Efficacy of Three-dimensional Locking Miniplates versus Three-dimensional Standard Miniplates in the Management of Mandibular Fractures - A Prospective Clinical Study.

Introduction: Fifty patients were included to compare the efficacy of three-dimensional (3D) locking miniplates versus 3D standard miniplates in the management of mandibular fractures. Materials and Methods: Fifty patients were randomly allocated to either 3D locking miniplate group or 3D standard miniplate group. All patients were followed for six months to compare post-operative occlusion, stability and associated clinical complications such as wound dehiscence, infection and plate/screw fracture and mental nerve paraesthesia. Results: All the fractures were adequately fixed when checked intraoperatively. Four patients in each group had mildly deranged occlusion, one patient in Group A and two patients in Group B had reduced stability. None of the patients had complications of non-union or malunion. In Group A, one out of 25 patients had mental nerve paraesthesia and two had wound dehiscence. Moreover, in Group B, two patients had mental nerve paraesthesia and two others had wound dehiscence. The data when compared were statistically significant (=0.05). Discussion: The overall result of our study led us to the conclusion that both the plating systems were satisfactory and there is no statistically significant difference when used for open reduction and fixation in mandibular fractures. Healing was satisfactory in both groups.

Ameloblastoma: A retrospective analysis of 31 cases.

AIMS AND OBJECTIVE: To evaluate the surgical treatment given and do a regular follow up to study the recurrence rate and complications of ameloblastoma in our institution. MATERIALS AND METHODS: A total of 31 cases of various subtypes of ameloblastoma, treated with different modalities, in the Department of OMFS, were recalled for a follow up & radiographs were taken along with the clinical examination for any recurrence or complications such as fracture/exposure of the reconstruction plate, loosening of the screw, infection of the graft, any draining sinus/signs of infection. RESULTS: Two of our patients had fractured reconstruction plate, one patient developed infection, one patient complained of screw exposure and two other patients had infection of the iliac graft. CONCLUSION: We conclude that an adequate resection with a safe margin could be a treatment option and can be undertaken depending on the extent, location of the lesion and histopathologic variant.

Healing of extraction socket following local application of simvastatin: A split mouth prospective study.

BACKGROUND: The role of simvastatin in lowering serum cholesterol level is well described. However, recent findings suggest they have a role in bone formation as well. AIM AND OBJECTIVES: The present prospective study was conducted to evaluate the efficacy of simvastatin on bone formation in extraction sockets. MATERIALS AND METHODS: 15 patients undergoing all four first premolar extraction were selected based on inclusion and exclusion criteria. Extraction sockets of left premolars (24 and 34) were considered as cases and right premolars (14 and 44) as controls. Overall 30 extraction sites were assigned to each group. Atraumatic extraction was done in all cases following which simvastatin mixed with gelatin sponge was placed in extraction socket of 24 and 34 while only gelatin sponge was placed in 14 and 44. All sockets were then closed with 3-0 vicryl. The patients were kept on follow-up and complications such as dry socket, pain, and swelling were recorded. Intra oral peri apical radiographs were taken immediately after extraction and at 2nd month and 4th month to record changes in the density of alveolar bone. The radiographic measurements were compared and the differences were statistically analyzed. RESULT: Percent increase in bone density at the end of 8th week and 16th week was significantly high in case as compared to the control group. CONCLUSION: Local application of simvastatin induces bone formation in extraction sockets. Application is very simple and provides a very cost effective way of faster bone regeneration following tooth extraction.

Bone Ring Augmentation Around Immediate Implants: A Clinical and Radiographic Study.

PURPOSE: The purpose of this study was to evaluate the efficacy of bone ring augmentation technique for three-dimensional augmentation of severely defective sockets along with placement of immediate dental implants. MATERIALS AND METHODS: A clinical study was conducted on 14 patients with 15 defective sockets requiring extractions and immediate implant placement. Following extraction, bone ring with an implant osteotomy, harvested from chin, was sculptured and fitted into the extraction socket. The bone apical to the socket was prepared for implant through the central osteotomy of the ring. Implant was then placed through the ring into the apical bone. After 6 months, prosthesis was placed. Clinical and radiographic examination was done to evaluate the soft tissue and crestal bone level around implants immediate postoperatively and at 1st, 3rd, 6th, and 9th month postoperatively. RESULTS: Out of 15 grafted sockets, 14 showed an evidence of bone healing with no significant crestal bone resorption. One ring showed soft tissue dehiscence which underwent severe resorption at 6th month postoperative visit. CONCLUSION: The bone ring augmentation technique is an effective method for three-dimensional augmentation of severely defective sockets. This technique helps in reducing the overall treatment time by allowing grafting and placement of implant simultaneously in a single visit. However, longer observation periods are needed to draw more definite conclusions on the success of bone ring augmentation technique.

