Can Histopathological Evidence of Ankylosis of the Tooth be Helpful in the Prevention of a Medicolegal Case in Case of Iatrogenic Fracture of the Mandible during Dental Extraction where Preoperative Radiographs have not been Taken?

A fracture of the mandible is a rare complication that can occur during a dental extraction being carried out under local/general anesthesia. It is always advisable to take a pre-operative radiograph of the tooth to be considered for extraction to study the root configuration and make a surgical plan for the case. Most of the dental extractions carried out without taking a preoperative radiograph are completed uneventfully. However, in rare cases, complications can arise owing to local anatomical variations and lead to medicolegal issues and litigation. This article discusses the management of a case of iatrogenic fracture of the mandible during dental extraction, wherein a pre-operative radiograph was not taken; however, following extraction of the tooth and management of the fracture mandible, the histopathology report of the extracted tooth was suggestive of ankylosis of the tooth.

Odontogenic Keratocyst with Diverse Variations: A Rare Case Report.

Rationale: An odontogenic keratocyst (OKC) is a developmental odontogenic cyst lined by squamous epithelium having intrinsic growth potential. Hence, metaplastic changes such as the formation of mucous cells, ciliated cells, and hyaline bodies with ortho/para keratinisation have been known to create unusual histopathological variations. Patient Concerns: A 34-year-old male patient reported with swelling on the lower right side of the face and numbness on the overlying skin. Diagnosis: Based upon the histopathological findings, a final diagnosis of glandular odontogenic cyst with OKC was confirmed presenting mixed features of basal layer palisading squamous epithelium with goblet cells and satellite cysts appeared to be entrapped in the connective tissue wall. Treatment: Surgical enucleation of the cyst was done. Outcomes: No recurrence was reported in 1 year of follow-up. Take-away Lessons: Diverse variations appear within odontogenic cysts and tumours. The high recurrence rate and aggressive nature of the cyst, divulges appropriate treatment and long-term follow-up.

Osteoid Osteoma of the Mandibular Condyle: A Diagnostic Dilemma.

Osteoma is benign osteogenic lesions characterized by proliferation of either cancellous or compact bone and can be central, peripheral, or extraskeletal. The most common site is in the skull. When affecting the facial bones, they are frequently found in the mandible, the most common locations being the posterior lingual surface and the mandible angle area. Here, we are presenting a rare case of osteoid osteoma of the mandibular condyle causing facial deformity in a 21-year-old male patient. On investigation, orthopantomogram revealed a solitary ill-defined homogeneous mixed radiopaque-radiolucency with a thin sclerotic border on the left mandibular condyle, cone-beam computed tomography showed a solitary irregular bony multilobulated overgrowth and the fusion imaging of positron emission tomography-computed tomography showed lobulated protuberance along medial margin of the left mandibular condyle with methylene diphosphonate bone scan showed well defined focal increased tracer uptake. The left side condylectomy was performed followed by shaving of inferior border with modified condyle formation by sliding osteotomy. Secondary surgery for correction of occlusion was done, and the patient was advised for orthodontic correction. The present case showed no recurrence after 18 months of follow-up.

Age estimation in Indian adults by the coronal pulp cavity index.

BACKGROUND: Age estimation from tooth coronal index (TCI) using intraoral periapical radiographs by paralleling technique based on a reduction in the size of the dental pulp cavity with advancing age as a result of secondary dentin deposition. AIM AND OBJECTIVES: The aim of this study is to estimate age for Indian adults using radiographs of mandibular first molar and second premolar teeth using coronal pulp cavity index. MATERIALS AND METHODS: The study material consists of 400 intraoral periapical radiographs of mandibular second premolar and mandibular first molar from enrolled participants of either gender in the age group of 20-60 years. STATISTICAL ANALYSIS: Data analysis was done using SPSS (Statistical Package for Social Sciences), and Pearson's correlation coefficient (r) was used to find the correlation between age (years) and TCI. RESULTS: TCI was computed for each tooth and regressed on the real age of the sample. The correlation coefficient "r" was -0.865 (for premolar combined sample) and -0.850 (for molar combined sample). The obtained equations were tested on test sample of fifty teeth and age was determined. The absolute mean error between actual and predicted age for premolars was 6.72 months and for molars, it was 9 months. CONCLUSION: Age estimation using TCI is a precise, noninvasive, less time-consuming, and an inexpensive method.

To estimate the efficacy of 0.1% tacrolimus with Colgate Oraguard-B paste for the treatment of patients with symptomatic oral lichen planus.

AIM AND OBJECTIVES: To investigate the efficacy of 0.1% tacrolimus with Colgate Oraguard-B paste for the treatment of patients with oral lichen planus (OLP). MATERIALS AND METHODS: One hundred and fifty patients with symptomatic OLP participated in the study, who had clinically and histopathologically proven OLP. In this study, patients were provided with 0.1% tacrolimus ointment with Colgate Oraguard-B paste as the study medication. Patients were asked to use the medication over the areas three times a day until resolution of the lesion. Patients were recalled to assess the drug response every 15 days. The duration of treatment ranged from 3 months to 4 months, with follow-up of 2 years and 6 months. STATISTICAL ANALYSIS: The Wilcoxon signed-rank test was performed, which is a nonparametric statistical hypothesis test for comparing two related samples, matched samples or repeated measurements on a single sample to assess whether their population mean ranks differ (i.e., it is a paired difference test). In our study, the pre- and post-Visual Analogue Scale (VAS) values were compared and the mean, standard deviation and P values were calculated. RESULTS: Of 150 patients, 71 (47.33%) patients had complete resolution of the lesion to the topical tacrolimus therapy. Sixty-five (43.33%) patients had marked resolution of their lesions, i.e., the size of the lesion was decreased. Fourteen (9.33%) patients had remission of lesion (reduction in burning sensation and size of lesion) in symptoms as recorded by the VAS. CONCLUSION: Topical tacrolimus ointment 0.1% in Oraguard-B paste is an effective treatment for different types of OLP.