A comparative in vitro analysis of various temporization materials with respect to pulp chamber temperature changes during polymerization.

AIM: (1) To compare the temperature rise in the pulp chamber with different resin materials used for making provisional fixed partial dentures in anterior and posterior region while using Polyvinylsiloxane impression materials as matrix. (2) To identify a superior provisionalization material based on the amount of heat dissipated suitable for anterior and posterior provisional fixed partial denture fabrication. SETTINGS AND DESIGN: Temporary crowns and bridges are integral to Fixed Prosthodontics. It has been observed that conventional fixed prosthesis temporisation materials release heat due to the exothermic polymerisation reaction. When such a provisional material is directly let to set on a vital tooth, the heat transfer causes irreversible changes in the pulp tissue depending of the degree of change. Hence, this study observes amount of heat generation in various materials during temporisation procedure, by simulating similar conditions. MATERIALS AND METHODS: Two Models were fabricated, one simulating missing lateral incisor (Model A) and another simulating missing first molar (Model B). Intact maxillary central incisors and canine for Model A and intact mandibular Second Premolar and Second Molar were selected to act as abutments. These abutment teeth were fitted with the tip of a K-type Thermocouple inside their pulp chambers and these were connected to a digital thermometer. Five temporisation materials were chosen for fabrication of temporary crowns through Direct technique. (1) polymethy methacrylate (Self Cure acrylic), (2) bisacryl composite (Protemp 4), (3) visible light cure urethane dimethacrylate (Revotec LC), (4) barium glass and fumed silica infused methacrylate (Dentsply Integrity) and (5)nano-hybrid composite (VOCO Structur 3). Ten observations were made for each provisional material on each model. During each observation, temperature rise was recorded at 30s interval from the time of application, through the peak and till a decrease in temperature is observed. Polyvinyl siloxane was used as matrix for all except light cure resin, where polypropylene sheet was used. STATISTICAL ANALYSIS USED: Anova test used for statistical. RESULTS: ANOVA test revealed that there was a significant difference in the temperature changes associated with the provisional restorative materials used. Among the five, polymethy methacrylate (self cure resin) showed the maximum rise in temperature, followed by bisacryl composite (Protemp 4), visible light cure urethane dimethacrylate (Revotec LC), barium glass and fumed silica infused methacrylate (Dentsply Integrity) and nano-hybrid composite (VOCO Structur 3). There was no comparable difference between Model A and B but an overall reduction of temperature rise was observed in model B. CONCLUSION: VOCO Structur 3 showed the least temperature rise in the pulp chamber, and overall temperature rise was less for model B which can be attributed to the residual dentin thickness.

A systematic review of Pilomatrix carcinoma arising from the previous scar site of Pilomatrixoma.

Pilomatrix carcinoma is a rare tumor arising from the hair follicle matrix cells most commonly seen in the head and neck region. Also known as "calcified epithelial carcinoma of Melherbe," it was first reported in 1980 by Lopansri and Mihm. Since then till date to the best of our knowledge only around 125 cases were reported in literature, of which only 11 cases were reported to arise from histologically proven areas of previous pilomatrixoma which is the benign variant. One such case is being reported here along with the review of literature. A 50-year-old man presented with a swelling in the nape of his neck since 6 months, which was gradually increasing in size. He had a history of similar swelling at the same site 18 months back for which he underwent a surgery at a center outside. Final histopathology report was suggestive of pilomatrixoma with negative margin. Wide local excision of the tumor with 3 cm margin, placement of surgical clips followed by a primary closure was done. The final histopathology report is suggestive of pilomatrix carcinoma. The patient has no recurrence in 6 months follow-up. The differential diagnosis of pilomatrix carcinoma should be considered in cases of recurrent skin tumors. Wide local excision is the preferred treatment. Re-excision should be done in margin positive cases and cases where simple excision was done due to improper preoperative diagnosis. Due to the rarity of the disease, adjuvant treatment is not properly defined.

Evolution of treatment in gastric cancer- a systematic review.

Multimodality is the standard of care in gastric cancer but surgery remains the mainstay of curative treatment. As we are heading towards a more conservative approach for functional preservation without compromising oncological outcomes in all malignancies, the guidelines keeps changing based on various studies.The extent of surgery used to vary between the east and west, with the east performing more radical surgery and the west more reliant on multimodality therapy. This practice has been changing in the recent times.In this article we have reviewed how the treatment protocols of gastric cancer has evolved and modified, highlighting the practice changing trials.

An in vitro evaluation of tensile bond strength of soft liners bonded to different denture base resins.