Clinical use of the resorbable bioscaffold poly lactic co-glycolic acid (PLGA) in post-extraction socket for maintaining the alveolar height: A prospective study.

BACKGROUND: A common sequel of tooth extraction is alveolar bone resorption. It makes the placement of dental implants difficult and creates an esthetic problem for the fabrication of conventional prostheses. Therefore, alveolar bone following tooth extraction should be preserved. AIMS AND OBJECTIVES: The present prospective study was conducted to evaluate the efficacy of the resorbable bioscaffold poly lactic co-glycolic acid (PLGA) in maintaining the alveolar height in post-extraction socket. MATERIAL AND METHODS: 20 patients were selected based on inclusion and exclusion criteria and were randomly divided into two groups: cases and control comprising of 10 patients each. Atraumatic tooth extraction was done in all patients. PLGA bioscaffold was placed in cases and socket was closed with 3-0 vicryl. In control group, socket was directly closed with 3-0 vicryl. The patients were kept on follow-up and complications such as dry socket, pain, and swelling were recorded. IOPA were taken at 1st, 4th, 12th, and 24th week to record changes in the height of alveolar bone. The radiographic measurements were compared and the differences were statistically analyzed. RESULTS: Reduction in alveolar bone height after placement of PLGA bioscaffold was significantly less in cases as compared to controls at 4th, 12th, and 24th week following extraction. No complications were observed throughout the follow-up period. CONCLUSION: PLGA scaffold significantly reduces bone resorption. Application is very simple and can be easily performed in a dental setup. However, PLGA scaffold adds significantly to the cost of treatment.

Distraction osteogenesis in the treatment of temporomandibular joint ankylosis with mandibular micrognathia.

AIMS: The aims of the study were to evaluate the efficacy of simultaneous interpositional arthroplasty with distraction osteogenesis (DO) as a single procedure and to give the patient acceptable functional rehabilitation with correction of the gross facial asymmetry. MATERIALS AND METHODS: Nine patients of temporomandibular joint (TMJ) ankylosis with micrognathia were treated with interpositional arthroplasty and simultaneous DO and followed for a period of minimum 3 years. Preoperative, immediate postoperative, at the end of distraction, at 6 months and 3 years postdistraction consolidation radiographs were taken along with the clinical examination for mouth opening, deviation, length of the mandible and ramus, midline shift, occlusal cant, and occlusion. RESULTS: The results showed an increase in the mouth opening, length of the mandible and ramus height, correction of deviation, occlusion, and midline shift. Relapse was not seen in any case, rather one patient developed infection at the distractor site and two patients had fracture of the roots of the teeth at the osteotomy site. There was an overall improvement in the facial asymmetry. CONCLUSION: Simultaneous interpositional arthroplasty with DO should be used to correct TMJ ankylosis associated with facial asymmetry/micrognathia, as it reduces the need for second surgery, thereby saving the trauma of a second surgery and difficulty in intubation, increases the length of the mandible, corrects the deformity, thereby resulting in an acceptable facial esthetics and function.

Micro-marsupialization versus surgical excision for the treatment of mucoceles.

BACKGROUND: Mucocele is a common disorder of minor salivary glands which arises due to mucous accumulation resulting from their alteration. Several techniques have been described for the treatment. However, most of them are invasive or require costly armamentarium. PURPOSE: The present study was conducted to evaluate the efficacy of micro-marsupialization technique as an alternative to surgical excision for the treatment of mucoceles. MATERIALS AND METHODS: A prospective study was conducted. A total of twenty patients were selected based on clinical diagnosis of mucoceles and were randomly divided into two groups comprising ten patients each. Micro-marsupialization was done in Group 1 patients and surgical excision in Group 2. Patient's gender, age, size, location, duration, complications, and recurrences were evaluated during various visits. Data between the two groups were analyzed by descriptive and analytical (Chi-square tests) statistics. RESULTS: The mean age of the patients in Group 1 was 19.6 ± 9.6 years while in Group 2 was 21.9 ± 11 years. The most common location for mucocele in Group 1 as well as Group 2 patients was lower lip (60% and 80%, respectively). In Group 1, two patients had recurrence while in Group 2, one patient had a recurrence. All recurrent cases were subsequently treated by surgical excision. No statistically significant difference was found between the two methods. CONCLUSION: Micro-marsupialization technique is as efficacious as surgical excision for the treatment of mucocele. It is advantageous over surgical excision as it is simple to perform, is less invasive therefore not associated with complications associated with invasive procedure, and is well tolerated by patients.

