Questionable accuracy of CBCT in determining bone density: A comparative CBCT-CT in vitro study.

BACKGROUND: The accuracy of the estimation of radiological bone density with the use of the cone-beam computed tomography (CBCT) grayscale is still questionable. Standardization and correlation with the gold standard computed tomography (CT) Hounsfield units (HU) is required prior to clinical application. OBJECTIVES: The objective of the present study was to evaluate the reliability of the grayscale for the estimation of bone density, using samples with intact soft tissue in order to substantiate the clinical use of the scale. MATERIAL AND METHODS: A total of 240 sites in 20 goat heads were scanned to obtain radiological bone mineral density via Hounsfield units in CT and the grayscale in CBCT. The anatomical architecture of soft tissues was preserved for all samples. Two observers obtained the data, which consisted of 3 variables (mean, minimum and maximum) for both scales. The statistical analysis of the data was conducted using Cronbach's alpha, Pearson's correlation coefficients, the independent samples t tests, and regression analysis. RESULTS: Differences in the means of the mean, minimum and maximum values between the 2 scales were statistically highly significant (p = 0.000). The correlation coefficients for the mean, minimum and maximum values of the 2 scales were 0.496, 0.037 and 0.396, respectively. Regression analysis revealed that the R2 values for the mean, minimum and maximum values were 29.79%, 21.05% and 19.45%, respectively. CONCLUSIONS: The positive but weak correlation between the 2 scales and the low predictive reliability of the grayscale reveals its questionable applicability for the estimation of density in comparison with the standard HU.

Efficacy of Diode Laser Ablation and Low Level Laser Therapy on Healing and Bacterial Load Reduction at Intraoral Biopsy Site.

Statement of the Problem: Healing complications after the conventional surgical biopsy procedure along with bacterial colonization indicates scope for sophisticated techniques. Amalgamation of photo-disinfection along with healing properties of diode laser with practiced biopsy technique can help in dealing with post biopsy complications. Purpose: The present study will analyze the possibility of conjugation of conventional surgical biopsy technique with diode laser regarding its superior properties for achieving better healing and analgesia along with sterilization of the biopsy site. Materials and Method: A randomized control trial was done where punch biopsy procedure was performed for homogenous leukoplakia. Patients were randomly divided into laser group (Test group) and control group. Test group received laser ablation and low level laser therapy (LLLT) on surgical site along with warm saline rinses whereas control group was prescribed with systemic analgesic and antibiotics. Pain on visual analogue scale (VAS), erythema along with the size of defect was evaluated on day 0, 2 and 4. Swabs were collected from the biopsy site and culture was done for evaluation of bacterial load. Results: Highly statistical significant values indicating laser induced analgesia were obtained after analysis for 2nd and 4th day (p= 0.00). Erythema and biopsy defect size evaluation showed significant results for 2nd day (p value 0.023 and 0.004 respectively), which showed absence of erythema and enhancement of healing in test group compared to controls. Statistical significant results were obtained for estimation of bacterial colonization with p value as 0.00, 0.00 for 2nd and 4th day claiming laser supported bacterial disinfection. There was a significant percentage increase on 2nd (p= 0.013) and decrease on 4th post-operative day (p= 0.022). Conclusion: The results encourage the conjugation of conventional incisional punch biopsy with low level lasers to avoid systemic intervention for post biopsy complications.

Occult prostate carcinoma with metastasis to the mandible presenting as numb chin syndrome.

Prostate cancer is one of the leading causes of death due to malignancy in men. Occult malignancy presenting with no primary symptoms could be a challenge to the diagnostician. Metastasis of prostate carcinoma to the mandible is rare and usually presents with non-specific symptoms. Only 1% of oral cancers account for lesions which present as metastasis of other primary malignancies. We report a rare case of prostate carcinoma being diagnosed as metastasis to the mandible with the patient presenting with numb chin syndrome.

Association of temporomandibular joint morphology in patients with and without temporomandibular joint dysfunction: A cone-beam computed tomography based study.

