IMPORTANCE OF ASSESSING THE POSITION OF THE INFRA-ORBITAL FORAMEN IN QUAD ZYGOMA OR UNILATERAL DOUBLE ZYGOMA IMPLANT SURGERY.

AIM: Evaluate the frequency of occurrence of extreme inferior positioning of the Infraorbital foramen from the infra-orbital rim that can potentially interfere with the placement of Quad or Unilateral Double Zygomatic implants. MATERIALS AND METHODS: CBCT scans of 60 patients were read to identify the Infraorbital foramen (IOF)and Infra-orbital rim (IOR). The distances between the two were measured. In cases with increased values, virtual surgical planning was done to evaluate whether two Zygoma implants could be placed in one zygomatic bone. RESULTS: Two out of the 60 cases showed a more inferior location of the IOF, reducing the amount of bone available , thus rendering quad zygoma or unilateral; double zygomatic implants infeasible. CONCLUSION: Measurement of the distance of the IOF from the IOR is an important step worth incorporating in Quad Zygoma or unilateral double zygoma implant surgery planning.

Implications in the quantification of SARS-CoV2 copies in concurrent nasopharyngeal swabs, whole mouth fluid and respiratory droplets.

OBJECTIVE: Association of SARS-CoV2 burden in the aerodigestive tract with the disease is sparsely understood. We propose to elucidate the implications of SARS-CoV2 copies in concurrent nasopharyngeal swab (NPS), whole mouth fluid (WMF) and respiratory droplet (RD) samples on disease pathogenesis/transmission. METHODS: SARS-CoV2 copies quantified by RT-PCR in concurrent NPS, WMF and RD samples from 80 suspected COVID-19 patients were analysed with demographics, immune response and disease severity. RESULTS: Among the 55/80 (69 %) NPS-positive patients, SARS-CoV2 was detected in 44/55 (80 %) WMF (concordance with NPS-84 %; p = 0.02) and 17/55 (31 %) RD samples. SARS-CoV2 copies were similar in NPS (median:8.74 × 10^5) and WMF (median:3.07 × 10^4), but lower in RD (median:3.60 × 10^2). The 25-75 % interquartile range of SARS-CoV2 copies in the NPS was significantly higher in patients who shed the virus in WMF (p = 0.0001) and RD (p = 0.01). Multivariate analyses showed that hospitalized patients shed significantly higher virus copies in the WMF (p = 0.01). Hospitalized patients with more severe disease (p = 0.03) and higher IL-6 values (p = 0.001) shed more SARS-CoV2 virus in the RD. CONCLUSIONS: WMF may be used reliably as a surrogate for diagnosis. High copy numbers in the NPS probably imply early disease onset, while in the WMF and RD may imply more severe disease and increased inflammation.

A Randomized Double-Blind Placebo-Controlled Phase IIB Trial of Curcumin in Oral Leukoplakia.

Oral leukoplakia is a potentially malignant lesion of the oral cavity, for which no effective treatment is available. We investigated the effectiveness of curcumin, a potent inhibitor of NF-κB/COX-2, molecules perturbed in oral carcinogenesis, to treat leukoplakia. Subjects with oral leukoplakia (n = 223) were randomized (1:1 ratio) to receive orally, either 3.6 g/day of curcumin (n = 111) or placebo (n = 112), for 6 months. The primary endpoint was clinical response obtained by bi-dimensional measurement of leukoplakia size at recruitment and 6 months. Histologic response, combined clinical and histologic response, durability and effect of long-term therapy for an additional six months in partial responders, safety and compliance were the secondary endpoints. Clinical response was observed in 75 (67.5%) subjects [95% confidence interval (CI), 58.4-75.6] in the curcumin and 62 (55.3%; 95% CI, 46.1-64.2) in placebo arm (P = 0.03). This response was durable, with 16 of the 18 (88.9%; 95% CI, 67.2-96.9) subjects with complete response in curcumin and 7 of 8 subjects (87.5%) in placebo arm, demonstrating no relapse after 6 months follow-up. Difference in histologic response between curcumin and placebo was not significant (HR, 0.88, 95% CI, 0.45-1.71; P = 0.71). Combined clinical and histologic response assessment indicated a significantly better response with curcumin (HR, 0.50; 95% CI, 0.27-0.92; P = 0.02). Continued therapy, in subjects with partial response at 6 months, did not yield additional benefit. The treatment did not raise any safety concerns. Treatment of oral leukoplakia with curcumin (3.6 g for six months), thus was well tolerated and demonstrated significant and durable clinical response for 6 months. Cancer Prev Res; 9(8); 683-91. ©2016 AACR.

