Crown Fragment Reattachment by the Minimal Intervention Approach for Coronal Tooth Fractures: A Case Series.

Dental trauma is the most frequently encountered injury that requires immediate attention. Several procedures are available to manage broken teeth afflicted by trauma but the choice of procedure depends upon structural, functional, and esthetic considerations. The goal is to choose the least invasive, immediate, and simple technique that can meet the patient's expectations. The aim of this case series is to present a minimal intervention approach as a primary treatment option for the reattachment of trauma-induced fractured coronal tooth fragments, to preserve and enhance function, esthetics, and structure.

Maxillofacial injuries in pregnancy following domestic abuse: A challenge in management.

Domestic violence against women remains one of the most difficult obstacles in the growth of civilization. The maxillofacial region is commonly involved, and injuries are complex to characterize and manage due to diverse presentations, underlying physiological changes and sometimes an association with pregnancy complications, creating a challenge for the operating surgeon. This case report discusses the clinical presentation of maxillofacial injuries sustained by a pregnant woman who also had obstetric complications. The management of such trauma by a multidisciplinary squad led by the maxillofacial surgery team is outlined. Increasing awareness among oral healthcare providers for the early identification of interpersonal abuse along with timely intervention and adequate referral is important. Close monitoring and follow-up are also mandatory.

Axenfeld-Rieger Syndrome: Rare Case Presentation and Overview.

Axenfeld-Rieger syndrome (ARS) is an extremely rare autosomal dominant disorder characterized by ocular, craniofacial, dental and periumbilical abnormalities. We present a case of a 10-year-old boy. Its awareness among oral surgeons is essential for timely diagnosis and subsequent prevention of ophthalmic and systemic complications as craniofacial and dental features constitute the early recognizable symptoms of this syndrome. Systematic ophthalmic surgeries aid in relieving vision abnormalities, while symptomatic dental treatment should be provided for masticatory and esthetic rehabilitation.

Diagnosis and treatment considerations of atypical oral pain in tuberous sclerosis.

Diagnosis and management of non-specific, atypical, and non-dental pain are challenging. We hereby report a case of a 23-year-old female who presented with a complaint of intermittent dull ache over her lower front anterior teeth with no radiographic findings. She was diagnosed after history, imaging, and neurology consultation and treated conservatively with complete remission of symptoms. Proper history and counseling are mandatory for all patients. It is important to recognize patients with underlying neurological conditions and take adequate interdepartmental consultation before labeling complaints psychogenic or carrying out unwarranted dental treatment.

Palatal peripheral ossifying fibroma: A rare occurrence.

Peripheral ossifying fibroma (POF) is a reactive, inflammatory, hyperplastic soft tissue growth of the gingiva. Lesions are usually labial and small with an anterior maxillary presentation, occurring commonly in the younger population. We present an unusual case of a large POF in a 68-year-old woman that presented on the posterior palate with a unique radiographic appearance. Various differential diagnoses of POF and such palatal lesions, etiopathogenesis of POF, and the surgical management of these lesions have been discussed in detail. Close post-operative follow-up of these lesions is mandatory due to the high recurrence rates.

Palatal actinomycosis osteomyelitis-Complication of impacted tooth in a diabetic.

This article aims to highlight palatal actinomycosis osteomyelitis as an unseen complication of maxillary tooth impactions. A middle aged male with uncontrolled diabetes reported with a complaint of nasal regurgitation of fluids. After clinical and radiographic evaluation, he was diagnosed with actinomycosis osteomyelitis of the hard palate as a sequelae of a long-standing palatally impacted tooth. He was treated by a combination of medical and surgical therapy. Palatal actinomycosis should be considered a differential in nonhealing lesions of the hard palate and a possibility before leaving maxillary impactions untreated, especially in immunocompromised individuals. Adequate follow-up is mandatory to note for any radiographic changes and if diagnosed, treatment should be started promptly to prevent grave complications.

Inverted Maxillary Third Molar Impactions.

Maxillary third molars are one of the most commonly impacted teeth, but its inverted type is very rare. Five cases of inverted and impacted maxillary wisdom teeth are described here. Two were symptomatic and required transalveolar extractions, while three were conservatively managed. Complications may arise from surgical removal of inversions, and so, removal must be carefully weighed against the benefits of retaining them. This case series discusses the rare occurrence of impacted inverted maxillary third molars, its increased incidence in the Indian population, and the dilemma considering its treatment options. If left untreated, regular follow-up should be done to note for any complication.

Micronuclei as a Predictor for Oral Carcinogenesis.

OBJECTIVES: The aim of the study was to provide a quantitative evaluation of oral mucosal micronuclei (MN) frequency as a biomarker for oral cancer susceptibility in carcinogenesis progression. METHODS: 60 patients were included in the study. 30 patients with biopsy proven epithelial dysplasia (ED, 15) and oral squamous cell carcinoma (OSCC, 15) comprised the study group and 30 patients with normal buccal mucosa, reporting for minor surgical procedures formed the controls. After informed consent, exfoliated cells were collected from the affected site using a premoistened wooden spatula and spread on precleaned slides, fixed, stained using modified rapid Papanicolaou method and subjected to microscopic examination. MN were identified and scored according to Tolbert et al. criteria. RESULTS: Maximum patients with ED and OSCC were males and in age groups of 20-40 and 40-60 years, respectively. The most common site was the buccal mucosa. The maximum of MN count/500 cells in OSCC group was 11.93, 4.0 in ED and 1.46 in controls, with the mean and mean MN index ± SD distribution in the three groups showing high statistical significance (P = 0.000). A significant difference between mild and moderate ED and between moderately and well-differentiated OSCC was also observed. CONCLUSION: MN assays can help in early detection of premalignant and malignant lesions, thereby improving survival and reducing morbidity associated with treatment. MN index is thus a feasible and economical method for screening high-risk populations of oral cancer, to be able to timely identify genomic damage in order to prevent the cancer epidemic.

