Short-term follow-up of anterior and posterior both column fractures of acetabulum managed through both column plating.

OBJECTIVE: To evaluate the results of short-term follow-up of patients of both column acetabular fractures managed through anterior and posterior column plating. INTRODUCTION: Both column acetabular fractures are challenging articular injuries. Majority of them are treated operatively. The concept of "secondary congruence" was introduced by Letournel. Despite this, biomechanical data on secondary congruence indicate that nonoperative treatment leads to an increase in peak pressures in the supraacetabular region with the potential risk of developing posttraumatic degenerative osteoarthritis. Operative management is therefore justified. METHODOLOGY: A cohort of 10 patients having both column (anterior and posterior) acetabular fractures managed using bicolumnar plating between January 2016 and December 2017 were enrolled in the study and were analyzed during follow-up period. RESULTS: In total, 80% of the patients had excellent to good result. Average postoperative score was 85.7. Assessment was done using modified Harris Hip score.

Comparative analysis of cheiloscopy, pulpal tissue and fingerprint for gender identification.

Background: The most important step in identifying an unknown person is determining one's gender and as a dentist, the oral tissues are potential sources of information in this aspect. A study was carried out to assess and evaluate the accuracy of cheiloscopy, pulp tissue, and fingerprints in determining gender. Material and Methods: A study comprising of 160 individuals (80 males and 80 females) was conducted. After obtaining informed written consent and recording their bio-data; lip prints, and fingerprints were recorded. The patients' extracted tooth was collected, their pulp extirpated, for assessment of the Barr body. Results: We found that every lip pattern was unique and hence can be used to identify an unknown individual. The occurrence of the Barr body was determined, and all female samples were found to be positive for the existence of the Barr body. In fingerprint patterns, a significant difference was noted between both sexes with ulnar loops and whorl patterns only. A highly significant difference was observed in the fingerprint ridge density between genders. Conclusions: We conclude that the Barr body in pulpal tissue can be considered as the best possible technique for gender determination within the dental tissues. Lip prints did not show any differences in genders and had no role to play in gender determination. Fingerprint ridge density can also be used to determine gender.

Radiographical Evaluation of Morphological Alterations of Mandibular Third Molars: A Cone Beam Computed Tomography (CBCT) Study.

Introduction  Morphological changes or variations in the lower third molar can be of concern during the endodontic, orthodontic, or prosthetic intervention. The goal of the present study was to evaluate the morphological alterations in the roots and root canal of a mandibular third molar in Bhopal, Central India, on cone beam computed tomography (CBCT) images. Methodology CBCT scans of 277 mandibular molars, of both genders, between the ages of 18 and 60 years were assessed for the presence of root numbers, the configuration of the canal based on Vertucci's categorization, and a C-shaped canal. Scan results were analyzed for differences in canal configuration between the roots and topographical distribution. A chi-square test was applied to find any significant differences between the teeth at p 0.05. Results Scans analyzed for variations in the third molar had a mean age of 38.64 + 5.71 years. The majority (95.3%) of the molars had two roots, 1.5% had three roots, and 0.4% had five roots. The mesial side of double-rooted teeth predominantly had Type II canal configuration (67.0%), while it was Type I (79.2%) in the distal aspect of the root. C-shaped canals were detected in 21 teeth, and no significant topographical difference was noted in the CBCT images. Conclusion The majority of the current population showed two roots with the same number of canals in the studied tooth. CBCT can be used as a diagnostic aid in identifying the canal numbers and their configuration so as to render appropriate intervention and minimize subsequent failure.

Functional outcome of conversion total hip arthroplasty (CTHA) using uncemented distally loading femoral stem for failed fixation of proximal femoral nail - A case series.

