A 3D-printed vanperio educative dental model - A review report of its chairside evaluation.

Background: Patient education and demonstration of osseous defects by teachers and clinicians are difficult even though there are different models made up of metal, plastic, plaster, stone, and acrylic. To overcome such difficulty, 3D printed Vanperio model was printed for multifunctional activity. Aims and Objective: The aim of this article was to provide information on the 3D printed VANPERIO model and its implications in the field of periodontics and general dentistry. Conclusion: Vanperio model proves to be a promising model for teachers, students, and clinicians in the field of periodontics and general dentistry as it helps in patient education, student learning and also for various demonstrations which is not possible to achieve in other available expensive models.

Dental Fluorosis and Periodontium: an Original Research Report of In Vitro and In Vivo Institutional Studies.

Fluorosis is one of the global problems that have persisted for a very long time now without any specific treatment and cure. Fluoride is known for its influence on the tooth structures like enamel and dentin, but little information exists on its effect on the surrounding periodontal structures and bone. With this background, we conducted multiple studies assessing etiological, diagnostic, therapeutic and clinical criteria in subjects with and without dental fluorosis in a single group of the population residing in high fluoride water areas (1.5-3.0 ppm) of Davangere District, Karnataka, India. These preliminary studies conducted are hereby elaborately presented and discussed in this comprehensive review article along with their important conclusions.

Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature.

PURPOSE: Subependymal giant cell astrocytomas (SEGAs) are rare tumors typically found in tuberous sclerosis patients. They typically grow in the region of the foramen of Monro and can occlude it, leading to hydrocephalus. Currently, gross total resection is the standard of care, with low rates of recurrence but high rates of complication, especially with larger lesions. Laser interstitial thermal therapy (LITT) is a newly emerging treatment modality for a variety of pathologies. Here, we present a case series of SEGAs managed via LITT and endoscopic, stereotactic septostomy. METHODS: A retrospective chart review was performed to identify three cases in which SEGAs were treated via LITT and septostomy. Stereotactic ablation was performed via magnetic resonance (MR) thermometry with laser output set to 69% for 2.5 min, with post-ablation scans for visualization of treatment area. RESULTS: Average age at surgery was 8.2 years. Pre-operative tumor volumes were 0.43, 1.51, and 3.88 cm3. Post-operative tumor volumes were 0.25, 0.21, and 0.68 cm3. Mean tumor volume reduction was 70%. No complications occurred. CONCLUSION: LITT with septostomy should be considered a viable primary or adjunct treatment modality for SEGAs.

Tooth for a tooth: Tissue engineering made easy at dental chairside.

BACKGROUND: Stem cells are unspecialized, multipotent cells which can differentiate into different cell types. The human periodontal ligament encloses subpopulation of Periodontal Ligament Stem Cells (PDLSCs) which are able to regenerate the periodontium by differentiating into various cells of PDL. Literature have shown the promising results of periodontal regeneration by exvivo cultured transplantation of PDLSCs into the osseous defects. METHODS: Based on current literature on use of ex vivo culture and associated problems, a novel technique is being presented , Stem cell application in periodontal regeneration (SAI-PRT) which uses autologous PDLSCs along with its niche adhering to extracted tooth root for direct application using gelatin sponge as scaffold in regeneration of intrabony periodontal defect bypassing ex-vivo culture. RESULTS: The cases initiated under SAI-PRT protocol, and have shown excellent clinical and radiographic improvement in intrabony defect using direct transplant of autologous PDLSCs . CONCLUSIONS: SAI-PRT can be used for the treatment of periodontal osseous defects at chair side.

Evaluation of the Mandibular Function, after Nonsurgical Treatment of Unilateral Subcondylar Fracture: A 1-Year Follow-Up Study.

