Cone Beam Computed Tomography-Based Evaluation of the Accuracy of Implant Surgery with Conventional (Free Hand) Implant Placement vs Computer Fabricated 3D Guide Implant Placement.

Introduction: Dental implants have been used in a variety of conventional technique-based forms for many years which had its own drawbacks. With the advent of cone beam CT, proper surgical and prosthetic planning is possible now a days. To achieve ideal implant placement, good prosthetic fabrication and overall successful prognosis computer fabricated guide aided surgery have been developed. Aim and Objective: The aim of this study was to compare and evaluate the accuracy of implant placement in partially edentulous patients with conventional free hand technique and computer fabricated guide of implant placement by comparing pre- and post-CBCT data. Methods: The present split mouth study design was conducted with forty sample size on twenty randomly selected patients who were treated with bilateral partially edentulous sites requiring dental implants. Patients were treated with both conventional (free hand) technique and computer fabricated 3D guide aided technique of implant placement. Comparison of accuracy of implant placement was done by comparing the pre- and postoperative CBCT data in terms of mean coronal deviation, mean apical deviation and mean angular deviation. Results and Conclusion: The results showed that there is no statistically significant difference between mean coronal deviation, mean apical deviation and mean angular deviation of planned and placed implants in both conventional technique (free hand technique) and computer fabricated 3D guide aided implant placement technique. Hence, this study concluded that conventional technique of implant placement is equally efficient in comparison with computer fabricated guide aided surgery in terms of accuracy of implant placement.

A combination of follicular and plexiform ameloblastoma: A rare case report.

Ameloblastoma is a benign but locally aggressive neoplasm of odontogenic epithelium origin. Follicular type is the most common variant of ameloblastoma followed by plexiform, acanthomatous, and granular subtypes. Synchronized existence of plexiform ameloblastoma with follicular ameloblastoma is a rare event. When the plexiform type coexists with other common variant, it is termed as hybrid ameloblastoma. Here, we present a case of hybrid ameloblastoma with follicular and plexiform variants occurring in a 43-year-old female patient having persistent swelling for 5-6 months in the left mandibular body region extending up to the left angle of the mandible. The tumor was treated by en bloc resection followed by reconstruction.

Osteomyelitis of Maxilla: A Rare Presentation Yet Not So Rare.

Objective: To retrospectively study the patients diagnosed with osteomyelitis of jaw in Punjab Government Dental College and Hospital, Amritsar. Material and Methods: A total of 21 case records of patients with osteomyelitis of jaw were analysed retrospectively from January 2018 to December 2020 at Department of oral and maxillofacial surgery, Punjab Government Dental College and Hospital, Amritsar, India. Results: Of the 21 patients, maxilla was involved in 14 (66.6%) patients, whereas 6 patients (28.6%) had mandibular osteomyelitis and 1 patient (4.8%) had osteomyelitis of zygoma. 18 patients had underlying systemic disease with diabetes present in 10 patients (47.6%). History of alcoholism was present in 5 patients (23.8%) as one of the predisposing factors. 14 patients had odontogenic cause as predominant aetiology followed by sinusitis in 3 patients. Osteomyelitis due to post-herpetic and hematogenous infection, trauma and unknown aetiology was found in 1 patient each. With adequate medical and surgical intervention, most of our patients had satisfactory outcome. Conclusions: High incidence of maxillary osteomyelitis was found in our study in contrary to previous studies and literature. As this is a small study, further prospective studies with longitudinal follow up of larger number of patients would be desirable to confirm these findings.

Collagen matrix membrane as a biological dressing in defects of the oral mucosa.

OBJECTIVES: The objectives of this study were to evaluate the usefulness of the extracellular collagen matrix membrane as a biological wound dressing material for defects of the oral mucosa. MATERIALS AND METHODS: One hundred two patients were included in the study. A bovine-based extracellular matrix collagen membrane was used. The study was confined to those defects of oral mucosa which were large enough to close primarily. RESULTS: The results were evaluated under various parameters such as hemostasis, pain relief, granulation, epithelialization, and contracture of the wound. Secondary infection and allergenicity to the membrane were also considered, and finally, the usefulness of the collagen membrane was tested by the use of the Chi-square test and P < 0.001 was found. CONCLUSION: We concluded that the extracellular collagen membrane could be used as a biological dressing in oral defects. Although it does not replace, it is proved as a good substitute of autologous graft.