BACKGROUND: The etiology of temporomandibular disorders (TMDs) is complex and associated with multiple predisposing and initiating factors. Articular eminence morphology and steep eminence inclination have been postulated as the etiological factors, but there has been no clear evidence of association of morphology of the temporomandibular joints (TMJ) complex as a probable predisposing factor in the pathogenesis of TMDs. MATERIALS AND METHODS: This was a cross-sectional, case-control study, and cone-beam computed tomography scans, and the evaluation was performed for 60 joints in 30 patients with symptomatic TMDs and for 40 healthy joints of 20 age-matched patients. One-way ANOVA, post hoc, unpaired t-test, Chi-square, and intra-class correlation coefficient test were used to determine the correlation between the TMJ articular eminence inclination, height, condylar bone changes, condyle, and fossa shapes with symptomatic TMDs. The P < 0.05 were considered statistically significant. RESULTS: There was a statistically significant difference of articular eminence inclination and height with a steeper eminence inclination in the control group (P = 0.044*, and 0.035*). The condylar bone changes were found to be significantly more in the TMJ disorder group (P = 0.001*). There was no significant association of condyle and fossa shapes (P = 0.482 and 0.689) and of articular eminence inclination and height with condylar bone changes (P = 0.695, 0.498, 0.192, and 0.823) and condyle shapes (P = 0.389, 0.521, 0.260, and 0.387). The eminence inclination was not associated with fossa shapes (P = 0.471 and 0.086), but eminence height was associated with fossa shapes in the TMJ disorder group (P = 0.043* and 0.111). CONCLUSION: The results depicted that there was no significant association between TMJ complex anatomy and TMJ disorders in the present study population.

Mindful awareness for female dental students through yoga, motivational video, and a combination of two on stress reduction.

OBJECTIVE: Assessment of the potential effect of yoga, motivational videos, and a combination of two on stress reduction in female dental students. METHODS: The current study design is a nonrandomized trial carried out among female dental students (n = 120). The selected subjects were allocated into three groups, namely, group A: yoga group assigned under a professional yoga instructor, group B: motivational video group, and group C: a combination of two (A and B) involving yoga sessions and motivational videos; following which formative examinations were carried out at 6 weeks which were referred to as stressor 1 and those carried out at 12 weeks were referred to as stressor 2. Using Spielberger's State-Trait Anxiety Inventory for Adults (STAI-A) recordings were measured at baseline, stressor 1, and stressor 2. RESULTS: There was a significant decrease in trait anxiety scores at both stressors in all the groups with a significant reduction in depression score from stressor 1 to 2 in group 1 and group 3 subjects. The significant decrease occurred in STAI-A scores in group 1 and group 3 subjects at both stressors (P < 0.001) with no change observed in group 2 subjects. CONCLUSION: The present study is one of a kind and positively correlates yoga and motivational videos with stress reduction. Both of these interventions proved to be beneficiary for physical as well as mental health of study subjects.

Efficacy of Transcutaneous Electric Nerve Stimulation on Parotid Saliva Flow Rate in Relation to Age and Gender.

STATEMENT OF THE PROBLEM: Treatment with salivary substitutes and stimulation of salivary flow by either mechanical or pharmacologic methods has side effects and only provides symptomatic relief but no long-lasting results. PURPOSE: To assess the effectiveness of extraoral transcutaneous electric nerve stimulation (TENS) as a mean of stimulating salivary function in healthy adult subjects; as well as to determine the gender and age-dependent changes in salivary flow rates of unstimulated and stimulated parotid saliva. MATERIALS AND METHOD: Hundred patients were divided into two groups; Group I aged 20-40 and Group II aged ≥ 60 years. The TENS electrode pads were externally placed on the skin overlying the parotid glands. Unstimulated and stimulated parotid saliva was collected for 5 minutes each by using standardized collection techniques. RESULTS: Eighty seven of 100 subjects demonstrated increased salivary flow when stimulated via the TENS unit. Ten experienced no increase and 3 experienced a decrease. The mean unstimulated salivary flow rate was 0.01872 ml/min in Group I and 0.0088 ml/min in Group II. The mean stimulated salivary flow rate was 0.03084 ml/min (SD= 0.01248) in Group I, and 0.01556 ml/min (SD 0.0101) in Group II. After stimulation, the amount of salivary flow increased significantly in both groups (p< 0.001). Statistical comparison of the two groups revealed them to be significantly different (p< 0.001), with Group I producing more saliva. Gender-wise, no statistically significant difference was seen among the subjects in Group I (p = 0.148), and those in Group II (p= 0.448). Out of 12 subjects with 0 baseline flows, 7 continued to have no flow. Five subjects observed side effects, although minimal and transient. CONCLUSION: The TENS unit was effective in increasing parotid gland salivary flow in healthy subjects. There was age-related but no gender-related variability in parotid salivary flow rate.

Age estimation based on Kvaal's technique using digital panoramic radiographs.