Background: Clinically, adhesion failure is the most critical problem because of the failure of the optimal bond between denture base and the soft liner. Objectives: This study was performed to assess the tensile bond strength of two temporary soft liners to different denture base resins. Materials and Methods: Forty-eight blocks with 16 samples each of heat-cured denture base resin of three different types were fabricated from custom-made stainless steel die after de-waxing mold space. Surface roughening of each acrylic resin specimens which bonds with soft liners was done by abrading the surface and to this temporary soft liners (Perma soft denture liner and Pro soft denture liner) were bonded. The universal testing machine was used to test the tensile strength of bonded space. The results were statistically analyzed using the Statistical Software IBM SPSS Statistics for Windows, version 20.0. (Armonk, NY, USA: IBM Corp.) using the Chi-square test, Post hoc Tukey's HSD, and two way ANOVA tests. Results: It was observed that Perma soft was prevalent over Pro-soft denture liner on the basis of tensile bond strength with all three different types of denture base resins. Trevalon HI and acrylic composite exhibited better bond strength results with both Perma soft and GC Pro-soft denture liner as compared to other types of denture base resins. Conclusion: Perma soft had a better bond strength compared to Pro-soft denture liner in bonding modified denture base and conventional resins.

RésuméFond: Cliniquement, l'échec d'adhésion est le problème le plus critique à cause de l'échec de l'obligation optimale entre la base de râtelier et le paquebot mou. Objectifs: Cette étude a été exécutée pour évaluer la force d'obligation extensible de deux paquebots mous temporaires à de différentes résines de base de râtelier. Matériel et Méthodes: les blocs de Forty-eight avec 16 échantillons chacune de résine de base de râtelier heat-cured de trois différents types ont été fabriqués de l'acier inoxydable custom-made meurent après que de-waxing moisissent l'espace. Le fait de rendre rude de surface de chaques exemplaires de résine en acrylique que les obligations avec moules paquebots ont été faits en abrasant la surface et à ce temporaire les paquebots mous (Perma le paquebot de râtelier mol et le paquebot de râtelier mol Avantageux) étaient bonded. La machine de mise à l'essai universelle a été utilisée pour évaluer la limite élastique à traction d'espace bonded. Les résultats ont été statistiquement analysés en utilisant le Statistique Le logiciel IBM la Statistique de SPSS pour Windows, la version 20.0. (Armonk, NEW YORK, Etats-Unis: Société d'IBM.) l'utilisation de l'épreuve de Chi-square, Postez le HSD de Tukey hoc, et deux voie. Résultats: Il a été remarqué que Perma mol était qui prévaut sur le paquebot de râtelier Pro-soft sur la base de l'obligation extensible la force avec tous les trois différents types de râtelier base des résines. Trevalon SALUT et le composite en acrylique a exposé de meilleurs résultats de force d'obligation avec tant Perma mous que GC Pro-soft le paquebot de râtelier en comparaison d'autres types de râtelier basent des résines. Conclusion: Perma mol avait une meilleure obligation la force comparée au paquebot de râtelier Pro-soft dans bonding a modifié la base de râtelier et les résines conventionnelles.

In vitro evaluation of antimicrobial efficacy of silver zeolite against common oral pathogens.

Objectives: Antimicrobial efficacy and toxicity analysis of 5 different concentrations of silver zeolite (SZ) compound against 5 common oral pathogens Streptococcus mutans, Streptococcus pyogenes, Lactobacillus sp., Staphylococcus aureus, Candida albicans. Material and methods: The antimicrobial efficacy of 5 different concentrations of SZ was tested against 5 common oral pathogens using the agar well diffusion method and the MIC and MBC values were determined using the micro broth dilution method. The toxicity of all 5 different concentrations was evaluated using brine shrimp assay and lethal concentration (Lc50) value was determined. Results: At 10 µg/mL the antimicrobial activity of SZ was almost negligible. The antimicrobial activity was observed in an increasing trend against all the test microorganisms as the concentration increased. At 75 & 100 µg/mL the zone of inhibitions was more than the control. Furthermore, MIC and MBC values of SZ with concentrations 25, 50, 75, and 100 µg/mL were determined and recorded. SZ was equally effective against all the test organisms. The LC25 (lethal concentration25) value was 1.6 µg/mL, whereas the LC50 value was 1.77 µg/mL and the LC75 value was 1.90 µg/mL, calculated from the probit computational method. Conclusion: SZ has the potential to change the ongoing system and bring about a revolution as an antimicrobial drug. However, the dose must be regulated as it can be toxic in higher concentrations. SZ compounds with the correct study of physicochemical properties and toxicity analysis can increase their pharmacological use and market value.

