Comparative Evaluation of Immediate Post-Operative Sequelae after Surgical Removal of Impacted Mandibular Third Molar with or without Tube Drain - Split-Mouth Study.

INTRODUCTION: Third molar surgery is one of the most common surgical procedures performed in general dentistry. Post-operative variables such as pain, swelling and trismus are major concerns after impacted mandibular third molar surgery. Use of passive tube drain is supposed to help reduce these immediate post-operative sequelae. The current study was designed to compare the effect of tube drain on immediate post-operative sequelae following impacted mandibular third molar surgery. AIM: To compare the post-operative sequelae after surgical removal of impacted mandibular third molar surgery with or without tube drain. MATERIALS AND METHODS: Thirty patients with bilateral impacted mandibular third molars were divided into two groups: Test (with tube drain) and control (without tube drain) group. In the test group, a tube drain was inserted through the releasing incision, and kept in place for three days. The control group was left without a tube drain. The post-operative variables like, pain, swelling, and trismus were calculated after 24 hours, 72 hours, 7 days, and 15 days in both the groups and analyzed statistically using chi-square and t-test analysis. RESULTS: The test group showed lesser swelling as compared to control group, with the swelling variable showing statistically significant difference at post-operative day 3 and 7 (p≤ 0.05) in both groups. There were no statistically significant differences in pain and trismus variables in both the groups. CONCLUSION: The use of tube drain helps to control swelling following impacted mandibular third molar surgery. However, it does not have much effect on pain or trismus.

"Oral Submucous Fibrosis Scoring Index" to Predict the Treatment Algorithm in Oral Submucous Fibrosis.

PURPOSE: The main aim of the study is to propose a treatment protocol based on scoring system. MATERIALS AND METHODS: One hundred patients were selected randomly having oral submucous fibrosis. They were classified into five groups based on clinical signs and symptoms, radiological and histopathological grading and severity of fibrosis. Patients of particular group were subjected to specific treatment for each group and followed for 2 years regularly. RESULTS: We found that almost all patients got symptomatic relief and they are able to take regular diet. Patient's interincisal mouth opening increased significantly. CONCLUSION: Based on this scoring and grouping we can give definite and prompt treatment to the patients with satisfactory results. This proposed scoring and staging can play major role in controlling and treating this widespread global disease. Thus, OSMF scoring index is very effective to decide the severity of disease and progress.

Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects.

BACKGROUND: Platelet-rich concentrates are the most widely used regenerative biomaterials. Stimulation and acceleration of soft and hard tissue healing are due to local and continuous delivery of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. This article aims to evaluate the clinical efficacy of open flap debridement (OFD) with or without platelet-rich fibrin (PRF) in the treatment of intrabony defects. MATERIALS AND METHODS: Twenty subjects with forty intrabony defects were treated with either autologous PRF with open-flap debridement (test, n = 20) or open-flap debridement alone (control, n = 20). Soft tissue parameters included: Plaque index, sulcus bleeding index, probing depth, relative attachment level and gingival marginal level (GML). The hard tissue parameters included-distances from: Cement enamel junction to the base of the defect (CEJ-BOD): Alveolar crest to the base of the defect (AC-BOD): And CEJ to AC. The parameters were recorded at baseline and at 9 months postoperatively calculated using standardized radiographs by image-analysis software. RESULTS: Statistically significant (0.005*) intragroup improvements were seen with all the hard and soft parameters in both test and control groups, except for GML. Statistically significant improvements were seen with the mean defect fill (CEJ-BOD and AC-BOD) (P = 0.003*) when intergroup comparisons were made. CONCLUSIONS: Adjunctive use of PRF with OFD significantly improves defect fill when compared to OFD alone. PRF has consistently been showing regenerative potential; it is simple, easy and inexpensive biomaterial compared with bone grafts.

Ectopic mandibular third molar leading to osteomyelitis of condyle: a case report with literature review.

BACKGROUND: A tooth is said to be ectopic if it is malpositioned either due to congenital factors or displaced due to pathological lesions. The incidence of osteomyelitis of condyle has a rare occurrence, very few cases have been reported, either their etiology is unknown or is due to hematogenous spread or a tuberculous focus. This particular case may be a rare of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle. CASE REPORT: This report presents a unique case where an ectopically placed mandibular third molar led to extraoral sinus and scar formation below the ear lobule with osteomyelitis of the mandibular condyle and proposes various indications for its removal along with literature review. DISCUSSION: Ectopic eruption of a tooth into the dental environment is common, whereas ectopic eruption of tooth in other sites is rare. The exact etiology of ectopic eruption of mandibular third molar in condyle is a rare occurrence and to the best of our knowledge, only 14 cases have been reported in the literature. Management of such cases should be meticulously planned after ruling out various local as well as systemic factors as an underlying cause for osteomyelitis and on the basis of the position and type of ectopic tooth and related potential trauma which could be caused by surgical intervention with less morbidity. CONCLUSION: This particular case may be the unique of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle. Diagnosis and management in such cases deserve very special attention to rule out various local and systemic causes which can cause osteomyelitis to affect very unusual site like mandibular condyle. The aim of surgical intervention should be to cause minimum morbidity without affecting the functional efficiency of the mandibular condyle. In this report, we also have proposed the indications for surgical intervention to remove ectopically erupted teeth.