There are no clearly defined guidelines for when an open or closed treatment is indicated for treatment of mandibular condylar fractures. The aim of the study is to analyze the mandibular function after nonsurgical treatment of unilateral subcondylar fractures, in a prospective study. A prospective study was conducted on 30 patients with unilateral mandibular subcondylar fracture undergoing nonsurgical treatment. Clinical and radiographic examinations were done prior to treatment and at 12-month follow-up. Pain, perceived occlusion, mouth opening, protrusion, and horizontal movements of the mandible were evaluated by clinical examination. Radiologic evaluation was done using Panoramic and Reverse Towne's radiographs. At 12-month follow-up, there was minimal pain in the temporomandibular joint region, there was an improvement in the perceived occlusion, and mouth opening did not reduce. There was insignificant absolute difference between left and right lateral mandibular movements. The amount of increase in the protrusion of mandible was insignificant. On radiographic evaluation, the degree of coronal and sagittal displacement was insignificant at follow-up. Mean ramus height pretreatment and 12 months posttreatment were 0.98 ± 0.50 and 0.87 ± 0.47, respectively. Based on this study, patients had adequate mandibular function and minimal pain after nonsurgical treatment. Unilateral subcondylar fractures of the mandible can be treated nonsurgically in patients with minimal occlusal discrepancies, adequate mouth opening, minimal displacement of condyle, and minimal ramus height shortening.

Missed Opportunities for Nutritional Rehabilitation in Children Admitted to Surgical Wards.

Background. Malnutrition in children has serious health and economic consequences. We studied documentation of malnutrition, actual prevalence, and treatment given in children admitted to surgical wards. Methods. Retrospective study of 154 patients aged <5 yrs admitted to general surgical, orthopedic, and otorhinolaryngology wards. Records were evaluated for completeness of data, way of documentation, and data quality. Descriptive analysis was done. If malnutrition was not identified and/or proper action was not taken, it was defined as a "missed opportunity." Results. Of 154 records audited, 100 (64.94%) were males, 108 (70.13%) were from general surgery ward, and 78 (50.65%) were residing in suburban area. The mean (SD) age of the study population was 2.32 (1.16) years whereas mean (SD) duration of stay was 5.84 (6.29) days. Weight and height were mentioned in 116 (75.32%) and 8 (5.19%) records, respectively, mostly by nonsurgical personnel. Documentation and treatment of malnutrition were poor. Out of 106 apparently correct weight records, 19 (17.93%) children were severely undernourished and 30 (28.30%) were moderately undernourished whereas 20 (18.87%) children were not undernourished but required nutritional attention. Conclusion. There is poor documentation of nutritional indicators of children admitted to surgical wards. From data that was available, it is apparent that malnutrition is at high levels. "Identification" and hence management of malnutrition need more attention.

Autologous Stem Cell Application in Periodontal Regeneration Technique (SAI-PRT) Using PDLSCs Directly From an Extracted Tooth···An Insight.

Periodontal regeneration represents the ultimate goal of periodontal therapy. The current regenerative techniques have limited success rates especially in advanced periodontal defects. Currently the research is focused on novel cell-based approaches for periodontal regeneration to overcome the limitations of existing treatment. The human clinical trial on stem cells based periodontal regeneration is promising. The plethora of animal studies provide sound evidence to support the belief that periodontal ligament stem cells (PDLSCs) can be used for periodontal regeneration. The direct application of autologous periodontal stem cells in treatment of intrabony defects is attempted for the first time in periodontal literature. Stem cell Application in Periodontal Regeneration Technique (SAI-PRT) using direct PDLSCs has overcome the limitations and concerns of ex- vivo stem cell culture methods like high cost, technique sensitivity, loss of stemness during cell passage, genetic manipulation and tumorigenic potential. Clinical feasibility, success and cost effectiveness over currently available techniques are encouraging. The clinical utility of this novel idea is recommended.

Breastfeeding Practices, Demographic Variables, and Their Association with Morbidities in Children.

