Comparison of articaine and lignocaine for uncomplicated maxillary exodontia

To compare single buccal articaine injection versus conventional lignocaine buccal and palatal injections for uncomplicated maxillary tooth extractions. Single blinded randomized control trial. The outpatient department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from February to September 2011. Patients aged 20 - 60 years under simple extraction in the maxillary arch were included in the study. Patients were randomly divided into two groups-A and B toss method. Maxillary teeth were divided into three groups; group-1 [posterior teeth] including first, second and third molars on either side, group-2 [middle teeth] including the premolars and group-3 [anterior teeth] including incisors and canines. Group-A [study group] received buccal infiltration of 4% articaine with 1:200,000 adrenaline and group-B [control group] received buccal and palatal infiltration of 2% lignocaine/HCl with 1:100,000 adrenaline. Faces Pain Scale [FPS] and a Visual Analogue Score [VAS] was used for objective and subjective assessment of per operative pain respectively. A total of 194 patients were included in the study. Group-A comprised of 100 patients while group-B consisted of 94 patients. The mean age of the total sample was 41.12 +/- 13.6 years. Statistically significant difference was found for the VAS scores of anteriors [p=0.9], premolars [p=0.2] and molars [p=0.2] for groups A and B. The FPS scores for both groups were also statistically insignificant [p=0.864]. Buccal infiltration with a single articaine injection and lignocaine buccal and palatal infiltration were equally effective for maxillary exodontia

Optimal and efficient management of mandibular fractures

The aim of the study was to find out whether eliminating intraoperative intermaxillary fixation from the management of mandibular fractures has any bearing on treatment outcomes. A retrospective study was carried out on 53 mandibular fractures treated at Margalla Institute of Health Sciences and its affiliated hospitals from June 2010 to December 2014. Successful bone healing, occlusion and complications were assessed in mandibular fractures treated with open reduction and internal fixation and without the use of intraoperative intermaxillary fixation. Minor wound dehiscence was seen in 7 patients. 3 patients required hardware removal due to subsequent hardware failure; however no case of nonunion was seen. Clinically significant malocclusion [Moderate: Grade 2] was seen in only one patient after 3 months. There were negligible and comparable number of postoperative complications. It was concluded 'hand holding' of the mandibular fractures as an alternative to the more traditional IMF/MMF through various means, a reliable and predictable way of fixation of mandibular fractures

Buccal fat pad flap in management of oroantral fistula

Many options are exercised to affect surgical management of oroantral fistulae. Postoperative wound dehiscence is not uncommon, and the surgical management of such fistulae often becomes increasingly difficult because of a lingering maxillary sinus infection. This was a retrospective study done on 23 patients in which a double layered technique, consisting of buccal fat pad in conjunction with buccal advancement flap was used for surgical closure of oroantral fistulae. Only 3 of the patients had had a failure of the closure. We recommend this technique because of its many advantages and low risk of complications

Bioresorbable versus titanium plates for mandibular fractures

To compare bioresorbable plates with titanium plates for treatment of mandibular fractures. Randomized controlled trial. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, from January to December 2010. Patients with mandibular fracture were randomly divided in to two groups. The control group received titanium plates while the experimental group received the bioresorbable plates. All the procedures were carried out under general anaesthesia using standard surgical techniques. Frequency of plate/screw breakage or loosening, development of infection, malocclusion, malunion, wound dehiscence, the need for hardware removal and any other technical difficulties were compared between the two groups using chi-square test with significance at p < 0.05. A total of 34 patients were included in the experimental group where 53 resorbable plates were applied. The control group consisted of 35 patients and received 52 titanium plates. The mean age in the experimental group and the control group were 31.35 +/- 11.16 years and 34.31 +/- 10.69 years respectively. Breakage of 16 screws and 03 plates was seen in the experimental group while no screw or plate broke in the control group. The results showed significant association of screw breakage with resorbable plates and plate removal with titanium plates. Bioresorbable plates can be used as an alternative to titanium plates in mandibular fractures but with caution. They are a good means to stabilize fractures in patients where growth retardation and hardware removal may be a consideration

maxillofacial trauma management trends at Armed Forces Institute of Dentistry, Rawalpindi

