and positive bleeding on probing were considered. Subjects were instructed to report to the department after overnight fasting. Gingival crevicular blood samples were collected from anterior region showing bleeding on probing followed by finger stick blood sample collection. Then, the patients were instructed to take 75 gm of glucose and after 2 hours blood samples from two sites were collected similarly. Results were analyzed using unpaired t test and Pearson's correlation. RESULTS: Mean glucose levels form GCB and finger stick blood did not differ either during fasting or postprandial (p > 0.05). Significant correlation was found between GCB glucose levels and capillary finger stick blood (CFB) glucose levels during fasting (r = 0.946, p < 0.001) and postprandial (r=0.930, p < 0.001) blood estimation. CONCLUSION: Periodontal probing can be considered as an alternate noninvasive method of blood glucose estimation for screening of diabetes mellitus (DM). The technique described is safe, easy to perform, and helps to increase the frequency of diabetes screening in dental office. CLINICAL SIGNIFICANCE: The GCB from probing can be a good source of blood for estimating blood glucose levels and screening for diabetes using portable glucose monitors. Also, it will be a simple and relatively inexpensive in office screening procedure for any patient suspected to have diabetes.

Exposed Dental Implant? Local Autograft A Saviour!

Implant exposure due to faulty placement, posses as the most common reason for implant failure. The implant placed too close to buccal or lingual cortex have lead to such failure on numerous occasions. Also, anatomic variations like the thin buccolingual width of alveolar ridge predispose exposure of the implant. 25-year-old female patient had undergone surgical placement of implants in mandibular anterior region 2 months back in the private dental clinic. The clinician noted Grade I mobility in one of the implants placed. The case was referred to the author. Thin overlying gingiva depicted an entire buccal aspect of the implant, which suggested more than 90 % loss of buccal cortex. According to literature and review of similar case reports, the only way suggested was to surgically remove the implant and wait for 12-24 months for the bone to heal for subsequent placement. Rather than the removal of implants as suggested, the author followed a naval approach of reinforcing buccal cortex using an autogenous cortical block from mandibular symphysis. The reinforcement surgery had certainly saved patients time, money and most importantly limits a crucial period of edentulism, which may be enforced on a patient in case the implant was removed.

Management of Biomedical Waste: An Exploratory Study.

BACKGROUND: Dental operatories pose a threat due to the high chances of infection transmission both to the clinician and the patients. Hence, management of dental waste becomes utmost importance not only for the health benefit of the dentist himself, but also people who can come into contact with these wastes directly or indirectly. The present study was conducted to find out the management of biomedical waste in private dental practice among 3 districts of Karnataka. MATERIALS AND METHODS: The study population included 186 private practitioners in 3 districts of Karnataka (Coorg, Mysore, Hassan), South India. A pre-tested self-administered questionnaire was distributed to assess the knowledge and practices regarding dental waste management. Descriptive statistics was used to summarize the results. RESULTS: Out of 186 study subjects, 71 (38%) were females and 115 (62%) were males. The maximum number of participants belonged to the age group of 28-33 years (29%). Undergraduate qualification was more (70%). 90 (48%) participants had an experience of 0-5 years. Chi-square analysis showed a highly significant association between participant who attended continuing dental education (CDE) program and their practice of dental waste management. CONCLUSION: Education with regards to waste management will help in enhancing practices regarding the same. In order to fill this vacuum CDE programs have to be conducted in pursuance to maintain health of the community.

Botulinum toxin for the treatment of hyperfunctional lines of the forehead.

BACKGROUND: In the 21(st) century, we live longer and a more active life. However, while our adult longevity continues to extend, society does not welcome a tired and aged appearance. We wish to continue to look as young as possible. Most facial rejuvenation techniques such as surgery and injection of collagen, silicone, or autogenous fat do not address the fact that these lines are functional, i.e. they do not target the cause of hyperfunctional lines: the underlying facial mimetic musculature. AIM: To find the efficacy of Botulinum toxin for the treatment of hyperfunctional lines of the forehead. MATERIALS AND METHODS: The present study consisted of 25 subjects in the age group of 25-65 years with forehead wrinkles, who visited the Department of Oral and Maxillofacial Surgery, CIDS, Virajpet. The materials used for Botulinum toxin treatment were Botulinum toxin A, a standard freezer, sterile saline solution, alcohol swabs, and insulin syringes with 30 gauge needles. RESULTS: Of the 25 patients, 21 patients showed satisfactory improvement of their hyperfunctional facial lines within 72 h. Maximum improvement was noted in the age group of 25-40 years, while the older age group of 50-65 years showed less improvement. Maximum improvement was seen in type 5 skin, followed by type 4 and type 3 skin. Type 2 skin showed the least improvement. CONCLUSION: We conclude that Botulinum toxin A is a safe and efficacious method of nonsurgically eliminating hyperfunctional facial lines of the forehead in the aesthetic patient for a period of 4-6 months.