Comparison of efficacy of mandible and iliac bone as autogenous bone graft for orbital floor reconstruction.

OBJECTIVE: This study evaluated and compared the efficacy of mandible and iliac bone as autogenous bone graft for correction of orbital floor fractures. PATIENTS AND METHODS: Twenty patients who suffered orbital floor fractures took part in the study. The subjects enrolled in the study sustained both isolated orbital floor fracture and orbital floor fracture associated with fracture of zygomatico-maxillary complex. Each inferior orbital wall was reconstructed using either a mandible bone graft or an iliac graft. Mandibular symphysis was opted as a donor site for graft harvest from mandible and anterior iliac crest for the iliac group. CT scans were taken before the operation. Inclusion criteria consisted of at least 2 months postsurgical follow-up, pre- and post-surgical photographic documentation, and complete medical records regarding inpatient and outpatient data. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, and restriction of ocular movements before and after treatment. We also considered the time required for the harvest of the grafts and the donor site complications. A comparative study was carried out using Chi square test and student t test. We considered P value <0.05 to be statistically significant. RESULTS: Ten iliac crest grafts and ten mandible bone grafts were placed. The mean age of the patients was 33.1 years. 80 % of the patients were males. The most common complication of orbital floor fracture was diplopia, followed by enophthalmos and restriction of ocular movements. The post operative results were compared after 2 months of the surgery. In iliac crest group, diplopia got corrected in six out of seven patients (85 %), enophthalmos in four out of five patients (80 %) and restricted ocular movement showed 100 % correction. While in mandible group, diplopia and ocular movement showed 100 % correction and enophthalmos got corrected in five out of six patients (83 %). No statistically significant differences were found between the two groups on comparing these variables. On the other hand the mean time required for the harvest of iliac graft and mandible graft was 30.2 ± 3.52 min and 16.8 ± 1.75 min respectively. The difference was statistically significant. CONCLUSION: There is no difference in the ability of mandible and anterior iliac crest bone grafts to correct post-traumatic diplopia, enophthalmos and restricted ocular movements. But the time and ease of harvest of the graft from mandible was comparatively less and easy especially when the treating doctor was an oral and maxillofacial surgeon. Secondly the post-operative morbidity was low and the quality and contour of the bone graft was very adaptable for the reconstruction of the orbital floor.

Comparison Between Betamethasone and Sodium Hyaluronate Combination with Betamethasone Alone After Arthrocentesis in the Treatment of Internal Derangement of TMJ-Using Single Puncture Technique: A Preliminary Study.

PURPOSE: This study was designed to compare the intra-articular injection of betamethasone and sodium hyaluronate (combination) with betamethasone alone after arthrocentesis using single puncture technique into the upper joint space in the treatment of temporomandibular joint internal derangements. MATERIALS AND METHODS: Fourteen patients with internal derangement were randomly selected and divided into 2 groups (7 in each group). Arthrocentesis with single puncture technique of the upper joint space was then performed using ringer lactate under local anesthesia, followed by injection of either betamethasone and sodium hyaluronate combination or betamethasone alone into the joint. Clinical data was collected in the form of pain (visual analog scale), maximum mouth opening, and clicking sound before and after treatment up to 6 months. RESULTS: At the follow up of 6 months, there was statistically significant decrease in intensity of pain and increase in mouth opening was seen in betamethasone and sodium hyaluronate combination group compared to betamethasone alone group. Although there was statistically significant difference between the two groups when clicking was evaluated in the initial time interval (2nd post op day), on follow up of up to 6 months there was no statistically significant difference in clicking. CONCLUSION: Although patients benefitted from both techniques, arthrocentesis with intra-articular injection of betamethasone and sodium hyaluronate combination is superior to arthrocentesis with betamethasone injection alone.