A Unique Case of Gorlin-Goltz Syndrome with Associated Sotos Syndrome.

Both Gorlin-Goltz syndrome and Sotos syndrome are rare genetic conditions showing variable expressiveness. They both are inherited in an autosomal dominant pattern. Since these conditions tend to be multisystemic disorders, the familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis, better differentiation of these two conditions, or even the co-existence of two syndromes.

Thermostable Fe/Mn superoxide dismutase from Bacillus licheniformis SPB-13 from thermal springs of Himalayan region: Purification, characterization and antioxidative potential.

Superoxide dismutase (SOD; EC 1.15.1.1) is an enzyme that scavenges free radicals and increases the longevity. In this study, a thermostable superoxide dismutase (SOD) from Bacillus licheniformis SPB-13, from Himalayan region was purified to homogeneity using ion exchange chromatography (DEAE-Sepharose). The SDS and native PAGE analysis showed that SOD is composed of two subunits of 32 kDa each and total molecular mass of the enzyme was estimated as 68 kDa. The specific activity of enzyme was 3965.51 U/mg and was purified to 16.17 folds. The SOD showed maximum activity with 60 mM Tris-HCl buffer at pH 8.0 for 2 min of incubation. Enzyme along with FeCl3 as metal ion remained active till 70 °C. After reaction variables optimization, enzyme activity increased from 3965.51 to 4015.72 U/mg. Kinetic analysis of SOD showed km of 1.4 mM of NADH and Vmax of 10000 U/mg of protein. Turnover number (kcat) and catalytic efficiency (kcat/Km) were found to be 11,333 s-1 and 7092.2 s-1·mM-1 NADH. The activation energy (Ea) was calculated as 2.67 kJ·mol-1. After typing, it was found to be a member of Fe/Mn SOD family with IC50 value of 25 µg/ml, prevented the cell death at a concentration of 30 µg/ml and it increased the cell viability by 30%.

Polydopamine films change their physicochemical and antimicrobial properties with a change in reaction conditions.

The morphology and physicochemical properties of polydopamine are not totally inherent and undergo changes with differing reaction conditions like the choice of solvent used for polymerization. The polymerisation of dopamine to polydopamine carried out in different solvents like sodium hydroxide, sodium bicarbonate, PBS and Tris leads to polydopamine with exceptionally different morphological and physicochemical features with each solvent. Additionally, the different physicochemical characteristics and morphologies bestow the polymer films with different extents of antimicrobial activity. Moreover, the findings supported by chemical evidence from X-ray photoelectron spectroscopy reveal that higher antibacterial activities were obtained against E. coli and S. aureus with polydopamine films prepared by Tris and NaOH solvent induced polymerization. The antibacterial activity observed in saline was found to be higher than that in PBS medium for both E. coli and S. aureus. The higher antibacterial activity of polydopamine films prepared in Tris and NaOH solvents was attributed to the covalent incorporation of -OH groups on the surface provided by nucleophilic Tris and NaOH solvents during the polymerisation process. The distinct physicochemical and morphological changes were supported by the results from contact angle measurements, FE-SEM, EDAX, AFM, and XPS analysis. The present finding provides insight into the different chemistry, morphologies and properties of the designed polydopamine films with controlled antibacterial/antifouling properties. Additionally, new insights into the mechanism of formation, physicochemical changes in morphology and properties of polydopamine coatings were revealed.

Influence of the impacted mandibular third molars on fractures of the mandibular angle and condyle - A prospective clinical study.

AIMS: This study was set out to evaluate the relationship between the presence and absence of unerupted mandibular third molar and fracture of mandibular angle/condyle, and to analyse if prophylactic removal of symptom-free unerupted mandibular third molar is beneficial. METHODS: Hundred patients of mandible fracture were selected randomly irrespective of age, sex, caste, creed and socio-economic status. Data were collected from the patients on the basis of history, clinical examination and radiographs for the following information: age, sex, aetiology of fracture, presence and status of the mandibular third molar and location of mandible fracture. RESULTS: In group A (partially/completely unerupted mandibular 3rd molar), the incidence of angle and condylar fracture was 44.44% and 13.33%, respectively, whereas in group B (fully erupted/missing mandibular third molar), the incidence of angle fracture was 14.45% and the incidence of condylar fractures was 31.77%. CONCLUSION: Practice of prophylactic removal of mandibular third molar and resultant strengthening of angle region should be reconsidered, as it increases the risk of fracture at condylar region which is difficult to treat and associated with more morbidity.

