Periapical healing outcome following single visit endodontic treatment in patients with type 2 diabetes mellitus.

BACKGROUND: The prevalence of apical periodontitis in diabetes mellitus patients is high. The altered immunity in diabetes affects the healing process of periapical tissue. Single visit endodontic treatment has shown to increase the periapical healing rate with better patient compliance. Hence the present study aims at evaluating the clinical and radiographic healing outcome of single visit endodontic treatment, in type 2 diabetes mellitus patients with periapical disease. MATERIAL AND METHODS: Eighty patients with periapical disease were divided into 2 groups of 40 each: Group I, Control subjects and Group II, Type 2 diabetics. Glycosylated hemoglobin levels were assessed preoperatively and at follow up intervals in diabetics. Pre-operative assessment of periapical status was done using CPDR (Clinical periapical diagnosis of root), QLDR (Qualitative radiographic diagnosis of tooth) and QTDR (Quantitative radiographic diagnosis of tooth) criteria. Postoperative healing was evaluated following single-visit endodontic treatment by Strindberg criteria. RESULTS: Group 2 subjects had chronic and exacerbating lesions with significantly larger lesions (p=0.029). 100 % clinical healing outcome in diabetic group was seen in two months. Group 2 showed 85% success in one year on radiographic evaluation. Poor controlled diabetics showed failure compared to fair and good controlled. CONCLUSIONS: Type 2 diabetics had chronic and larger sized lesions when compared to control subjects. The periapical lesions in patients with poor diabetic control showed failure. The clinical and radiographic healing outcome of single visit endodontic therapy was delayed in diabetic patients. Key words:Apical periodontitis, diabetes mellitus type 2, endodontics, periapical lesion, strindberg criteria.

Evaluation of Radiomorphometric Indices in Panoramic Radiograph - A Screening Tool.

BACKGROUND: Mandibular cortical indices, like the mandibular cortical index (MCI), panoramic mandibular index (PMI), mental index (MI), antegonial index (AI) and gonial index (GI) have been developed to assess and quantify the quality of mandibular bone mass. Aim and Objectives : The aim of this pilot study was to measure the radiomorphometric indices in a digital panoramic radiograph and find the inter-relationship of the indices with age and sex of the patients. Materials and Method : A total of 23 randomly selected patients were included in the study. Panoramic radiograph of each patient was taken and radiomorphometric indices were determined. Results : There was 69.57% agreement between MI and PMI which was significant. Similarly 78.26% agreement was seen between AI and MI which was significant. In contrast 30.43%, 52.17% and 56.52% agreement was observed while comparing GI with PMI, MI and AI respectively. Conclusion : MCI, PMI, AI and MI can be effectively measured on a panoramic radiograph, hence could be used as a screening tool for determining osteoporosis. All indices have a negative correlation with age and a significant difference between the younger and older age groups. All indices were significantly lower in females when compared to males of the same age group.

Vanishing bone disease of the mandible - a case report.

BACKGROUND: Massive osteolysis (Gorham-Stout syndrome) is a rare condition of unknown etiology that is thought to result from a localized endothelial proliferation of lymphatic vessels resulting in destruction and absorption of bone. Osteolysis of the jaws has been reported in association with infection, cysts, neoplasia, and metabolic, endocrine, or hematologic abnormalities. Rare cases of idiopathic osteolysis have also been recorded. A detailed review from various peer reviewed journals has been discussed in this article. OBJECTIVES: To discuss the demographic distribution and possibilities of pathogenesis of Gorham-Stout syndrome. MATERIALS AND METHOD: A case report of vanishing bone disease of the mandible in a 60 year old female patient has been discussed. A detail review of literature highlighting the demographic distribution and pathogenesis of vanishing bone disease has been made. RESULTS: Thirty eight percentages of these lesions appear in older individuals with a slight male predilection. 68.6% of the oro-facial massive osteolysis occurs in mandible has been reported. Variable etiopathogenesis such as vascular proliferation, increased levels of circulating cytokines and circulatory disturbances have been associated with this disease. CONCLUSION: The Gorham-Stout syndrome though rarely seen in the facial skeleton, it is important to consider it in the differential diagnosis of osteolytic lesions of the jaws.