Restoration of Atrophic Edentulous Maxilla of a Patient with Ectodermal Dysplasia Using Quadruple Zygomatic Implants: A Case Report.

Rehabilitation of patients with ectodermal dysplasia often presents clinical challenge due to hypodontia, anodontia, and severe atrophy of edentulous ridges. Zygomatic implant therapy can be used as a method of achieving osseointegration without bone grafting in such situations. This clinical report describes the dental rehabilitation of atrophic maxilla of a 26-year old female patient with a fixed prosthesis, immediately loaded on four zygomatic implants.

Expert Consensus on the Detection and Screening of Oral Cancer and Precancer.

Oral cancer is an aggressive disease with a high incidence in both males and females in Asia and ranks as the first of all malignancies in India. The relatively high prevalence rate of oral cancer in Asia is mainly due to the fact that a high percentage of the population are smokers or chew betel nut. They comprised the so called 'high risk population' of oral cancer. Meanwhile, epidemiological surveys showed a much lower 5-year survival rate in patients with advanced TNM stage III and IV oral cancer than those in the earlier stage I and II disease after treatment. Therefore, it is important to identify and treat precancerous lesions and oral cancer at early stages. In this article, we describe the expert consensus contributed by outstanding clinicians and scientists at the 11th Asian Congress of Oral & Maxillofacial Surgery (ACOMS) and we highlight the importance of oral cancer screening by various conventional and novel methods based on scientific research.

Bone augmentation of the osteo-odonto alveolar lamina in MOOKP--will it delay laminar resorption?

PURPOSE: We aimed to describe a new technique and analyse the early outcomes of augmenting the canine tooth using a mandibular bone graft in an attempt to delay or retard the process of laminar resorption following the modified osteo odonto keratoprosthesis (MOOKP) procedure. DESIGN: This was a retrospective case series. PATIENTS AND METHODS: Eyes that underwent the bone augmentation procedure between December 2012 and February 2014 were retrospectively analysed. The procedure, performed by the oromaxillofacial surgeon, involved securing a mandibular bone graft beneath the periosteum on the labial aspect of the canine tooth chosen to be harvested for the MOOKP procedure. This procedure was performed simultaneously with the Stage 1 A of the MOOKP. Three months later, the tooth was harvested and fashioned into the osteo-odonto alveolar lamina similar to the method described in the Rome-Vienna Protocol. RESULTS: The bone augmentation procedure was performed in 11 eyes (five SJS/ six chemical injuries). The mean follow-up after Stage 2 of MOOKP procedure in these eyes was 7.45 months (2 to 20 months). Complications noted were peripheral laminar exposure (three eyes-SJS) and bone graft exposure and necrosis in the mouth (nine-SJS). No evidence of clinical laminar resorption was noted in any of the eyes. CONCLUSION: Laminar resorption in MOOKP can lead to vision and globe threatening complications due to the consequent cylinder instability and chances of extrusion. Augmenting the bone on the labial aspect of the canine tooth might have a role to play in delaying or preventing laminar resorption.

Full mouth rehabilitation with zygomatic implants in patients with generalized aggressive periodontitis: 2 year follow-up of two cases.

Rehabilitation of severely atrophied maxillae is often a challenge and patients with generalized aggressive periodontitis (GAP) make it even more complicated. This clinical report describes rehabilitation of GAP patients with zygomatic implants and followed-up for 2 years. Two patients of age 33 and 44 reported to a private dental practice and were diagnosed with GAP. Various treatment options were considered after which it was decided to do a full mouth implant supported fixed rehabilitation, with a combination of conventional and zygomatic implants. Two zygomatic and four conventional implants were placed and immediately loaded with a provisional prosthesis. After 6 months, definitive prosthesis was delivered. Implants and prostheses were followed-up for 2 years. No implant failures occurred, but a few biological complications were observed. The most common clinical observation in these patients during recall visits was peri-implant soft-tissue inflammation, which is a biological complication. This was with no trouble, controlled by using proper oral hygiene aids and maintenance. Within the limitations of this study, we can state that it can definitely be considered as a viable treatment option treating patients with GAP. However, studies with more follow-up time and controlled clinical trials should be performed in order to document the longevity of this treatment modality.

Structural & functional rehabilitation in eyes with lamina resorption following MOOKP--can the lamina be salvaged?