The aim of this study was to evaluate and analyze current trends in the management of trauma in patients presenting to oral and maxillofacial surgery department of Armed Forces Institute of Dentistry. Rawalpindi from Jan 2008 to Dec 2010. In this retrospective study, data of 613 patients with maxillofacial fractures treated at oral and maxillofacial surgery department, Armed Forces Institute of Dentistry was reviewed and analyzed. The main parameters recorded were gender, pattern of facial bones fracture and treatment modality of fracture. Out of these 613 patients, 564 [92%] were males and 49 [8%] were females with a male to female ratio of 11.5:1. The mandible was the most common bone to be fractured, with 307 fractures [50.1%], followed by 116 fractures [18.9%] of zygomatic bone, 83 fractures [13.5%] of maxillary bone, 64 patients [10.5%] had panfacial trauma, 26 [4.3%] were having nasal fracture while Naso-orbito-ethmoid fractures [NOE] were seen in 15 [2.4%] cases. The management of the injured face has undergone major changes, outcomes are considerably better than 30 years ago as more comprehensive assessment and management is now possible

Pattern and presentation of oral white lesions

Oral white lesions are not uncommon and a significant number of patients are asymptomatic. The purpose of this study was to determine the pattern and presentation of oral white lesions in patients reporting at oral and maxillofacial surgery department of AFID. World Health Organization [WHO] guidelines for oral mucosal examination were used to record data of 100 patients who presented with oral white lesions. Biopsies were performed in lesions whose definitive diagnosis was deemed difficult purely on the basis of history and clinical examination. The mean age was 38 +/- 13years with 57[57%] males. Forty two [42%] patients were asymptomatic. The most frequent site was buccal mucosa [64%] and more than half of these lesions appeared white [57%] while others were yellowish white [18%], grey white [15%] and with areas of redness within the lesion [10%]. Among habits, smoking was most common. The most common lesion was lichen planus [28%] followed by frictional keratosis [15%] and oral submucous fibrosis [13%]. Other rare lesions were geographic tongue, mucosal burns, candidiasis. As some of these lesions are premalignant, it is imperative for the dental and medical professionals to familiarize with their pattern and presentation to effect early diagnosis and management

Staged correction of facial asymmetry: a case report

Management of the facial asymmetry requires meticulous clinical and radiologic assessment to assess which bones are at fault. Correction of advanced cases may require surgically addressing occlusal cant deviation with asymmetrical impactions or down-grafting of maxilla, an asymmetrical rotation of mandible using either bilateral sagittal split or other ramus osteotomies and correction of residual chin deformity with a genioplasty. This may be accomplished within a single stage or stacked in a multi-staged plan. This is done in conjunction with orthodontics. Presented here is a case report of a post-pubertal young male patient with a skeletal class III profile, lower third facial asymmetry, occlusal canting and chin deviation

Transpapillary versus palatal injection technique for maxillary tooth extractions

To compare the pain during injection administration and efficacy of transpapillary injection with palatal injection for simple maxillary tooth extractions. Randomized control trial. The oral and maxillofacial surgery department of Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from July to December 2009. Patients requiring simple extraction in maxilla were randomly divided into two groups each consisting of 100 patients. Group 1 was given conventional palatal injection and served as a control, whereas Group 2 received the transpapillary injection. Two percent Lignocaine with Adrenaline [1:100,000] was used for both groups. Pain during injection and then during the extraction were recorded for both groups using the Visual Analogue Scale and Faces Pain Score Scales on specially designed proformas. The data was analyzed using SPSS version 17.0 and independent t-test was applied to compare pain between both groups. P-value of less than 0.05 was considered to be statistically significant. Group 1 consisted of 61 males and 39 females with an age ranging from 11-73 years [mean= 39.92 + 14.85 years] while Group 2 consisted of 59 males and 41 females with an age ranging from 10-70 years [mean= 39.31 + 18.53 years]. Results of FPS and VAS scores for injection and procedure were analyzed using independent t-test. Difference of scores for pain during injection were found to be significant [p < 0.05] while the scores for the procedure were seen to be statistically insignificant [p > 0.05] showing that transpapillary injection is equally effective for maxillary extractions as palatal injection but with significantly decreased pain during injection. Transpapillary injection is an easy and effective way of eliminating the pain of palatal injection for maxillary extractions