INTRODUCTION: Age estimation is important for administrative and ethical reasons and also because of legal consequences. Dental pulp undergoes regression in size with increasing age due to secondary dentin deposition and can be used as a parameter of age estimation even beyond 25 years of age. Kvaal et al. developed a method for chronological age estimation based on the pulp size using periapical dental radiographs. There is a need for testing this method of age estimation in the Indian population using simple tools like digital imaging on living individuals not requiring extraction of teeth. AIMS AND OBJECTIVES: Estimation of the chronological age of subjects by Kvaal's method using digital panoramic radiographs and also testing the validity of regression equations as given by Kvaal et al. MATERIALS AND METHODS: The study sample included a total of 152 subjects in the age group of 14-60 years. Measurements were performed on the standardized digital panoramic radiographs based on Kvaal's method. Different regression formulae were derived and the age was assessed. The assessed age was then correlated to the actual age of the patient using Student's t-test. RESULTS: No significant difference between the mean of the chronological age and the estimated age was observed. However, the values of the mean age estimated by using regression equations as given previously in the study of Kvaal et al. significantly underestimated the chronological age in the present study sample. CONCLUSION: The results of the study give an inference for the feasibility of this technique by calculation of regression equations on digital panoramic radiographs. However, it negates the applicability of same regression equations as given by Kvaal et al. on the study population.

Central Telangiectatic Osteosarcoma of the Mandible in a Paediatric Patient: A Rarity.

Osteosarcoma (OS) involving the head and neck region is rare and is a diagnostic challenge due to its aggressive nature and varied presentations. Although OS constitute 40% to 60% of all bone tumours, only 10% of these occur in the head and neck region, most commonly in the maxilla and mandible. OS of the jaw bone has a different pattern and behaviour when compared to OS at other anatomic location. It occurs in a more elderly population, less aggressive and usually spreads locally rather than distant metastases. Telangiectatic Osteosarcoma (TOS) of jaws in a paediatric patient is still a very rare variant and till date only two cases have been reported in literature. Radiographic evaluation plays an important role as the clinical symptoms are not specific to the condition. Conventional radiography should always be supplemented by advanced imaging modalities for the diagnosis, which gives a three dimensional assessment and also prevents superimposition of surrounding structures. Early diagnosis and radical surgery are the keys to high survival rates. Herein, we present a third ever reported case of TOS occurring in mandible of a nine-year-old male patient.

Rehabilitation of digital defect with silicone finger prosthesis: a case report.

Patients with acquired defects often had severe trauma which leads to psychological instability, functional loss and poor aesthetics. Digital defects threaten the integrity of one's self esteem and also leads to a reduced and compromised function. A well fitted and colour matched finger prosthesis can make a patient feel a capable person and not a handicap. This article describes a technique for fabrication of custom made finger prosthesis with a silicone elastomer. The customization of the prosthesis leads to a better fit and retention. An excellent shade matching is achieved by the use of intrinsic colours. The other advantages of using silicone as a material of choice for prosthesis fabrication are also discussed.

Carcinoma ex pleomorphic adenoma of parotid gland with hepatic metastasis: clinic-radiological case report.

Pleomorphic adenoma originally called the mixed tumour is a neoplasm commonly involving major salivary glands. The spectrum of malignancy in pleomorphic adenoma comprises three distinct entities - Carcinoma ex pleomorphic adenoma, carcinosarcoma and benign metastasising pleomorphic adenoma. Carcinoma ex pleomorphic adenoma consists of pleomorphic adenoma with a malignant epithelial component. Occasionally, carcinomas ex pleomorphic adenoma develops metastasis. Here we are reporting here a case of benign pleomorphic adenoma arising in parotid gland which turned into malignancy after four years. The patient developed facial nerve paralysis suggesting malignant transformation. Along the course of the disease, the patient developed regional metastasis to lymph nodes and neck and distant metastasis to liver. This case report emphasises the role of advanced imaging modalities in the early diagnosis of the condition and evaluation of metastasis. The patients with this condition should be treated early for favorable outcome and investigated for distant metastasis.

Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewers in Moradabad district.

BACKGROUND: To determine the prevalence and severity of oral submucous fibrosis (OSMF) among habitual gutkha, areca nut and pan chewers of Moradabad, India. METHOD: A survey was conducted for a period of one year in east, west, north and south zones of Moradabad district, Uttar Pradesh. One thousand habitual chewers were selected as study participants, using a stratified random sampling technique, between the ages of 11-40 yrs, with a habit of chewing gutkha, areca nut, pan for over a year. A detailed history was recorded and meticulous clinical examination was conducted. Evaluation of taste sensation, hearing, interincisal distance, clinical staging was done in the OSMF patients found amongst habitual chewers. The obtained data was statistically analyzed using an SPSS 16.5 version soft ware. RESULTS: The prevalence of OSMF was 6.3% (63/1000) and gutkha chewing was the most common abusive habit (42/63) amongst OSMF patients. Stage 1, Stage 2, Stage 3 OSMF was seen in 28, 19 and 16 patients respectively. Restricted mouth opening, altered taste perception and defective hearing was observed in 37/63 (58.7%), 24/63 (38.09%) and 14/63 (22.22%) respectively. CONCLUSION: Our study shows a prevalence of 6.3% OSMF among habitual chewers of Moradabad. Prevalence and severity were more in urban and rural patients respectively.