PURPOSE: To describe a new technique and analyze the outcome of procedures performed for anatomic and functional rehabilitation in eyes with lamina resorption following the modified osteo-odonto keratoprosthesis (MOOKP) procedure. DESIGN: Retrospective case series. PATIENTS & METHODS: Eighteen eyes were noted to have lamina resorption of the 85 eyes that underwent the MOOKP surgery over the last 10 years. Further intervention to salvage the globe, and therefore the visual potential, was possible in only 11 eyes, of which two are yet to undergo further intervention. Two patients who had undergone the procedure elsewhere also presented to our centre with evidence of resorption. In all, 11 eyes (nine operated at our centre, two operated elsewhere) were included in this study. Bone morphogenetic protein (BMP) was used alone or along with mandibular cancellous bone within the fibrovascular capsule of the osteo-odonto alveolar lamina, in an effort to prevent further resorption and promote bone generation in areas of resorption in ten eyes. In three of these eyes, there was a continued progression of resorption requiring lamina removal. In these three eyes and another eye with extrusion of the cylinder from the eye, the Lucia Type 2 keratoprosthesis was performed for visual rehabilitation (four eyes). RESULTS: The BMP procedure was performed in ten eyes. Continued resorption with need for further rehabilitative surgery in the form of Lucia Type 2 Kpro was required in three of these eyes. Of the four patients who had the Lucia Type 2 Kpro, visual acuity improved to better than 20/200 in three eyes over a mean follow-up period of 3 months. Of the remaining seven eyes that had the BMP procedure performed, all have remained stable with respect to anatomic integrity of the lamina and globe, with maintenance of or improvement in pre BMP visual acuity over a mean follow-up of 9.2 months. No other complications of the procedure were noted. CONCLUSION: Resorption of the lamina in MOOKP can be addressed by reinforcing the same with BMP in eyes where the cylinder mobility is not significant, as a means to prolong the longevity of the existing lamina. The Lucia Type 2 Kpro might also have a role to play in the functional rehabilitation of eyes with severe lamina resorption or cylinder extrusion if preparation of a new lamina cannot be performed for various reasons.

Zygomatic implant-retained fixed complete denture for an elderly patient.

Dental rehabilitation of a completely edentulous geriatric patient has always been a challenge to the clinician, especially in treating those with higher expectations and demands. Treatment duration and the amount of residual alveolar bone available are often important considerations when planning for dental implant-based fixed treatment for these patients. With the introduction of zygomatic implants, a graftless alternative solution has emerged for deficient maxillary bone with provision for immediate loading. This article describes the treatment of a completely edentulous elderly patient using zygomatic implants in conjunction with conventional implants. The implants were immediately loaded using a definitive acrylic resin fixed denture reinforced with a cast metal framework, to provide function and aesthetics.

Mandibular first molar having an unusual mesial root canal morphology with contradictory cone-beam computed tomography findings: a case report.

INTRODUCTION: The objective of this article is to highlight the importance of having a thorough knowledge about the root canal anatomy and the possibility of misleading findings in the cone-beam computed tomography (CBCT) images. METHODS: This case report presents the endodontic management of a right mandibular first molar with 2 roots and 2 canals. A CBCT imaging was performed to ascertain this rare root canal anatomy. RESULTS: The clinical and radiographic diagnosis of the existence of a single root canal within the mesial root of mandibular first molar did not correlate with the CBCT findings. CONCLUSIONS: The confirmative diagnosis should be based on cognitive deduction of the clinical picture and intelligent interpretation of radiologic information.

Immediate placement and loading of implants in anterior maxilla using an altered screw-retained implant fixed prosthesis.

This article describes the immediate placement and loading of implants in the aesthetic zone using an implant-retained, fixed prosthesis with a modified design. One section of the implant prosthesis has cemented crowns and the other section is the conventional screw-retained. This combined approach significantly offsets the unsuitable implant position, alignment or angulation, while ensuring the easy retrievability, repair and maintenance of the prosthesis at the same time.

Full-arch metal-resin cement- and screw-retained provisional restoration for immediately loaded implants.

Abstract This article describes the clinical and laboratory procedures involved in the fabrication of laboratory-processed, provisional, screw-retained, implant-supported maxillary and mandibular fixed complete dentures incorporating a cast metal reinforcement for immediate loading of implants. Precise fit is achieved by intraoral luting of the cast frame to milled abutments. Effective splinting of all implants is attained by the metal substructure and retrievability is provided by the screw-retention of the prosthesis.