Appropriate feeding practices are the key contributor to reducing morbidities and mortalities in under-five children. A cross-sectional questionnaire based survey of mothers of children aged less than 5years was conducted in 781 mothers. More than half of mothers (57.5%) started feeding within an hour of birth, 55.9% gave exclusive breastfeeding for six months, 89.1% of the mothers stopped breastfeeding before two years of age, 18.2% of the mothers bottle-fed the babies, and 15.6% had problems during breastfeeding in first 6 months. Early initiation of breastfeeding within one hour of birth promoted exclusive breastfeeding, and breastfeeding for longer duration. Exclusive breastfeeding increased frequency of feeds. Multivariable logistic regression showed that initiation of breastfeeding after an hour of birth (p = 0.035), not providing exclusive breastfeeding for 6 months (p < 0.0001), unemployed mothers (p = 0.035), having two or more kids (p = 0.001), and complementary feeds given by person other than mother (p = 0.007) increased hospitalization. Starting breastfeeding after an hour of birth (p = 0.045), severe malnutrition (p = 0.018), and breastfeeding for < two years (p = 0.026) increased rates of diarrhea. Breastfeeding practices were not optimum and interventions to improve these practices need to be strengthened.

Comparison of clinical efficacy of methylprednisolone and serratiopeptidase for reduction of postoperative sequelae after lower third molar surgery.

BACKGROUND: Surgical removal of mandibular third molars results in some degree of post-operative pain, swelling and trismus. These can be controlled by proper administration of local anesthesia, careful bone removal, minimal trauma to adjacent soft tissues and administration of methylprednisolone and serratiopeptidase drugs. The aim of the present study was to compare the efficacy of methylprednisolone and serratiopeptidase in controlling post-operative pain, swelling and trismus after surgical removal of impacted mandibular third molars. MATERIAL AND METHODS: The subjects were divided into two groups of 50 patients each undergoing surgical removal of mandibular third molars. Group A was given methylprednisolone 4mg orally every 8th hourly and Group B was given serratiopeptidase 10 mg every 12th hourly orally. Post-operatively pain, swelling and trismus were evaluated at the end of 1st, 3rd and 5thday. RESULTS: The results of this study showed that methylprednisolone is an effective analgesic, while serratiopeptidase has moderate analgesic activity. Serratiopeptidase is more effective than methylprednisolone in controlling post surgical swelling and trismus. Hence combination of these two drugs would be very effective than individual drug when widespread post-operative sequelae are expected after surgical removal of impacted lower third molars. CONCLUSIONS: We conclude that methylprednisolone affords better pain relief while serratiopeptidase exerts better anti-inflammatory and anti-swelling effects in the post-operative period. Synergistic combinations of these two drugs would however prove to be more effective when extensive post-operative sequelae are expected. Key words:Methylprednisolone, serratiopeptidase, pain, swelling, trismus, third molar.

Proficiency of residents and fellows in performing neonatal intubation.

OBJECTIVE: To determine success rate and time taken for intubation by pediatric residents/fellows. METHODS: Prospective observational study among neonates requiring endotracheal intubation. RESULTS: 212 attempts and 118 successful intubations were recorded in 153 videos. An average of 1.93 attempts per successful intubation was observed. Success rate at first attempt and mean time taken by first year, second year, third year residents and fellows were 26% and 51.9; 79% and 39.8; 69% and 40.1; and 67% and 31.5 seconds, respectively. Complications were noted in 77 (36%) attempts. 44 (21%) intubations were performed within 30 seconds. Increase in complications was noted with increase in attempt time beyond 40 seconds. CONCLUSIONS: Skill improved from first year to second year. Most intubations exceeded 30 second time limit. There is a need to improve training methodology to ensure intubation time by health personnel does not exceed the expected time limit.

Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: randomized double-blind clinical trial.

OBJECTIVE: Dental handpieces, ultrasonic scalers, air polishers, air abrasion units produce the most visible aerosols. The objective of this study was to assess the effect of chlorhexidine (CHX), povidone iodine (PI), and ozone (OZ) on the microorganisms in dental aerosols. MATERIALS AND METHODS: A total of 60 patients were included in this study, they were randomly assigned into three groups and were subjected to scaling before and after rinsing with 0.2% CHX, 1% PI or irrigation with OZ. Blood agar plates were used to collect the gravitometric settling of aerosols and were sent for aerobic and anaerobic culture. RESULTS: The results demonstrated high percentage reduction of aerobic and anaerobic colony forming units (CFUs) in all three groups. In aerobic CFUs, CHX showed the highest reduction (57%) at mask position whereas at chest position and at 9 ft, PI showed higher CFU reductions (37% and 47%, respectively). In anaerobic CFUs, CHX showed the highest percentage of reduction at chest level (43%) and at 9 ft (44%). CONCLUSION: CHX, PI and OZ showed similar effects in reducing aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a preprocedural agent, considering its beneficial effects.

