Evaluation of Zygomaticomaxillary Complex Fractures with Gillies Approach in Al-Baha Region of Saudi Arabia: A Cohort Study.

Background: The aim of this study was to evaluate the accuracy of the degree of fracture reduction after open reduction and internal fixation of Zygomaticomaxillary Complex (ZMC) fractures in the Saudi population of the Al-Baha region, using Gillies approach. Further comparison with preoperative and postoperative standardized computed tomography (CT) views with the calculation of residual deformity percentage, which remained after the ZMC rehabilitation. Methods: A 5-year retrospective CT-based study on preoperative and postoperative axial CT scans of 46 male patients with ZMC fractures. The CT measurements were made (in millimeters) at the fracture site of maximum displacement through the anterior orbital rim and orbital floor, posterolateral wall of the maxillary sinus, zygomatic arch, and zygomaticofrontal suture. For the zygomatic arch, measurements were made (in mm) by drawing a tangent to the fractured arch segments and dropping a perpendicular to the inward displaced fractured arch. The total difference in all measured parts between preoperative and postoperative displacement was calculated in percentages. Results: Upon comparison of preoperative and postoperative zygomaticomaxillary complex CTs, three-point fixation at the regions of infraorbital rim, frontozygomatic suture, and posterolateral wall of the maxilla results in a reduction of the fracture sites in the range of 72.85% to 85%. Maximum reduction was noted at the zygomatic arch, that is, 85%, and minimum at the infraorbital rim, that is, 72.85%. The reduction obtained at all four sites was statistically significant, with P values ranging from .011 to .039. Conclusion: Gillies temporal approach and three-point fixation at the regions of the infraorbital rim, frontozygomatic suture, and posterolateral wall of the maxilla results in satisfactory treatment of ZMC fractures and improves patients oral health and quality of life.

Characteristics and Management of Pediatric Benign Intraosseous Mandibular Tumors: A 10-Years Prospective Study.

Background: The management of intraosseous mandibular tumors in children is challenging. This study investigated clinical and pathological characteristics, surgical treatment, and outcome of pediatric benign intraosseous mandibular tumors. Materials and Methods: A prospective study included patients under 18 years presenting with benign intraosseous mandibular tumors that were surgically managed. Clinical and surgical data were collected and statistically analyzed. Results: The study included 84 patients (38 males and 46 females): 66.7% had non-odontogenic tumors and 33.3% had odontogenic tumors. The most common non-odontogenic tumors were central giant cell granulomas (31%). The most common odontogenic tumors were odontomas (9.5%). Conservative surgery and radical resection were performed equally. Curettage was the commonest treatment modality (27.4%). Fifty percentage of cases required reconstruction, which was done by costochondral rib graft (42.9%) and free fibula flap (7.1%). One patient had recurrence. All cases got good functional and aesthetic results. Conclusion: Non-odontogenic tumors were more common than odontogenic tumors. Central giant cell granulomas were the most common non-odontogenic tumors, while odontomas were the most common odontogenic tumors. Treatment depended on type, size, and aggressiveness. Pediatric mandibular reconstruction with costochondral rib grafts was simple and satisfactory. Microsurgical reconstruction had high success rates. Appropriate management achieved good aesthetic and functional outcomes.

Regeneration of periodontal ligament fibers around mini dental implants and their attachment to the bone in an animal model: A radiographic and histological study.

Background: Tissue-engineered periodontal ligament (PDL) around a dental implant by using PDL stem cells (PDLSCs) may be useful in periodontal regeneration and can reduce or eliminate certain shortcomings of dental implants. Materials and Methods: PDLSCs were isolated from extracted human PDL cells and cultured in a bioreactor. They were identified using markers CD45, CD73, CD90, CD105, and CD146. After the formation of multiple cellular layers, they were then attached on titanium mini dental implants and placed in rabbit tibia. The rabbits were sacrificed after 9 months, and the implants were analyzed histologically and radiographically by Cone beam computed tomography (CBCT). Results: Isolated PDLSCs obtained from human premolars showed a colony-forming ability on the 7th day and 14th day. Immunocytochemistry revealed that cells had taken up the adequate positive stains for primary antibodies CD73, CD90, CD105, and CD146 and negative staining for CD45. The histological sections obtained from sacrificed rabbits, when viewed under the light microscope, clearly showed the presence of PDL around dental implants. CBCT examination showed that the implant was well within the bone and did not migrate. The site appeared to be normal without any lytic changes in the bone. Conclusion: It can safely be postulated from the present study that tissue engineering of PDL can be achieved around dental implants using PDLSCs. Important inter-tissue interactions like the formation of a functional PDL around the implantation site, and induction of bone formation in the vicinity of the implants may be possible. Future research in humans is required for further research.