Age estimation from pulp/tooth area ratio (PTR) in an Indian sample: A preliminary comparison of three mandibular teeth used alone and in combination.

Pulp/tooth area ratio (PTR) method of adult dental age estimation has been examined on few tooth types. We assessed the lateral incisor (LI) and first premolar (PM1) in addition to canine (C) - alone and in combination. Periapical radiographs from 61 Indians aged 21-71 years were examined. PTR of LI produced the best age correlation (r = -0.395) followed closely by PM1 (r = -0.362). The canine revealed the lowest correlation (r = -0.206); among tooth combinations, the three teeth taken together had the best R value (-0.438) followed by LI + PM1 (-0.435), LI + C (-0.406) and C + PM1 (-0.37). The standard errors of estimates (S.E.E.) of the regression analyses for the individual teeth and tooth combinations ranged from ±12.13 to 13.08 years, indicating minimal difference in age estimates using solitary or multiple teeth. Errors were higher than in European groups (±2.5-5 years) which may partly owe to moderate age correlation of secondary dentine deposition in Indians. Moreover, facial soft-tissue superimposition in living subjects evaluated herein possibly precluded optimal tooth and pulp canal visualization. These indicate that the PTR method should be used judiciously in age estimation of living Indian adults, although further studies on larger samples with evenly distributed age-groups is necessary for deriving definitive conclusions.

Primary intraosseous carcinoma of mandible: a case report.

Primary de novo intraosseous carcinoma is a rare neoplastic lesion which commonly occurs in the jaws. It is an epithelial odontogenic malignancy arising from odontogenic epithelial residues in the bone rather than from a preexisting epithelial lesion. In the present case report, the clinical, radiological and histological features of primary de novo intraosseous carcinoma are discussed and its aggressiveness and local invasiveness are highlighted.

Age estimation in Indians from pulp/tooth area ratio of mandibular canines.

In India, age estimation of living individuals is gaining importance, particularly in cases of child labour, ascertaining majority status and to assess disputed age in criminals. Previous studies on adult age prediction in Indians have focused on histological parameters, which are invasive in nature and not feasible in the living. Methods for age estimation in living adults make use of radiographs to indirectly measure the rate of secondary dentine deposition and studies have focused on ratios of linear measurements rather than absolute dimensions per se. Recently, the ratio of the pulp/tooth area of canines was suggested by a group in Italy who developed regression formulas for age estimation. The present study has assessed the usefulness of one of the formulas on an Indian sample and also examined the use of an India-specific equation in age prediction. Intraoral periapical digital radiographs of mandibular canines were obtained from 143 individuals (aged 20-70 years) using the paralleling technique; pulp and tooth areas were measured using a commercially available computer software programme and the pulp/tooth area ratio was computed. Age was calculated using the Italian formula which revealed a mean absolute error (MAE) of 11.01 years in Indians, an error recognisably greater than the 4.38 years reported in the Italian sample. The divergence may be explained on account of population differences that exist between Italians and Indians as well as variation in the pattern of secondary dentine deposition in Indians. The Indian formula derived (age=64.413-(195.265 x PTR), where PTR is the pulp/tooth area ratio) was applied on a control group of 35 radiographs. The Italian formula was also applied on the control sample to ascertain if the Indian formula markedly improved age prediction. No apparent difference was observed between the two (MAE was 10.76 and 11.58 years, respectively, using the Indian and Italian formula) however, the Indian formula had a tendency to produce more 'stable' age estimates. This could be on account of low correlation (r=-0.34) between secondary dentine deposition and age in Indians and the consequent large pulp/tooth area ratio in some cases; such cases would invariably result in very low age estimates using the Italian formula, unlike the Indian formula which had factored in the low correlation.