Introduction and aims: There is paucity of prospective studies on conversion total hip arthroplasty (CTHA) for failed proximal femoral nailing. The objective of this study is to evaluate the functional outcome of CTHA using extensively porous coated distal loading stem for failed proximal femoral nailing. Patients and methods: Fifteen consecutively operated patients for failed proximal femoral nail treated with single stage procedure of nail extraction and CTHA were included in this prospective observational study. All patients received metal-on-polyethylene bearing with uncemented press-fit acetabular cup (Pinnacle cup; DePuy, Warsaw [IN], USA) and extensively porous coated distally loading revision stem (Solution stem; DePuy, Warsaw [IN], USA). All patients were assessed preoperatively and postoperatively at one, three, six and more than twelve months using the Harris Hip Score (HHS). The responsiveness of HHS was assessed using Effect Size (ES) and Standardised Response Mean (SRM). ES and SRM >0.8 indicates adequate responsiveness. Results: The mean duration of follow-up was 16.9 months for the overall cohort (SD: 7.9; range: 6-28 months). The mean preoperative HHS was 32 ± 6.1, the mean HHS at six months follow-up was 89.7 ± 4.0 and the mean HHS at final follow-up of atleast one year was 93.7 ± 3.0. There was a statistically and clinically significant improvement in the HHS from preoperatively to final follow-up postoperatively (p < 0.0001). At the final follow-up, twelve patients (80%) had an excellent outcome and three patients (20%) had a good outcome as per HHS grading. The ES was 9.87 and the SRM was 8.86 thereby suggesting adequate responsiveness. One patient developed surgical site infection and another patient developed dislocation. Both were successfully treated and subsequently the patients made uneventful recovery. None of the patients required revision surgery. Conclusion: HHS has adequate responsiveness for assessing the functional outcome of CTHA. We recommend the use of an uncemented cup and uncemented extensively porous coated, distal loading stem for failed PFN fixation in intertrochanteric hip fractures.

Assessment of Pathway and Location of Posterior Superior Alveolar Artery: A Cone-Beam Computed Tomography Study.

Objective The current study evaluated the complicated pathway of the posterior superior alveolar artery (PSAA) and measured the prevalence, diameter, and length of PSAA to the alveolar crests of molars using cone-beam computed tomography (CBCT). The study compared findings between dentate and edentulous patients grouped by their age. In addition, the study researched the presence of the septa. Methods One hundred and fifty CBCT scans of patients with ages ranging from 20 to 80 years were analyzed for the study. The measurements of PSAA were obtained from CBCT scans. Results The PSAA was detected on CBCT scans of 87.3% of participants. The majority course of PSAA was intraosseous (right side 53.3%, left side 63.3%). The diameter of PSAA was 1.30±0.42 mm on the right side and 1.19±0.40 mm on the left side. The length of PSAA to the alveolar crest of the third molar (A1) was 17.16±2.72 mm on the right side and 17.82±3.2 mm on the left side, to the first molar (M1) was 11.6±2.66 mm on the right side and 11.65±2.37 mm on the left side, and to second molar (M2) was 12.51±1.96 mm on the right side and 12.44±2.72 mm on the left side. There was no significant difference noticed between dentate and edentulous participant groups. Six percent (6%) of the scans showed the septa in the maxillary sinus. Conclusions The study showed that CBCT scans and their analysis help the clinician to make a better radiographic diagnosis and clinical application while using surgical procedures, such as implant placement and sinus lift.

A Rare Case of Bilateral Fracture Neck Femur Treated with Bilateral Distal Loading Stem Total Hip Arthroplasty, in a Single Sitting.

INTRODUCTION: Bilateral intracapsular neck of femur fractures is rare and has been reported in patients with metabolic bone diseases, after electroconvulsive therapy and due to stress fractures. Total hip arthroplasty (THA) is considered as a treatment of choice for old aged patients. Surgery done in a single sitting for such patients helps in early mobilization. CASE REPORT: A 60-year-old male, known case of epilepsy and chronic renal disease, presented to us with bilateral intracapsular fracture of neck of femur following episode of convulsion. The patient was operated for a distal loading stem THA on both sides in a single sitting. Proximally deficient hip was managed with screw and cerclage looping fixation of greater trochanter on both sides. The post-operative course was uneventful. At 2 weeks, the patient was allowed protected weight-bearing with a walker. At 8 weeks, the patient was doing full weight-bearing, while at 4 months, the patient was carrying out all activities of daily living. Mean Harris hip score was 86 at the end of 6 months. CONCLUSION: Bilateral long stem distal loading THA can give good clinical and functional outcomes in a case of the bilateral neck of femur fracture with a deficit of proximal femur. The patient can safely be operated for arthroplasty on both sides in a single sitting. Single sitting surgery will help in early mobilization and better functional outcomes.