Factors influencing lingual nerve paraesthesia following third molar surgery: a prospective clinical study.

BACKGROUND AND OBJECTIVES: The purpose of this prospective study was to evaluate the incidence and various risk factors influencing the sensory deficit in case of lingual nerve injury (LNI) in individuals whose impacted mandibular third molars are surgically removed under local anesthesia. MATERIALS AND METHODS: The study was based on the data collected prospectively from a random group of 100 patients who underwent surgical removal of bony impacted lower third molar in a dental hospital. Details of the patient, reason for extraction, type of impaction, method of surgery and signs and symptoms of nerve injury are recorded. Neurosensory testing was done to evaluate the LNI at 1 week, 1 months, 3 months and 6 months interval. Comparison was carried out using Chi square test. For all tests a P < 0.05 was considered significant. RESULTS: The incidence of LNI was 4 % and of temporary in nature which recovered well within 6 months postoperatively. The age of the patient above 26 years, lingual flap retraction, depth of impaction (red line ≥10 mm) and duration of surgery above 30 min were the significant factors for causing LNI. CONCLUSIONS: The age of the patient, depth of impaction, lingual flap retraction and longer duration of surgery are significant risk factors for LNI during mandibular third molar surgery. Greater care should be taken to avoid the morbidity and patients should be informed well ahead about the probable complications.

Estimation of C-reactive Protein Associated with Mandibular Fracture.

BACKGROUND: The aim of the present study is to evaluate the C-reactive protein (CRP) levels pre-operatively and post-operatively following a surgical intervention of mandibular fracture with osteosynthesis by rigid fixation using AO/ASIF principles and to try and correlate the prognosis of the convalescent period. METHODS: Twenty five patients with trauma were surgically treated. The blood samples are collected pre-operatively, immediate post-operatively, after 24 h and on the seventh post-operative day. RESULTS: The CRP levels were high pre operatively due to body's initial response to trauma. An increase was noticed immediately after the surgery (mean value 1.96 ± 0.56 mg/dl). After 24 h of surgery, CRP levels were raised markedly (mean value of 2.3 ± 0.58 mg/dl). On the seventh day after the surgery CRP levels were significantly decreased to attain normal level (mean value of 1.58 ± 0.52 mg/dl), indicating normal healing at the surgical site. CONCLUSION: In cases of patients with mandibular fracture the CRP concentration increases directly after the trauma and the surgical procedure. Then it undergoes a gradual normalisation which ensures non complicated healing post operatively.

Effect of alkalinisation of lignocaine for intraoral nerve block on pain during injection, and speed of onset of anaesthesia.

Injections of lignocaine as local anaesthetic for pain control in oral and maxillofacial surgery can themselves be painful. The time of onset of anaesthesia is from 3 to 5 min. Sodium bicarbonate has been used worldwide to reduce both these drawbacks to the injection, so making procedures more acceptable. This randomised prospective trial of 100 patients aged 18-55 years who were given 3 nerve blocks (inferior alveolar, lingual, and long buccal) was designed to assess the effect of alkalinisation of the lignocaine solution with sodium bicarbonate. All patients were given 2% lignocaine hydrochloride with adrenaline 1:80,000 and 50 patients were randomly allocated to be given 8.4% sodium bicarbonate in a 1/10 dilution. Pain was measured on a visual analogue scale (VAS). No patient given the injection with sodium bicarbonate complained of pain, compared with 39/50 (78%) not given sodium bicarbonate (p<0.0001). The mean (SD) time (seconds) to onset of local anaesthesia in the group given sodium bicarbonate was 34.4 (9.8) compared with 109.8 (31.6) in the control group (p<0.001). Our results have confirmed the efficacy of the alkalinised local anaesthetic solution in reducing pain on injection and resulting in quicker onset of anaesthesia.

