Ameloblastoma of the anterior mandible.

Ameloblastoma or adamantinoma is the rarest of the three forms of tumor of the odontogenic type. They are benign, locally aggressive neoplasms arising from ameloblasts, which typically occur at the angle of the mandible, and are often associated with an un-erupted tooth and must, therefore, be differentiated from a dentigerous cyst which will be centered on the crown. When in the maxilla (less common), they are located in the premolar region, and can extend up in the maxillary sinus. Ameloblastoma is reported to constitute about 1-3% of tumors and cysts of the jaws. The tumor is by far more common in the mandible than in the maxilla and shows predilection for various parts of the mandible in different racial groups. The relative frequency of the mandible to maxilla is reported as varying from 80-20% to 99-1%. Here, we are representing a case of ameloblastoma of anterior mandible which was considered as a rare site of occurrence.

Huge ossifying fibroma of the maxilla.

Ossifying fibroma of bone is a central neoplasm of bone. It is more common in young adult with marked predilection for mandible. It is more common in females. Lesion is generally asymptomatic until growth produces a noticeable swelling and deformity. It presents an extremely variable roentographic appearance depending upon stage of development. This lesion is composed basically of many delicate interlacing collagen fibres, seldom arranged in discrete bundle, interspersed by large numbers of active, proliferating fibroblasts. The lesion should be excised conservatively. We present a case of huge ossifying fibroma arising from maxilla.

Osteogenic potential of cissus qudrangularis assessed with osteopontin expression.

PURPOSE: Fracture healing involves complex processes of cell and tissue proliferation and differentiation. Many factors are involved, including growth factors, inflammatory cytokines, antioxidants, bone breakdown (osteoclast) and bone building (osteoblast) cells, hormones, amino acids, and uncounted nutrients. We studied the osteogenic potential of Cissus quadrangularis (CQ), a plant that has been customarily used in the Indian subcontinent to hasten the process of healing in bone fractures. MATERIALS AND METHODS: Total of 60 patients (age, 20-35 years) of mandible fracture was divided in two groups. Patients of group 1 were given capsules of CQ and fracture healing was assessed with osteopontin expression during treatment. Group 2 was control group. RESULTS: Clinical and radiological analysis in our study was suggestive of better healing of fractures in group 1. All the samples of group 1 examined for osteopontin expression using western blot analysis and flow cytometry showed significant levels of expression of osteopontin protein and CD4+ T cells expressing osteopontin, respectively. CONCLUSION: We conclude that CQ accelerates fracture healing and also causes early remodeling of fracture callus.

Retrospective study of absorbable gelatin sponge soaked in triamicinolone acetonide as interpositioning material in temporomandibular joint ankylosis in 350 patients.

AIM: To evaluate the feasibility and usefulness of absorbable gelatin sponge soaked in triamcinolone acetonide as an interposition material in the treatment of temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: This retrospective study was conducted in 350 patients of TMJ ankylosis who visited our outpatient department between 2000 and 2010, and were treated by the same surgeon. Patients were randomly divided into two groups, where in group 1, absorbable gelatin sponge soaked with triamcinolone acetonide was interposed in the surgical gap created after arthroplasty and in group 2, temporalis fascia was interposed. Preoperative assessment included history and physical examination, along with cause of ankylosis, Postoperative observation were undertaken for maximum mouth opening (MMO), facial nerve paralysis and recurrence. RESULTS: At one year follow-up, in group 1 MMO ranged from 35 to 45 mm with no case of re-ankylosis while in the other group 25-43 mm, with re-ankylosis in 20 patients (13.69%). CONCLUSION: The findings of this study showed successful management of TMJ ankylosis using absorbable gelatin sponge soaked in triamcinolone acetonide in cases which did not require condylar reconstruction.

Bio-resorbable plates as effective implant in paediatric mandibular fracture.

AIM: To evaluate the efficacy of bio-resorbable plates in paediatric mandibular fracture. MATERIALS AND METHODS: In the present study, 40 cases of mandibular fractures were treated by Inion Cps plating system using, 2 and 2.5 mm (LPLA/DLPLA/TMC/PGA) bio-resorbable bone plates and screws of 6 and 8 mm screws. The assessment of the patients was done at 2 week, 1, 3, and 6 months using the clinical parameters and bite force recording. RESULTS: There was significant reduction in pain at different follow-ups. Paraesthesia was found in two patients with body fracture which remained for 2 week and 1 month follow-up. No paraesthesia was found after 3rd follow-up. Significant stability of fracture fragments were found on different follow ups. Implant exposure was present only in two patients (5%) at 1 month follow up. There was significant increase in incisor, right molar and left molar bite force at 1, 3 and 6 months, from 2nd week onwards. CONCLUSION: These findings show that the use of bio-resorbable plates in paediatric mandibular fracture was efficacious enough to bear the masticatory loads during osteosynthesis of the fracture. The recent and significant achievement is the advent of bio-resorbable osteosynthesis devices that has almost solved the problems of stress shielding, secondary surgery and corrosion when metal implants are left-in situ.

Congenital large maxillary teratoma.