Retrograde Ender nailing for humerus shaft fractures.

Humerus fractures are common; their management remains controversial. Infection, neurovascular injury, joint problems and non-union are recognised complications of surgical treatment. These complications can be decreased by opting for a surgical treatment that is less invasive and safe. We present a series of 59 patients treated with retrograde Ender nailing; 56 healed in an average of 9.1 weeks, 2 had delayed union (> 15 weeks) and one went on to non-union, which healed after secondary plate fixation. Nail back out occurred in 8 cases, of which only 3 required nails repositioning. The mean Constant score at final follow-up (mean 19 months) was 91; it was significantly lower in patients over 50 years of age and in those with segmental fractures. In this series, Ender retrograde nailing gave overall satisfactory results and appeared as a safe and efficient technique.

Use of Frontal Sinus and Nasal Septum Pattern as an Aid in Personal Identification and Determination of Gender: A Radiographic Study.

INTRODUCTION: Personal identification and gender determination of unknown person has a vital importance in forensic investigation. Human skull radiography is a useful tool in human identification in natural disaster, in any accidents such as fire accident and road traffic accident where body remains become degraded or severely destroyed. AIM: Present study was performed to evaluate the measurement of frontal sinus, uniqueness of various pattern of nasal septum when combined with frontal sinus observed on posterio anterior cephalogram for sex determination as well as personal identification. MATERIALS AND METHODS: A total of 80 individuals, 40 males and 40 females, between the age ranges of 18-30 years were selected. The selected individuals had their Posterio Anterior (PA) cephalogram performed after taking their informed consent. Right and left areas and the maximum height and width of the frontal sinus were determined and septum patterns were evaluated and both patterns were also combined and compared. The radiographs were taken on Xtropan 2000 OPG X-ray machine with cephalography attachment and KODAK CR 7400 digital radiography system. Mean and SD values of the greatest height and width of frontal sinus in male and female patients were thus evaluated. The mean values of the frontal sinus were greater in males and the left area was larger than the right area, based on student's t-test at the 5% level of significance. RESULTS: The combination of Frontal Sinus Patterns and Nasal Septum Patterns (FP+NSP) were assessed and found that there were nine classifiable patterns in 26 (32.5%) individuals (12 males and 14 females), each of which had common representations in more than one individual. Besides these patterns, there were unique unclassifiable patterns in 54 (67.5%) individuals. CONCLUSION: The present study supports the use of radiographic evaluation of frontal sinus dimensions, frontal sinus patterns, nasal septum deviations and the combination FP+NSP patterns for personal identification and gender determination in forensic investigations.

Evaluation of the effect of transcutaneous electrical nerve stimulation (TENS) on whole salivary flow rate.

BACKGROUND: Saliva plays a critical role in maintaining oral homeostasis; it modulates the ecosystem through lubrication of the alimentary bolus, protection against microorganisms, buffer and repair of the oral mucosa, and helps in dental re-mineralization. Various local and systemic factors such as medications, radiation therapy, systemic conditions, etc. can lead to reduction in salivary flow. A decrease in salivary function, known as Xerostomia, increases a patient's risk for caries and other oral infections. Palliative management of Xerostomia includes wetting agents such as ice chips, drugs and saliva substitutes. Systemic agents stimulate salivary flow but often have unfavorable side effects. Newer modalities like transcutaneous electrical nerve stimulation (TENS), which has fewer side effects, have been used to stimulate salivary flow. The aim of the present study was to assess and evaluate the effect of TENS on whole salivary flow rates in healthy adult subjects. STUDY DESIGN: A total of 80 healthy adult subjects were enrolled in the study. Unstimulated and stimulated saliva (using TENS) was collected for 5 minutes and the mean salivary flow rates were calculated. Data obtained was analyzed using the SPSS (Statistical package for social sciences) version 15. Students 't' test was employed for comparative analysis. RESULTS: Sixty-five of the 80 subjects demonstrated an increase in the salivary flow rate on application of TENS. Twelve subjects demonstrated a mild reduction in the salivary flow rates. Seven subjects experienced transient mild twitching of facial musculature as side effects. CONCLUSION: Significant increase in salivary flow rates was observed on application of TENS with minimal or no side effects. Key words:Stimulated saliva, whole salivary flow, TENS.

Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers - a sham controlled, split mouth follow up study.

INTRODUCTION: Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness, and occasional bleeding from the affected area(s). The aims of treatment are to reduce pain and healing time. AIMS: To assess clinically the efficacy of Low-level laser therapy (LLLT) on recurrent aphthous ulcers for reduction of pain, lesion size, and healing time and to compare the results with those of a sham control group. SETTINGS AND DESIGN: A total of 30 patients who presented with two separate aphthous ulcers were included in the study. Each lesion was randomly allotted to either the active treatment group or the sham control group. MATERIALS AND METHODS: Lesions which were included in the active group were treated with LLLT in a single sitting, which was divided into four sessions. Lesions in the sham control group were subjected to similar treatment without activating the LASER unit. Each patient was evaluated for pain, lesion size, and complete healing at the following intervals; immediately post LLLT and one day, two days, and three days follow up. Statistical Analysis : The Student's t-test was used for statistical evaluation of the data. RESULTS: Complete resolution of the ulcers in the active group was 3.05 ± 1.10 days as compared to 8.90 ± 2.45 days in the sham control group. Immediately, post the LLLT application, complete pain relief was observed in 28 of the 30 patients of the active group. CONCLUSION: LLLT was effective in relieving pain and reducing the healing time during the treatment of aphthous ulcers.

Correlation of presence of Candida and epithelial dysplasia in oral mucosal lesions.

BACKGROUND: Candida and epithelial dysplasia have long been associated with oro-mucosal lesions. AIM AND OBJECTIVE: The present study was designed to evaluate the correlation between presence of Candida organisms and epithelial dysplasia in various oral mucosal lesions associated with areca nut and tobacco use. MATERIALS AND METHODS: A total of 50 individuals were selected, between age range of 19-70 y. Three separate cytosmears were prepared for each participant. All the slides were stained with PAS stain and the best slide was viewed for candidal organisms. STATISTICAL TESTS: The data was analysed using the SPSS version16. Chi square test was performed. RESULTS: Out of these, samples of 26 participants displayed presence of Candida. It was further observed that all the samples that were positive for presence of Candida displayed the organism in hyphal form. Out of 50 biopsy specimens stained for presence of Candida using PAS stain, samples of only 2 participants demonstrated presence of Candida in hyphal form, whereas the biopsy specimens stained for demonstrating dysplastic changes using H&E stain displayed various levels of cellular atypia in samples of 16 participants. Out of these 12 were mild, 3 were moderate & 1 displayed severe dysplastic changes. CONCLUSION: The study revealed a statistically non significant correlation between the presence of Candida and epithelial dysplasia in oral mucosal lesions.

Antioxidant therapy as monotherapy or as an adjunct to treatment of periodontal diseases.

BACKGROUND: Treatment of periodontal diseases by nonsurgical debridement has been considered as a gold standard procedure. Various other treatment modalities have been tried and tested to treat periodontal diseases. The aim of this study was to investigate the effect of antioxidant therapy on the progression of periodontal disease as monotherapy and/or as an adjunct to nonsurgical debridement. MATERIALS AND METHODS: 70 subjects were divided into three groups, i.e. clinically healthy, gingivitis and periodontitis group on the basis of Community Periodontal Index of Treatment Needs score. Gingivitis and periodontitis groups were further subdivided into three subgroups. At the baseline, periodontal attachment loss was recorded and scaling and root planing was performed in two subgroups. 6 mg antioxidant was administered in three divided doses for 2 weeks. Saliva samples were collected at baseline, 15(th) day, 30(th) day and 45(th) day for evaluation of uric acid levels. RESULTS: Uric acid levels were significantly low in patients with more periodontal attachment loss as compared to clinically healthy and gingivitis groups. As the treatment was initiated, significant increase in uric acid levels was observed. CONCLUSION: Rise in salivary antioxidant levels was observed on the administration of antioxidant therapy. Hence, antioxidant therapy can be used as an adjunct to the nonsurgical periodontal therapy.