Evaluation of immuno-histochemical markers in oral squamous cell carcinoma.

Evaluation of immuno-histochemical (IHC) markers like p53, p63, PDPN, C-erb-B2, CK19, and VEGF in oral squamous cell carcinoma (OSCCs) is of interest to dentists. Sixty formalin-fixed paraffin embedded tissue blocks from the Department of Oral Pathology, New Horizon Dental College and Research, Institute, Sakri, Bilaspur, Chhattisgarh, India. The conventional IHC method was used to assess the expression of p53, p63, PDPN, C- erb-B2, CK19 and VEGF using the different antibodies. Data shows that P53, p63 had high values of labeling index (LI) of staining while PDPN, C-erb-B2 had low values of LI of staining. The values of LI of staining for CK19, and VEGF were in between the two types of IHCs. Combining the analysis of multiple IHC markers for OSCC can yield precise cancer diagnosis results.

Clinico-Pathological Characteristics, Management, and Outcome of Benign Intraosseous Maxillary Tumors in Adolescents: A Prospective Study.

INTRODUCTION: Benign intraosseous maxillary tumors, although uncommon among the adolescents, represent a major challenge to the maxillofacial surgeons. Treatment ranges from conservative surgery to radical resection and reconstruction. Maxillary defect reconstruction in adolescents is uncommon. it can be achieved by prosthetic obturators, local and regional flaps, and free-tissue transfer. AIM OF THE WORK: To investigate the clinical and pathological patterns, treatment, and outcome of benign intraosseous maxillary tumors in adolescents. PATIENTS AND METHODS: A 10-years prospective study included patients between 12-18 years who presented with benign intraosseous maxillary tumors and surgically treated (conservative surgery or radical resection) with immediate reconstruction. Cases were followed up to assess functional and aesthetic outcomes and detect complications. RESULTS: Study included 38 patients; 63.2% had non-odontogenic tumors and 36.8% had odontogenic tumors. The most common non-odontogenic tumor was central giant cell granuloma (31.6%). The most common odontogenic tumors were adenomatoid odontogenic tumor and ameloblastoma (10.5% each). Treatment included Conservative surgery (55.3%) and radical resection (44.7%). Reconstruction was performed in 17 cases by temporalis muscle flap (9.83%), obturator (2.46%), and free fibula flap (1.64%). All cases gained accepted functional and esthetic results. CONCLUSIONS: Non-odontogenic tumors were more common than odontogenic tumors. Central giant cell granulomas and ossifying fibromas were the most common non-odontogenic tumors. Ade-nomatoid odontogenic tumor and ameloblastoma were the most common odontogenic tumors. Maxillary reconstructions with tem-poralis muscle flap and obturator were simple and satisfactory. Microsurgical reconstruction had high success rates. Aesthetic, and functional results were satisfactory when appropriate reconstruction was performed.

Periodontal and Dentition Status among Psychiatric Patients in Indore: A Descriptive Cross-sectional Study.

AIM: To assess and record periodontal and dentition status among psychiatric patients using modified WHO Oral Health Assessment form 1997. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted at Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore, among the inpatients and outpatients. Ethical approval for the study was obtained from Institutional Review Board of Sri Aurobindo College of Dentistry. Statistical analysis was done using SPSS, IBM version 20.0. Descriptive statistics was used to find the frequencies, mean, and standard deviation of variables considered in the study. RESULTS: Among all the disorders, schizophrenia subjects had shallow pockets 28 (25.2%) and deep pockets 55 (49.5%). Only 2 (2.6%) study subjects who had major depressive disorder had more than 12 mm loss of attachment (LOA). The highest mean DMFT score was recorded for schizophrenia patients (13.0 ± 7.09). CONCLUSION: The results reveal an unmet need of projecting effective planning and implementation strategies toward the improvement of periodontal and dentition status health of the psychiatric patients. CLINICAL SIGNIFICANCE: The study highlights the importance of incorporating dental health education to psychiatric rehabilitation programs.