Aggressive atypical ameloblastic fibrodentinoma: Report of a case.

Ameloblastic fibroma and related lesions constitute a group of lesions, which range in biologic behaviour from true neoplasms to hamartomas. This group of lesions is also sometimes referred to as mixed odontogenic tumors and usually includes ameloblastic fibroma, ameloblastic fibrodentinoma and ameloblastic fibro-odontoma. Despite numerous efforts however, there is still considerable confusion concerning the nature and interrelationship of these mixed odontogenic tumors and related lesions. The malignant counterpart of these lesions namely aameloblastic fibrosarcoma, ameloblastic dentinosarcoma and ameloblastic odontosarcoma respectively are said to arise secondarily in their benign counterpart or de novo. Recurrence of the benign lesion raises the risk towards malignant transformation therefore a radical surgery should be planned inspite of enucleation or curettage. Here we present a case of an aggressive ameloblastic fibrodentinoma which was radically excised in the light of clinical and histological presentation followed by reconstruction of mandible.

Preseptal transconjunctival vs. subciliary approach in treatment of infraorbital rim and floor fractures.

BACKGROUND: Injuries in the orbital region have profound functional as well as aesthetic implications. Treatment of orbital fractures remains one of the most controversial issues in maxillofacial trauma with regard to the classification, diagnosis, surgical approach and treatment. PURPOSE: This study evaluated and compared the efficacy of two most commonly applied approaches the preseptal transconjunctival with lateral canthotomy and the subciliary approach for the treatment of infraorbital floor and rim fractures. PATIENTS AND METHODS: Twenty patients reported to G.D.C.R.I. Bangalore who suffered infraorbital floor and rim fractures, were randomly divided into two groups with 10 patients in each group. In one group, anatomic reduction and reconstruction was done with preseptal transconjunctival approach with lateral canthotomy and in the other group with subciliary approach. RESULTS: In transconjunctival group, transient entropion was significant (30%). In subciliary group, transient ectropion was significant (30%). CONCLUSION: In our study, preseptal transconjunctival approach with lateral canthotomy and subciliary skin-muscle flap approach for the open reduction and rigid fixation of infraorbital floor and rim fractures had showed less morbidity and lesser risk of complications and given satisfactory results.

Basal cell ameloblastoma-review of literature with report of three cases.

The ameloblastoma is the most common epithelial odontogenic tumor of the jaw with several histologic variants viz. follicular, plexiform, acanthomatous, desmoplastic, and granular cell and basal cell types. The basal cell ameloblastoma is a rare histological variant which tends to demonstrate microscopic features similar to cutaneous basal cell carcinoma and basaloid squamous cell carcinoma. In the current article we report three cases and review the literature of this rare tumor.

Internal derangement of temporomandibular joint: an evaluation of effect of corticosteroid injection compared with injection of sodium hyaluronate after arthrocentesis.

AIMS AND OBJECTIVES: Internal derangements are the commonest disorders of temporomandibular joint (TMJ). Different treatment modalities including conservative and surgical methods have been proposed to treat the same. Arthrocentesis is gaining popularity in the treatment of internal derangement of TMJ. Being minimally invasive it does not have the demerits of surgical approaches and at the same time is producing better results than conservative approaches. This study evaluates and compares corticosteroid and sodium hyaluronate after arthrocentesis in the treatment of internal derangement of TMJ. MATERIALS AND METHODS: Sixteen patients with internal derangement were randomly selected and divided into 2 groups (8 in each group). Arthrocentesis of the upper joint space was then performed using Ringer lactate under local anaesthesia followed by injection of either betamethasone or sodium hyaluronate into the joint. Clinical data was collected in the form of pain (visual analog scale), maximum mouth opening, joint sound and deviation before and after treatment up to 6 months. RESULTS: Both groups of patients were benefited from the treatment at the 6 month follow up and there was slightly less intensity of pain in sodium hyaluronate group compared with corticosteroid group. Maximum mouth opening was also increased in both groups. A decrease in clicking and deviation were seen in both groups. There was no statistically significant difference between betamethasone and sodium hyaluronate. CONCLUSION: Intra articular injection of corticosteroid or sodium hyaluronate after arthrocentesis had considerable effect on the TMJ. Both betamethasone and sodium hyaluronate can be used after arthrocentesis with similar results.