Central myofibroma of the maxilla.

Myofibroma is a rare benign localized or generalized proliferation of myofibroblastic tissue occurring mostly in infants or children. In the oral region, most lesions occur in the mandible, lip, buccal mucosa, and tongue; however, the lesions arising in the maxilla are very rare. Myofibroma has an aggressive clinical presentation and is often treated aggressively because of an inappropriate diagnosis. A unique feature of central myofibroma of the jaws is the potential for teeth and other odontogenic structures to be involved by tumor. We report a case of myofibroma arising in the left side of the maxilla of a 12-year-old girl and describe the differential diagnosis from other spindle cell lesions of neural and smooth muscle origin. We treated the case using surgical excision under general anesthesia. Immunohistochemical staining was done for establishing the diagnosis since histopathological diagnosis with conventional staining could not distinguish myofibroma from spindle cell tumors.

Gorlin-Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature.

OBJECTIVE: In Indian scenario, Gorlin-Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. MATERIALS AND METHODS: The diagnostic findings of Gorlin-Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. RESULTS: The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. CONCLUSIONS: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested.

Myoepithelial carcinoma of buccal mucosa: A rare tumor.

Myoepithelial carcinoma is a rare neoplasm of salivary glands that account for < 1% of all salivary gland tumors. The most common sites of involvement are major salivary glands mainly parotid gland. Intraorally, it can arise from minor salivary glands; palate is the most common site of occurrence. It also occurs in nasopharynx, paranasal sinuses, nasal cavity and larynx in head and neck region. Myoepithelial tumors were first described in 1943. Their malignant variant, myoepithelial carcinoma, was first reported by Stromeyer et al., in 1975, characterized by distinct morphologic heterogeneity and an infiltrative growth pattern into adjacent tissues. Here, we report a rare case of a 55-year-old female with myoepithelial carcinoma of buccal mucosa. It was also rare because of unusual location of tumor. Our patient was treated with wide local resection and remained free of disease for 15 months.

Nasolabial cyst: review of literature and a case report.

The nasolabial cyst is a rare non-odontogenic cyst that develops within the skin adjacent to the ala of nose around the uppermost portion of the nasolabial crease; its pathogenesis is uncertain. This lesion grows slowly and measures between 1.5 to 3.0 cm; it is characterized clinically by a floating tumefaction in the nasolabial sulcus, which elevates the upper lip. The diagnosis is essentially based on the clinical findings. Bi-digital palpation revealed fluctulance between the floor of nasal vestibule and the gingivobuccal sulcus, which helps to confirm the diagnosis. This paper reports a case of a 35-year-old female patient that presented a soft swelling in the right ala of the nose; the clinical features suggested a nasolabial cyst. Complete surgical excision of the cyst was done under local anesthesia and the diagnosis was confirmed by histopathology. In spite of the low occurrence of nasolabial cysts, it is important to recognize the clinical characteristics of this lesion. The purpose of this paper is to review the literature and discuss the histopathology, etiology and different treatment options of this condition.

Placement of single tooth implant in healed socket with immediate temporization: Clinical study.

INTRODUCTION: Edentulous condition inadequately compensated for, by dentures, impair oral function and is accompanied by reduced self-confidence. In a continued effort to achieve these goals, implant dentistry was introduced. Immediate temporization is somehow a recent concept, which allows the maintenance of soft tissue contours, along with interdental alveolar contours. AIMS AND OBJECTIVES: Aims of the present study were to study the placement of implant in the post-extracted healed tooth socket of anterior maxilla and to evaluate the feasibility of early function on implants placed. MATERIALS AND METHODS: In the present study, HI-TECH IMPLANTS TRX-OP one-piece immediate loading implant system with the built on abutment has been used. Immediate temporisation has been done and results have been evaluated in terms of stability, gingival health, esthetics, marginal bone loss, patient's psychological attitude, and satisfaction. RESULTS: Out of eight implants, 6 successfully healed whereas 2 implants suffered failure. CONCLUSION: Overall conclusion drawn from the study is, immediate temporization is a successful method providing psychological, financial and emotional benefits to the patient.

Fine needle aspiration cytology: a diagnostic aid for oral lesions.