Aetiology and pattern of dentoalveolar injuries in patients at armed forces institute of dentistry, Rawalpindi

To determine the aetiology and pattern of dentoalveolar injuries in patients presenting to oral surgery department of Armed Forces Institute of Dentistry, Rawalpindi. Cross sectional study. Oral Surgery department, Armed Forces Institute of Dentistry, Rawalpindi. September 2008 to August 2009. One hundred and thirty eight consecutive patients presenting to oral surgery department with dentoalveolar injuries irrespective of the age and gender were included in the study. Edentulous patients, patients with only soft tissue injury and patients with other maxillofacial injuries but no dentoalveolar injury were excluded. The included patients were asked about the cause of injury and the pattern of injury was noted clinically. This information was collected on specially designed proformas. All injuries were classified according to Andersean's classification. Out of these 138 patients, 111 [80.4%] were males with a male to female ratio of 4.1:1. The age ranged from 2-65 years with a mean age of 21.22 years. RTA was the most common cause of injury and was seen in 58 [42%] patients. Followed by fall noted in 52 [37.7%] patients. Other causes observed were contact sports in 7 [5.1%], violence in 4 [2.9%] and work place accident in 7 [5.1%] patients. Regarding pattern, the most common type of injury was avulsion and subluxation followed by crown fractures, luxation, root fractures and tooth displacements in various directions. Males especially the young lot was more affected by dentoalveolar trauma. RTA and fall remain the main causes of these injuries in our population. Avulsion, subluxation and luxation were the most common patterns of trauma observed. Maxillary incisors were the most commonly affected teeth in these traumatic episodes

Reasons and pattern of first molar extraction - a study

The aim of this cross sectional prospective study was to determine reasons and patterns of permanent 1[st] molar extraction in patients reporting to oral and maxillofacial surgery department at Armed Forces Institute of Dentistry, Rawalpindi. All patients referred to oral and maxillofacial surgery department for extraction of permanent first molar teeth from 1st of January 2009 till 31[st] of December 2009 were included in the study irrespective of their age and gender. The primary reason of extraction was recorded along with other relevant information. The pattern of extractions of the permanent first molars was also noted. A total of 470 patients were included in the study. Out of these 291 [61.9%] were males [M: F 1.6:1]. Caries was the most common cause with 281 extractions [59.8%] in all age groups in both genders followed by periodontitis, which was responsible for 109 [23.2%] of permanent first molar extractions. Mandibular molars were more frequently extracted [62.7%] as compared to the maxillary molars [37.3%], with the mandibular left molar being the most frequently extracted tooth in the sample population

Oral cancer - are the dentists doing enough for its prevention and early diagnosis? - a study

The aim of this study was to determine whether and to what extent the dental profession is helping in the prevention and early diagnosis of oral cancers. Data were collected by distributing self administered questionnaires among two hundred randomly selected dentists of Rawalpindi and Islamabad to know what role they play in the prevention and early diagnosis of this deadly disease. More than half [52%] of the dentists did not ask or asked rarely about the use of tobacco, alcohol and other risk factors and only about a third [34%] advised and helped their patients to quit these habits. Only 22% of the dentists regularly examined the entire oral mucosa of all their patients and even fewer [12%] considered the possibility and then searched for a coincidental oral cancer. Only about 06% took biopsies of suspicious lesions regularly. The findings of this study indicate that the dentists of this region need to do a lot more for the prevention and early diagnosis of oral cancer

Inadequacies in history taking and clinical examination by the dentists

History taking and clinical examination are the most important steps in the diagnosis and hence overall patient management in medicine, surgery and dentistry. The purpose of this study was to determine the history taking and clinical examination practices of dentists. Self-administered questionnaires were distributed among two hundred randomly selected dentists of Rawalpindi and Islamabad. The questionnaire assessed how often these dentists recorded all the steps of history and how often they examined their patients thoroughly. While the vast majority of dentists asked most of their patient's demographics, chief complaint and the history of their chief complaint and examined all teeth of their patients, a considerable number of them missed the medical, family and socioeconomic history, did not record vital signs, and did not examine the entire head and neck and oral mucosa of all their patients. This study emphasizes deficiencies and inadequacies in the history taking and clinical examination practices of dentists in the studied sample