Notching in the posterior border of the ramus of mandible in a patient with neurofibromatosis type I - a case report.

Neurofibromatosis Type I (NFI) is a relatively common hereditary, autosomal dominant neurocutaneous condition. It is a benign peripheral nerve sheath tumour arising from Schwann cells and peripheral fibroblasts. Even though it is a neurocutaneous disorder, NF I has significant skeletal manifestations. Oral and maxillofacial skeletal structures are also often involved in the form of deepening of sigmoid notch, enlarged mandibular canal and notching of inferior border of mandible. In this paper, we are reporting a female patient of NF I who presented with a notching in the posterior border of ascending ramus of mandible.

Ackerman's tumour of buccal mucosa in a leprosy patient.

Leprosy (Hansen's disease) is a chronic granulomatous disease caused by Mycobacterium leprae (Hansen's bacillus). Oral manifestations occur in 20-60% of cases, usually in lepromatous leprosy, and are well documented. They may involve both the oral hard and soft tissues. Incidence of verrucous carcinoma/Ackerman's tumour developing in anogenital region and plantar surfaces of feet in lepromatous leprosy has been sufficiently documented in the literature. However, association of oral verrucous carcinoma with lepromatous leprosy has not been established. We report for the first time a case of verrucous carcinoma of the buccal mucosa occurring in a leprotic patient, with brief review of literature on orofacial manifestations of leprosy.

Encysted Tenia solium larva of oral cavity: Case report with review of literature.

Cysticercosis is caused by the larvae of the pig tapeworm, Tenia solium. Oral cysticercosis is a rare event and is often a diagnostic challenge to the clinician. We report a 12-year-old girl who presented with a single, painless, nodule on the lower lip that was diagnosed as cysticercosis. Current literature on the clinical presentations, investigations, and treatment of the condition has been reviewed in this article. We have also proposed a set of criteria for the diagnosis of oral cysticercosis.

Positioning errors and quality assessment in panoramic radiography.

PURPOSE: This study was performed to determine the relative frequency of positioning errors, to identify those errors directly responsible for diagnostically inadequate images, and to assess the quality of panoramic radiographs in a sample of records collected from a dental college. MATERIALS AND METHODS: This study consisted of 1,782 panoramic radiographs obtained from the Department of Oral and Maxillofacial Radiology. The positioning errors of the radiographs were assessed and categorized into nine groups: the chin tipped high, chin tipped low, a slumped position, the patient positioned forward, the patient positioned backward, failure to position the tongue against the palate, patient movement during exposure, the head tilted, and the head turned to one side. The quality of the radiographs was further judged as being 'excellent', 'diagnostically acceptable', or 'unacceptable'. RESULTS: Out of 1,782 radiographs, 196 (11%) were error free and 1,586 (89%) were present with positioning errors. The most common error observed was the failure to position the tongue against the palate (55.7%) and the least commonly experienced error was patient movement during exposure (1.6%). Only 11% of the radiographs were excellent, 64.1% were diagnostically acceptable, and 24.9% were unacceptable. CONCLUSION: The positioning errors found on panoramic radiographs were relatively common in our study. The quality of panoramic radiographs could be improved by careful attention to patient positioning.

Intraoral venous malformation with phleboliths.

The most common type of vascular malformation is the venous malformation and these are occasionally associated with phleboliths. We report a case of a 45 year old woman with intraoral venous malformation with phleboliths.

Hemifacial microsomia: a clinicoradiological report of three cases.

Hemifacial microsomia is a congenital malformation in which there is deficiency in the amount of hard and soft tissues on one side of the face. It is primarily a syndrome of first and second branchial arches involving underdevelopment of the temporomandibular joint, mandibular ramus, masticatory muscles, ears and occasionally defects in facial nerve and muscles. Here, we report three cases of hemifacial microsomia diagnosed based on clinical and radiographic findings. All three cases had variable presentations ranging from the mildest form that included facial asymmetry and ear deformity to the most severe and unusual form with facial nerve paralysis and spine deformity.