Efficiency of ultrasonography in assessing cervical lymph node metastasis in oral carcinoma.

OBJECTIVES: The study was conducted to assess the value of ultrasonography (USG) for lymph node metastasis in patients with carcinoma of oral cavity. MATERIALS AND METHODS: A total of 20 cases were selected with primary tumor of oral cavity. Ninety-two lymph nodes were detected by ultrasound of 5 mm or more in diameter. The patients were examined preoperatively for palpable lymph nodes clinically and ultrasonographic examination of bilateral neck. Ultrasonographic parameters, such as size, shape, boundaries (well-delineated/ poorly delineated) and internal echoes for the lymph nodes were recorded. RESULTS: The histologic positive rate was 25%, 80% and 93% for nodes between 5 and 10 mm, 10 and 15 mm and for nodes 15 mm or more in size, respectively. Ultrasonographic findings showed a high significance as the size of nodes increases. The positive rate of 86% for the round nodes of 9 mm or more in size showed a high significance. The positive rate was 93% for well-delineated nodes and 68% for poorly delineated nodes. The most frequent echo pattern was homogenous followed by hypoechoic with positive rate for metastasis ranging from 83% to 88%. CONCLUSION: The diagnostic validity of USG as compared with histopathology showed sensitivity of 86% and specificity of 73% with overall efficiency of about 82% in detecting lymph node metastasis. USG is useful for preoperative evaluation of the neck, as the most reliable, inexpensive and easily available method. It is essential for diagnosis, staging and therapy choices.

Common bile duct stones - their presentation, diagnosis and management.

Common Bile duct stones (CBD) continue to pose a significant problem both to the patient and the Surgeon. They increase the morbidity of a patient undergoing Cholecystectomy from less than 5% to as much as 20% and almost zero mortality to as high as 30%. Recent times have thrown up a fair share of controversy in the management of this condition both due to technological innovations and costreduction-pressures. The aim in CBD stone disease, as in any benign disease is to discover a therapeutic algorithm with minimal morbidity, no mortality and at reasonable cost. This can be achieved only by a thorough understanding of the disease and also the available diagnostic and treatment modalities.This article dicusses the diagnosis, investigation and therapy of Common Bile Duct Stones (CBD) and gives a therapeutic algorithm.

Quality of life up to 30 years following liver transplantation.

Liver transplantation provides a return to a satisfactory quality of life (QOL) for the majority of patients in the short to medium term (first 5 years), but there is very little information on the QOL in the longer term and the factors influencing it. We therefore undertook a single-center cross-sectional analysis to determine QOL in patients 10 or more years after liver transplantation. All liver transplant recipients who were followed up at the Cambridge Transplant Unit for 10 or more years (transplanted between 1968 and 1994) and resident in the United Kingdom were asked to complete by post the Short Form 36 version 2 and the Ferrans and Powers questionnaires to evaluate their QOL. Univariate and multivariate analysis were performed to assess the relationship between a range of clinical parameters and QOL. One hundred two patients were invited to participate, and 61 (59.8%) responded. Overall, the patients reported a satisfactory QOL. On the Ferrans and Powers questionnaire, the patients had a mean Quality of Life Index score of 24.5. Factors associated with reduced physical functioning were age > 50 years at transplantation, female gender, and recurrence of the primary liver disease. On the Short Form 36 version 2 questionnaire, recipients had reduced physical functioning but normal mental health parameters in comparison with the normal population. Age > 60 years at the time of survey, female gender, and posttransplant complications were associated with reduced physical functioning. In conclusion, patients 10 or more years after liver transplantation generally have a good QOL, although physical functioning is reduced. Addressing issues such as recurrent disease and posttransplant problems such as osteoporosis may help to improve long-term QOL.