Unusual presentation of 'u-shaped' impacted maxillary central incisor with intranasal root: successful surgical management.

BACKGROUND: Dilacerations is a tooth deformity characterized by an angulation between crown and root causing non-eruption of the tooth. It generally occurs following trauma to the deciduous dentition apices of which lie close to the permanent tooth buds. According to Neville, maxillary and mandibular incisors contribute only approximately to 1% of the incidence of dilacerated teeth. CASE DETAILS: A 15 year old male patient reported with chief complaint of missing anterior teeth in the left side of maxillary arch. Radiographic evaluation showed impacted maxillary left central incisor. The radiograph depicted very unusual extreme curve in the root of the same tooth giving it characteristic U-morphology. The root of this tooth was curving into the nasal cavity. Due to extreme curve, surgical removal was suggested by orthodontist. Surgically removing this highly placed tooth with apex into nasal cavity was a surgical challenge. This was done effectively by removing the tooth under local anesthesia itself. CONCLUSION: U-shaped morphology in single rooted tooth is observed very rarely. This root curvature predisposes to fracture of root during surgical removal. Proper surgical protocol is to be followed during surgical removal of a tooth with such extreme root curvature to prevent fracture of the root and accidental displacement of the tooth into nasal cavity.

Comprehensive Survey to Study Awareness, Knowledge and Attitude Towards HIV/AIDS and Hepatitis B Amongst Dental Professionals Working in Rural India.

INTRODUCTION: Thirty years into the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic, social and behavioral research on HIV/AIDS remains limited. Data on sexual behavior and AIDS-related knowledge and attitudes are sparse and difficult to compare. The present survey aims primarily towards acquiring unique source of information from health professionals in rural population in order to document AIDS and hepatitis B awareness. The Surveys is an attempt to contain a wealth of data on HIV/AIDS and hepatitis B which until now was not disseminated to rural audience. MATERIALS AND METHODS: Pre-formed questionnaire of 45 questions will be given to all dental professionals, practicing in rural sector, willing to participate in study. Instructions will be given regarding filling the questionnaire. All participants requested to complete the questionair with best of their knowledge and without any assistance. Questionnair were completed in front of author and collected back personally. CONCLUSIONS: The outcomes of the present study, it is clear that our efforts in the last two decades in spreading the knowledge about the disease have met with some limited success. The fact that increasing number of cases of HIV/AIDS are being reported from rural parts, there is certainly a need to reorient the ongoing training programmes towards rural population.

Idiopathic huge pyogenic granuloma in young and old: An unusually large lesion in two cases.

Pyogenic granuloma (PG) is a reactive hyperplasia of connective tissue in response to local irritants, chronic irritation and hormonal changes. It is a tumor-like growth of the oral cavity frequently located in the region surrounding the anterior teeth or skin. It usually arises in response to various stimuli, such as low-grade local irritation, traumatic injury, hormonal factors or certain kinds of drugs. Clinically, the lesion appears as a smooth, lobulated, exophytic mass, exhibiting pink to reddish-purple color which can bleed on slight manipulation. PG has no malignant potential, but recurrence is common after surgical excision. Histologically, the surface epithelium may be intact and may show foci of ulcerations or exhibit hyperkeratosis. Gingiva is the most common site affected followed by buccal mucosa, tongue and lips. The size of lesion varies from millimeters to several centimeters; rarely exceeding 2-2.5 cm. PG larger than 2.5 cm are seldom reported. Estrogen has been considered as a major contributing factor in most of the cases. Thus, occurrence of PG is mostly seen in premenopausal age due to high levels of estrogen. In this article, two unusually large oral PG have been reported. In the first case, a 25-year-old young male patient and in the second case, 70-year-old female patient have been described. In both the cases, the size of lesion was more than 5 cm which has been rarely reported before. Also one of the cases describe here is of a postmenopausal female, which questions role of estrogen as an etiological factor.