PURPOSE: Oral lesions usually lead to a diagnostic dilemma. Fine needle aspiration cytology (FNAC) is an important diagnostic aid for making a preoperative diagnosis of oral lesions. It does not supplant histopathology but augments it. MATERIALS AND METHODS: FNAC of oral lesions was undertaken in 45 patients, and all the lesions were subjected to histopathologic examination. Aspiration was performed with 23- to 25-gauge needles held in a Cameco syringe holder (Amar Udyog, Chandigarh, India). RESULTS: We diagnosed benign lesions in 22 cases, malignant lesions in 15, and inflammatory lesions in 7 by FNAC, whereas in 1 case the specimen was insufficient for diagnosis. One result was false negative, but there was no false-positive result. Specificity and sensitivity of FNAC were 95.45% and 93.75%, respectively. FNAC gave a diagnostic accuracy of 90.0% for benign lesions, 94.0% for malignant lesions, and 100% for inflammatory lesions. CONCLUSION: The procedure does not have any side effects or complications. Hence FNAC can be used as a reliable diagnostic aid for oral lesions because it is safe, accurate, convenient, and cost-effective.

Incidence of lingual nerve paraesthesia following mandibular third molar surgery.

CONTEXT: The surgical removal of impacted mandibular third molar is associated with minor but expected complications like pain, swelling, bruising and trismus. The lingual nerve damage sometimes occurs after the removal of mandibular third molar producing impaired sensation or permanent sensory loss. This complication is usually unexpected and unacceptable for the patients particularly if no prior warning has been given. AIMS: The aim of the present clinical prospective study was to determine the clinical incidence of lingual nerve injury following mandibular third molar removal and to analyze possible factors for the lingual nerve injury. SETTINGS AND DESIGN: Clinical prospective study in the Department of Oral Surgery, Punjab Government Dental College and Hospital, Amritsar. MATERIALS AND METHODS: Ninety patients were selected randomly, amongst the patients, who reported to our department from January 2009 to December 2009 for the surgical removal of impacted mandibular third molar. To minimize the risk of lingual nerve injury, the standard terence wards incision was made in all cases and only buccal flap was raised. STATISTICAL ANALYSIS: The small number of paraesthesia precluded statistical analysis. RESULTS: Out of 90 patients, six patients were diagnosed with lingual nerve paraesthesia. The overall incidence rate of lingual nerve injury was 6.6%. CONCLUSIONS: It can be concluded that lingual nerve paraesthesia can occur with or without reflection of lingual flap in spite of all the measures taken to protect it. It may be contributed to the fact of anatomical variations of lingual nerve.

Numb chin syndrome: a case report and review of the literature.

Numbness of the lower lip, the skin of the chin, or the gingiva of the lower anterior teeth secondary to various dental diseases is a common manifestation that is largely underappreciated. The association of numb chin syndrome (NCS) with serious disease like metastatic malignancy and systemic conditions is frequent enough to warrant a search for these possible etiologies. In this paper we report a case of NCS that occurred secondary to malignant disease; we discuss our findings with special emphasis on metastatic malignancies leading to NCS, when the survival is only for a few months.

Massive osteolysis of hemimandible: a case report.

Massive osteolysis or Gorham's stout disease or phantom bone is a rare disorder which normally appears in adulthood with no specific predilection for any sex. Work to find out exact etiology of disorder has been done. But actual cause has not yet been found. Any of the bone could be involved in this disease. A clinical, radiographic and histological evaluation of massive osteolysis of mandible is presented and discussed.

Idiopathic gingival fibromatosis. A case report.

Gingival fibromatosis is a progressive gingival enlargement caused by an over growth of the collagenous element of the gingival fibrous connective tissue. Pharmacologically induced, hereditary (familial) and idiopathic forms of gingival fibromatosis are recognized. This paper reports a case of idiopathic gingival fibromatosis in a 13 year old boy involving the right maxillary and mandibular arches who had also been treated 3 years back for a gingival enlargement involving the left maxillary and mandibular arches. The enlargement was quite sever and caused significant esthetic and functional problems on both occasions.

Complications associated with rigid internal fixation of mandibular fractures.

A clinical evaluation is made in twenty patients with twenty seven mandibular fractures, managed with rigid internal compression plate and screw osteosynthesis. An analysis regarding complications of this method is made and discussed.