Isolation and immunohistochemical characterization of periodontal ligament stem cells: A preliminary study.

CONTEXT: It is a known fact that periodontal tissue regeneration can be achieved by the use of periodontal ligament stem cells (PDLSCs). Current mainstay of periodontal treatment is focusing on stem cell tissue engineering as an effective therapy, making it important to isolate PDLSCs from periodontal tissues. AIMS: The present research endeavor was undertaken to elucidate a technique for isolating PDLSCs for in vivo reconstructing the natural PDL tissue. SETTINGS AND DESIGN: The study design involves In vitro prospective study. MATERIALS AND METHODS: Premolar teeth were extracted from 12 patients who were under orthodontic treatment. PDL cells were scraped from their roots. Using 10 ml of Dulbecco's modified Eagle's medium with pH 7.2, the specimens of the periodontal tissue were transferred to laboratory where cell culture was done. Isolated stem cells were grown on 24-well microtiter plates-containing cover slips. They were incubated overnight at approximately 37°C in 95% air and 5% humidification. Anti-CD 45, CD73, CD90, CD105, and CD146 antibodies were used. After staining, cells were observed under phase-contrast microscopy and in inverted microscope. RESULTS: The cells showed a marked growth and 90% confluence at day 6. Cells presented thin and long fibroblastic spindle morphology. Isolated PDLSCs showed colony-forming ability at the 14th day after seeding. Immunohistochemical staining of PDLSCs showed positive uptake for CD146, CD90, CD73, CD105, and negative uptake for CD45. CONCLUSIONS: The human PDLSCs can be clearly isolated and characterized by using CD90, CD73, CD146, and CD105 markers of stem cells.

A comparison of the efficacy of scaling and root planning with application of pomegranate chip, pomegranate gel, and scaling and root planing in sufferers with adult periodontitis - A prospective study.

CONTEXT: The use of herbal compounds is a comparatively safer alternative to synthetic compounds for periodontal therapy. AIM: This study aims to investigate effect of extracts from pomegranate in a chip and gel form on periodontitis following scaling and root planing in adult periodontitis patients. SETTINGS AND DESIGN: An in vivo prospective study. MATERIALS AND METHODS: Thirty patients of adult periodontitis with initial pocket depth ≥4 mm were enrolled into the research and divided randomly into three groups, (10 in every group). After baseline examination, scaling root planing of tooth was achieved. Then subgingival application of medicated chips in Group 1, gel in Group 2, and placebo in Group 3 was done. Plaque index, gingival index, probing pocket depth, and relative attachment ranges were recorded at baseline, 21 days and 45 days. STATISTICAL ANALYSIS USED: Analysis of variance test. RESULTS: The study confirmed significant improvements of plaque index ratings in Group 1 at day 21. It showed significant improvements of gingival index scores, probing pocket depth, and clinical attachment at day 21 and 45. Gingival index rankings and probing pocket depth were extensively elevated altogether in three groups at day 21 and 45. Relative attachment degree was extensively raised in Group 1 and Group 2 at day 21 and day 45 and in Group 3 at day 45. The relative attachment degrees confirmed significance at day 21 between Group 1 and Group 2, and Group 1 and Group 3. CONCLUSION: Pomegranate extracts in chip and gel shape may offer additionally advantages to scaling and root planing for remedy of periodontal pockets.

Piezosurgery versus Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction.

AIM: The aim of this study is to compare piezoelectric surgery versus rotatory osteotomy technique in removal of mandibular impacted third molar. MATERIALS AND METHODS: Sample size of 30 patients 18 males, 12 females with a mean age of 27.43 ± 5.27. Bilateral extractions were required in all patients. All the patients were randomly allocated to two groups in one group, namely control group, surgical extraction of mandibular third molar was done using conventional rotatory osteotomy and in the other group, namely test group, extraction of lower third molar was done using Piezotome. RESULTS: Parameters assessed in this study were - mouth opening (interincisal opening), pain (visual analog scale VAS score), swelling, incidence of dry socket, paresthesia and duration of surgery in both groups at baseline, 1st, 3rd, and 7th postoperative day. Comparing both groups pain scores with (P < 0.05) a statistically significant difference was found between two groups. Mean surgical time was longer for piezosurgery group (51.40 ± 17.9) minutes compared to the conventional rotatory group with a mean of (37.33 ± 15.5) minutes showing a statistically significant difference (P = 0.002). CONCLUSION: The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient, and protection of tooth structures. Therefore, the piezoelectric device was efficient in decreasing the short-term outcomes of pain and swelling although taking longer duration than conventional rotatory technique it significantly reduces the associated postoperative sequelae of third molar surgery.