Unusual intramaxillary plexiform schwannoma.

BACKGROUND: Neoplasms of peripheral nerve in the head and neck region are of common occurrence, but origin in the oral and para-oral tissues is uncommon and they rarely occur centrally within the jaws. Schwannoma is a benign neoplasm originating from the neural sheath of peripheral soft tissues, but its occurrence within the jaw bones is most unusual. Plexiform schwannoma is a unique variant of Schwann cell tumours having plexiform pattern. Literature revealed only one case of plexiform schwannoma of the jaw bones, i.e. involving the mandible. CASE REPORT: In this report, we present the first documented case of intraosseous plexiform schwannoma of the maxilla, an extremely rare benign neurogenic tumour treated surgically. DISCUSSION: Schwannoma is a benign neoplasm originating from the neural sheath of peripheral soft tissues, but to occur within the jaw bones is exceptional. Plexiform schwannoma is a rare variant of Schwann cell tumour having plexiform pattern of intraneural growth with multinodularity. Plexiform schwannoma is a benign neoplasm with no malignant potential, but recurrences are evident if excised incompletely. Plexiform schwannoma has similar clinical and histopathological features as that of plexiform neurofibroma which has high malignant potential; hence, it is imperative to correctly diagnose and differentiate this lesion as treatment modality of these two lesions differs.

Efficacy of 4 % Articaine and 2 % Lidocaine: A clinical study.

OBJECTIVES: This study was undertaken to compare the anesthetic properties of 4 % Articaine hydrochloride and 2 % Lidocaine both with 1:100,000 epinephrine for mandibular inferior alveolar nerve anesthesia. MATERIALS AND METHODS: Thirty healthy patients were included in this randomized double-blind clinical cross over study. Each subject received each test solution at different times. Inferior alveolar nerve block anesthesia was used for extraction of bilateral impacted mandibular third molar on different occassions. The time of onset of action, duration of anesthesia, efficacy of anesthesia, hemodynamic parameters and oxygen saturation were monitored during the procedure. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. RESULTS: No statistically significant differences were seen in the onset and duration of anesthesia between the Articaine and Lidocaine solutions. CONCLUSIONS: 4 % Articaine offers better clinical performance than 2 % Lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions.

Periodontal disease and type I diabetes mellitus: Associations with glycemic control and complications.

OBJECTIVE: The aim of the study was to evaluate periodontal health status in patients diagnosed with type 1 diabetes mellitus (DM1) and to establish a correlation between metabolic control and periodontal health status. MATERIALS AND METHODS: Periodontal health parameters namely plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL) were recorded in 28 patients diagnosed with type 1 diabetes mellitus (DM1) and 20 healthy controls. Diabetes history was recorded based on the information provided by the physician and it included date of diagnosis, duration, age of diagnosis, latest values of glycosylated haemoglobin and existing diabetic complications. Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications. RESULTS: The periodontal health in the diabetic group was compromised and they had greater bleeding index (P < 0.001), probing pocket depth (P < 0.001) and clinical attachment level (P = 0.001). Patients diagnosed for diabetes for shorter duration of time (4-7 years) showed bleeding index-disease severity correlation to be 1.760 ± 0.434. CONCLUSION: Periodontal disease was more evident in type 1 diabetes mellitus patients and periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.

Maxillary osteonecrosis and spontaneous teeth exfoliation following herpes zoster.

BACKGROUND: Reports of osteonecrosis and spontaneous tooth loss following herpes zoster infection of the fifth cranial are extremely rare. Only 39 previously recorded cases of post-zoster osteonecrosis have been found in the literature. The unusual feature of the case of interest to the dental surgeon is a rare complication of tooth exfoliation and maxillary osteonecrosis. CASE REPORT: This article reports a case of 52-year-old man with herpes zoster infection of the trigeminal nerve and related alveolar bone necrosis and teeth loss. The etiology and management of herpes zoster infection associated with destructive sequelae are discussed. DISCUSSION: Very few cases of osteonecrosis and spontaneous teeth exfoliation secondary to herpes zoster are found in the literature. The exact mechanism by which herpes zoster induces these destructive changes in the alveolar bone and teeth cannot be proposed. As Varicella zoster virus is an aneurotropic virus, the possible provoking factors may be the infection of the nerves innervating the periosteum or the chronic inflammatory changes in the form of adverse periodontal disease and delayed healing of the extraction sockets associated with compromised host resistance.

A modified temporal incision: an alternative approach to the zygomatic arch.

Zygomatic arch fractures occur due to a direct injury to the lateral aspect of the head. When there are multiple fractures of the arch, open reduction and internal fixation is indicated. Conventionally hemi-coronal and pre-auricular incisions are placed to approach the arch. A modified temporal incision has been described. Open reduction and internal fixation of zygomatic arch fractures has been done.

Temporary pupillary dilatation and ptosis: complications of PSA nerve block: a case report and review of literature.

Lidocaine, an amide local anesthetic is administered regularly for the minor oral and dental surgical procedures. In this article, ophthalmic complications arising from Posterior superior nerve block are discussed and a case report which had dilatation of pupil and ptosis of eye lids is presented. A review of literature is done regarding the ophthalmic complications. The precautions one needs to take during the administration of Local Anesthesia (LA) especially Posterior Superior Alveolar nerve block and management guidelines are highlighted.