Facial candidiasis after maxillofacial trauma: A rare encounter.

Facial oedema after maxillofacial trauma is a common occurrence, but those that soon resolve only to appear again do invoke interest! A rare case is presented of a recurring facial swelling occurring after a maxillofacial injury that did not resolve subsequent to medication and repeated aspirations. Cytospin preparations of the aspirate stained with Giemsa revealed candidiasis. The patient's symptoms resolved soon with antifungal medications and he has been asymptomatic since. Such a scenario has never been reported in the literature and can pose a diagnostic dilemma. It gives insight into the unusual clinical presentation of facial candidiasis, the importance of thorough debridement of soft tissue wounds at primary care centres and the need to consider mycoses as a differential diagnosis for nonresolving soft tissue facial swellings after maxillofacial trauma.

Alexidine versus chlorhexidine for endodontic irrigation with sodium hypochlorite.

OBJECTIVE: The objective of this study was to chemically evaluate precipitate formation on irrigation by different concentrations of chlorhexidine (CHX) and alexidine (ALX) with sodium hypochlorite (NaOCl). MATERIALS AND METHODS: Six test tubes were prepared with 1 ml of 4% NaOCl. One milliliter of 2%, 1%, 0.5%, and 0.25% ALX was added to the first four, and in the last two, 1 ml of 2% CHX and 0.2% CHX was added, respectively. Samples were observed for color changes or precipitates at multiple time intervals. All solutions were then centrifuged at 1000 rpm for 10 min and re-examined for precipitates. This process was repeated twice. Fifty freshly extracted premolars were biomechanically prepared, dried, divided into two groups, and irrigated with 10 ml of 4% NaOCl and 10 ml of 2% ALX (Group 1) and 10 ml of 4% NaOCl and 10 ml of 2% CHX (Group 2). These samples were sectioned and observed for precipitates on the dentinal surfaces by scanning electron microscopy (SEM). RESULTS: The color of the solution of ALX and NaOCl stayed transparent and no precipitate was observed. A color change was noted immediately on mixing CHX and NaOCl which did not change with time. Precipitates were only observed in the solutions of CHX with NaOCl and after centrifuging them. SEM views also showed dense precipitates covering the dentinal surface and occluding the dentinal tubules in Group 2. CONCLUSION: The interaction of ALX and NaOCl does not produce precipitates which together with its better antimicrobial action make ALX a more effective and safer replacement for CHX as an adjunctive endodontic irrigant.

Facial Nerve Paralysis-A Rare Complication of Open Reduction of Zygomaticomaxillary Complex Fractures.

Facial nerve paralysis is an unusual formidable complication that can manifest after various maxillofacial surgeries, including open reduction of facial trauma. The branches more predisposed to such injury are the zygomatic and marginal mandibular branches. Zygomaticomaxillary complex (ZMC) fractures are frequently encountered in maxillofacial trauma. The facial nerve has not been described as endangered during ZMC surgery. Paralysis of the buccal branch after ZMC repair with delayed onset has been reported only once. This report describes a patient with immediate facial nerve paralysis after open reduction and internal fixation of an isolated ZMC fracture through an intraoral approach. This is a previously unreported rare complication after ZMC fracture repair that should be discussed as a possibility when obtaining preoperative consent.

An in vitro Evaluation of Fracture Resistance of endodontically treated Teeth with Different Restorative Materials.

AIMS: The aim of the present study is to compare and assess the fracture resistance of root canal treated teeth with different restorative materials. MATERIALS AND METHODS: The present in vitro study was carried out on seventy-five freshly extracted, noncarious, single-canal human lower-first premolars with similar anatomic characteristics. Teeth were randomly assigned to five groups with 15 teeth being present in each group. Group I is control group (no alteration done), group II is restored with silver amalgam after endodontic therapy, group III is restored with posterior composite after end-odontic therapy, group IV is restored with posterior glass ionomer cement (GIC) after endodontic therapy, and group V is restored with miracle mix after endodontic therapy. Universal testing machine was used to assess the fracture strength. Analysis of variance (ANOVA) test followed by Tukey's post hoc test were used to determine the significant difference between each group. A p-value of < 0.05 was considered as statistically significant. RESULTS: The mean fracture resistance of control group showed highest fracture resistance with a mean Newton of 1083.33 ± 136.78. Among the restorative material, the highest fracture resistance was shown by teeth restored by composite (845.46 ± 47.36), followed by silver amalgam (845.46 ± 47.36). There was statistically significant difference among all the restorative materials compared with the control group (p < 0.05). However, among the teeth restored with silver amalgam and miracle mix, there was no statistical significance (p > 0.05). CONCLUSION: The present study concludes that composites are found to be having more fracture resistance followed by silver amalgam on endodontically treated premolar teeth. CLINICAL SIGNIFICANCE: Restoring nonvital teeth represents a major challenge for clinicians as they are extensively damaged due to caries and endodontic access preparations. With various restorative materials in the market, it becomes difficult for the clinician to choose the better restorative material for postendodontic restoration.