Fixed rehabilitation of patient with aggressive periodontitis using zygoma implants.

Treatment of patients with aggressive periodontitis has always been a challenge to the clinician. Both young and old are known to be affected by this progressive destructive condition of the supporting dental structures. Although dental implants have been offered as a viable treatment alternative for such patients, additional procedures (like bone grafting) and delayed protocols have limited their usage. This case report describes the treatment of a young patient with aggressive periodontitis using a graftless implant solution. Zygoma implants in conjunction with conventional implants were used with immediate loading.

Treatment of a maxillary dento-alveolar defect using an immediately loaded definitive zygoma implant-retained prosthesis with 11-month follow-up: a clinical report.

This article describes the dental implant-based rehabilitation of a partially edentulous patient with a unilateral maxillary dento-alveolar defect. A screw-retained prosthesis with a modified design was fabricated on zygomatic and regular dental implants. One section of the implant prosthesis has cemented crowns and the other section is conventional screw-retained. The design of the prosthesis overcame the hard and soft tissue deficit and provided the desired esthetics.

Edentulous arch treatment with a CAD/CAM screw-retained framework and cemented crowns: a clinical case report.

This article describes the rehabilitation of a completely edentulous patient using a milled titanium implant framework and cemented crowns. This combined approach significantly offsets unsuitable implant position, alignment, or angulation, while ensuring the easy retrievability, repair, and maintenance of the prosthesis. Hence, the dual advantage of cemented-retained crowns reproducing appropriate esthetics and function, irrespective of where the screw access openings are located in the substructure, can be obtained, along with the splinting effect and management of soft and hard tissue deficits achievable with a screw-retained framework.

Oral Candida species in healthy and HIV-infected subjects in Chennai, South India

Objective: Candidiasis is the most common fungal infection in human immunodeficiency virus (HIV) - infected individuals. As there is sparse data on the oral <I>Candida</I> species in HIV- infected individuals in India, we characterized <I>Candida</I> species from the oral cavity in two cohorts - with and without HIV infection and with presence or absence of clinical oral candidiasis, in Chennai, South India.<br>Methods: Saliva samples were collected from 147 consecutive study participants by the oral rinse technique. <I>Candidal</I> species were isolated by culturing specimens on Sabouraud‘s dextrose agar. The pure cultures so derived were speciated using the commercially available ID32C system, and the results were interpreted using APILAB plus software.<br>Results: In the HIV seropositive group, the most commonly isolated candida species was <I>C.albicans</I> (86%) followed by <I>C.tropicalis</I> (23%), <I>C.guilliermondi</I> (6%), <I>C.krusei</I> (5%) and others (4%). In the healthy cohort without clinical candidiasis, C.tropicalis was the most commonly isolated species.<br>Conclusion: There appears to be a marked variation in oral <I>Candida</I> species found in HIV-seropositive and seronegative individuals in India. To our knowledge, this is the first attempt to identify oral Candida species in a South Indian population.

Areca nut use in rural Tamil Nadu: a growing threat.

BACKGROUND: Areca nut is the fourth main psychoactive substance in the world. In India, tobacco is added to the quid and the commercially manufactured nonperishable forms of betel quid (pan masala or gutkha) are on the rise in the market. OBJECTIVE: To find out the prevalence of areca nut among the rural residents of Sriperambudur Taluk. SETTINGS AND DESIGN: A community-based survey using pre-tested semi-structured questionnaire. MATERIALS AND METHODS: The survey was conducted in 2 villages and their colonies, which were randomly selected out of 168 villages. Data was collected from 500 residents of the study population. The survey was conducted for a period of 2 months. STATISTICAL ANALYSIS: SPSS version 10.0. RESULTS: The study participants were more likely to initiate areca nut use by 22 years of age. As many as 19.8% (n = 99) of the study participants chewed areca nut products, out of whom 11.2% (n = 56) indulged in chewing habit alone (areca nut products). Areca nut use was higher among male study subjects compared to females. The commercial forms of areca nut products (gutkha) were the most prevalent ones [47.5% (n = 47) of those who used areca nut] observed in the community. Compared to female participants, male participants were more likely to perceive areca nut use as the most harmful habit draining the community health and wealth. CONCLUSION: There seems to be an increase in the prevalence of areca nut use. The community also perceives it to be a harmful habit. Therefore, effective interventions should be targeted towards the high-risk subpopulation of the community to decrease the prevalence of areca nut use in rural Tamil Nadu.