A comparative evaluation of platelet-rich plasma in combination with demineralized freeze-dried bone allograft and DFDBA alone in the treatment of periodontal intrabony defects: A clinicoradiographic study.

BACKGROUND: The aim of the present clinical trial was to compare PRP combined with a DFDBA to DFDBA mixed with a normal saline solution in the treatment of human intrabony defects. MATERIALS AND METHODS: Twenty interproximal intrabony osseous defects in twenty non-smoking, healthy subjects diagnosed with chronic periodontitis were treated in this study. Ten subjects each were randomly assigned to the test group (PRP + DFDBA) or the control group (DFDBA + saline). Clinical and radiographic measurements were made at baseline, three month and at six-month evaluation. RESULTS: The results at three and six months, when compared to the baseline, indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, bleeding on probing, probing depth, clinical attachment level and gingival recession; P < 0.01) and radiographic parameters (hard-tissue fill and bone-depth reduction; P < 0.01). However, the test group exhibited statistically significantly greater changes compared to the control group in plaque index at three months (P = 0.00), probing depth reduction at 6 months (P = 0.02) and the radiographic defect fill at 6 months (P = 0.01). CONCLUSIONS: Treatment with a combination of PRP and DFDBA led to a statistically significantly greater improvement in plaque index at 3 months, probing depth at 6 months and radiographic defect fill at 6 months in intrabony periodontal defects as compared to DFDBA with normal saline.

Periosteal fenestration vestibuloplasty procedure for sulcus deepening in a hemimandibulectomy patient following implant therapy.

Ablative surgery of the jaws may be necessary when malignant disease or destructive benign disease occurs. Surgical reconstruction needs to include the restoration of masticatory function so that the quality of life after the operation is optimal. When resection includes part of the upper or lower jaw, the aim of reconstruction should encompass not only the restoration of aesthetics, speech and swallowing, but also the recreation of an alveolar ridge suitable for prosthetic rehabilitation of the dental occlusion. In the present case, depth of vestibule was inadequate following implant placement thereby severely compromising prosthetic rehabilitation. Hence vestibuloplasty was done with periosteal fenestration operation, which provided retention and stability of mandibular prosthesis and hence greatly improved his overall quality of life.

Myositis ossificans circumscripta involving bilateral masticatory muscles.

Myositis ossificans (MO), as its name implies, is ossification and bone formation within a muscle. Pathogenesis is not all clear, but trauma is universally recognized as a trigger event. Myositis ossificans can be divided into 2 classifications: MO progressiva and MO traumatica. When it affects the muscles of mastication, it causes severe trismus. This rare disorder and its limited treatment options can potentially have debilitating effects to the patient's normal oral functioning and health. A computed tomographic scan and panoramic radiographs are essential diagnostic aids for evaluating conditions such as MO. Myositis ossificans can be one of the causes of extra-articular temporomandibular joint ankylosis. Surgical excision of the ossification is the main treatment modality. This is a case report of a patient who developed MO of the muscles of mastication.

Gunshot injury in the neck with an atypical bullet trajectory.

Gunshot injuries are on a rise in both developed and developing countries, the reason for this may be increased access to firearms. Gunshot injuries to the neck and maxillofacial region are associated with high morbidity and mortality due to the complex anatomy and presence of various vital structures in this region. It is indeed a rare finding that a bullet's trajectory passes through the neck region and does not damage any vital structures. We present one such case of gunshot injury to the neck.

Keratocystic odontogenic tumor: a review.

The odontogenic keratocyst is a very well known odontogenic cyst. There are many types of cysts of the jaws, but what makes the odontogenic keratocyst unusual are its characteristic histopathological and clinical features, including potentially aggressive behaviour, high recurrence rate, and an association with the nevoid basal cell carcinoma syndrome. The characteristic histologic feature i.e. the presence of parakeratin, is unique amongst all the different inflammatory and developmental cysts that occur in the jaws. Many treatment modalities have been advocated for its treatment, but none in particular has been regarded as the best treatment option. The 2005 WHO classification now uses the term 'keratocystic odontogenic tumor'. We present a review of treatment modalities of the KCOT.