Teratoma of the maxilla is a rare entity. Congenital intraoral teratoma occurs in 1:4000 births. It is a benign tumor, although malignancy has been described in adults. A 10-year-old male child with this condition is described in this report. This case illustrates a huge mass on the right side of the maxilla. The mass was excised under general anesthesia. Histopathologically, it consisted of all three layers of embryonic elements with predominantly fibrous tissue. Postoperative result was uneventful and no recurrence was detected after 2 years.

Pediatric facial injuries: It's management.

BACKGROUND: Facial injuries in children always present a challenge in respect of their diagnosis and management. Since these children are of a growing age every care should be taken so that later the overall growth pattern of the facial skeleton in these children is not jeopardized. PURPOSE: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. MATERIALS AND METHODS: Sixty child patients with facial trauma were selected randomly for this study. On the basis of examination and investigations a suitable management approach involving rest and observation, open or closed reduction and immobilization, trans-osseous (TO) wiring, mini bone plate fixation, splinting and replantation, elevation and fixation of zygoma, etc. were carried out. RESULTS AND CONCLUSION: In our study fall was the predominant cause for most of the facial injuries in children. There was a 1.09% incidence of facial injuries in children up to 16 years of age amongst the total patients. The age-wise distribution of the fracture amongst groups (I, II and III) was found to be 26.67%, 51.67% and 21.67% respectively. Male to female patient ratio was 3:1. The majority of the cases of facial injuries were seen in Group II patients (6-11 years) i.e. 51.67%. The mandibular fracture was found to be the most common fracture (0.60%) followed by dentoalveolar (0.27%), mandibular + midface (0.07) and midface (0.02%) fractures. Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

Evaluation of implants placed immediately or delayed into extraction sites.

AIMS AND OBJECTIVES: To compare the success rate of implant placed immediately in extraction socket vs implant placed delayed in extraction socket. MATERIALS AND METHODS: The study comprised of 8 patients (6 male and 2 female, aged from 14 to 58 year) for evaluation of implant placement immediately (i.e. Group - A) or delayed (i.e. Group - B) into extraction site, in which at 12 sites implants were placed. RESULTS: The inclusion criteria for implantation was tooth/teeth with one or two degree mobility, root stumps, tooth with failure root canal treatment and extraction sockets. HI-TEC TRX-OP (Life Care) with abutment, non-submerged, tapered at apical 5 mm, sand-blasted & acid etched surfaced implants were used. These are one stage single implants made of commercially pure titanium. The length of implants used was 10 mm and 13 mm and diameter was 3.70 mm and 4.50 mm. The vertical bone dimension was determined by palpation and radiograph (intra-oral periapical, orthopantomograph and dentascan in some patients). Gingival condition, bone condition was examined clinically and radiographically. DISCUSSION: Post-operative evaluation was done under clinical parameters (i.e. Pain (VAS), Swelling, Stability (By Glickman method), Gingival status, Probing depth (By Williams Periodontal probe), Patient's compliance / satisfaction, Complications (If any) and Radiological parameters was (Intra-oral periapical radiograph, orthopantomograph, Dentascan). CONCLUSION: Overall conclusion drawn from this study was that both the groups are showing similar results but Group-A is slightly better than Group-B.

Buccal fat pad versus sandwich graft for treatment of oroantral defects: A comparison.

AIM: To compare the efficacy of buccal fat pad (BFP) graft with sandwich graft (hydroxyapatite crystals embedded within collagen sheath) in closure of oroantral defects. MATERIALS AND METHODS: A 2-year prospective study was conducted; 20 patients were included in the study were divided into two groups having 10 patients in each. Group I patients underwent surgical closure of oroantral fistula with sandwich graft and Group II patients with buccal pad of fat. RESULTS: In Group I, the mean pain scores were 7.60 ± 0.84, 3.90 ± 1.10, 2.30 ± 1.16, 1.10 ± 0.99 and 0.40 ± 0.70 at immediate post-op., 1, 3, 6 and 12 week time intervals, respectively, whereas in Group II these were 7.30 ± 0.67, 3.50 ± 0.53, 1.70 ± 0.48, 1.00 ± 0.47 and 0.30 ± 0.48, respectively, at the corresponding time intervals. In Group I, swelling was seen to be present in 10 (100%), 7 (70%), 2 (20%) and nil (0%) patients at 1, 3, 6 and 12 weeks, respectively, whereas in Group II, it was seen to be present in 10 (100%), 10 (100%), 2 (20%) and nil (0%) patients at the corresponding time intervals. At 1 week, infection was seen to be present in 1 (10%) patient of Group I and 2 (20%) patients of Group II. At 3 and 6 weeks, infection was seen to be present in 1 (10%) patient of Group I and none of the patients of group II. No radiologic evidence of bone formation was seen in either group up to 1 week. At 3 week interval, there were 6 (60%) patients in Group I and nil (0%) in Group II showing bone formation, thus showing a statistically significant difference between the two groups. By 6 week time interval, radiologic evidence of bone formation was seen in 9 (90%) patients of Group I but in no patients of Group II, thereby showing a statistically very highly significant (P < 0.001) difference between the two groups. In Group I, in 1 (10%) patient, graft was rejected by first week; however, no further graft rejection took place. In Group II, no case of graft rejection was reported. CONCLUSIONS: The sandwich graft technique yielded a more promising closure of oroantral communication by provision of a more biologically apt base in terms of regeneration of lost bone structure at the floor of the maxillary sinus.