Predictive Factors for Submandibular Gland Involvement in Oral Cavity Squamous Cell Carcinoma-a Prospective Study from a Tertiary Cancer Center.

The oncological necessity of submandibular gland removal during neck dissection for oral cavity squamous cell carcinoma surgery has remained controversial. This study was aimed to determine the rate of SMG involvement and assess the feasibility of submandibular gland (SMG) preservation. We present a prospective study conducted at a tertiary cancer center from June 2017 to May 2019. All patients of oral squamous cell carcinoma who underwent primary surgery with neck dissection were included and analyzed for incidence and predictive factors for incidence of level IB nodal and SMG involvement as per CAP guidelines. A total of 60 patients were inducted in the study, wherein 63 neck dissections were performed including bilateral dissection in three cases. There was involvement of SMG in 6 patients with two cases each in floor of mouth cancer, gingivo-buccal, and alveolar lesions. The SMG was involved by direct contiguous spread from the primary lesion in two cases, extra-capsular extension from level IB lymph nodes in one and by both mode of spread in three glands. Perineural invasion was seen in 83.33% (n = 5) patients with SMG involvement (p- < 0.001), while 66.67% (4/6) patients had lympho vascular invasion (p-0.006) and all the cases with SMG involvement had extra-capsular extension (p < 0.001), suggesting PNI, LVI, and ECE as the strongest predictors of SMG involvement. This study demonstrates that oral cavity squamous cell carcinoma has low potential to metastasize to the SMG; however, high-risk factors include primary tumor site in floor of mouth or tongue, heavy level IB nodal burden, presence of LVI, PNI, and ECE. In the absence of these high-risk factors, SMG preservation with complete nodal clearance in level IB is a promising technique for reducing future complications.

Can Preoperative Ultrasonography and MRI Replace Sentinel Lymph Node Biopsy in Management of Axilla in Early Breast Cancer-a Prospective Study from a Tertiary Cancer Center.

Although SLNB is a less invasive procedure in detecting axillary lymph node metastases(ALNM) in early breast cancer; still, it carries some complications like lymphedema and in addition, performing SLNB requires surgical skills, technical knowledge, presence of facility like preoperative sentinel lymphoscintigraphy, and availability of hand-held gamma probe for intraoperative assessment. We calculated the relative diagnostic strength of preoperative axillary USG and MRI and compared with of SLNB for detection of ALNM in early breast cancer and assessed whether MRI and USG could accurately predict axillary LN status, potentially replacing SLNB. We evaluated 40 cases of clinically node-negative early breast cancer with preoperative axillary USG and MRI and subsequently subjected to SLNB. The sensitivity, specificity, PPV, NPV, and accuracy of axillary USG were 62.5%, 96.88%, 88.33%, 91.18%, and 90% respectively (p value < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of MRI in detection of ALNM were 75%, 93.75%, 75%, 93.75%, and 90% (p value < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of combined USG and MRI in detection of ALNM were 87.5%,90.63%, 70%, 96.67%, and 90% respectively (p value < 0.001), which are comparable to previous study series. The diagnostic performance of combined approach of axillary USG and MRI is promising, as the NPV of combined USG and MRI is approaching the NPV of the SLNB in detecting ALNM. Based on above findings, if axillary LNs are found nonsuspicious in preoperative axillary USG and MRI, further axillary dissection may be avoided, and if found suspicious, then ALND may be directly proceeded avoiding SLNB in between.

Oncoplastic Breast Reconstruction in Breast Conservation Surgery: Improving the Oncological and Aesthetic Outcomes.

Breast conservation surgery (BCS) is now the standard of care for patients with early breast cancer. The main contraindications for BCS besides the presence of multicentricity and diffuse microcalcifications are inadequate tumour size to breast size ratio. With the advent of oncoplastic techniques, the indications of BCS may be further extended to patient with larger tumour size and or small volume breast. We prospectively assessed 42 patients undergoing oncoplastic breast conservation surgery for cosmetic and oncologic outcomes. Cosmetic outcome assessment was done by comparison of operated breast to contralateral breast by an independent surgeon, nurse and patient's attendant at 6 months post-surgery. Risk factors for compromised oncologic outcomes included grades II/III tumours and non-ductal histology. Intraoperative margin assessment with frozen section analysis proved to be important in order to achieve negative surgical margins on final histopathology. By univariate analysis, tumours located in central quadrant and medial half of the breast had similar cosmetic outcomes comparable to tumours located in other quadrants. Majority of our patients (90%) had overall good to excellent cosmetic outcomes on Harvard scale. Oncoplastic breast conservation surgery techniques allow for larger parenchymal resections without compromising oncologic and cosmetic results. It further allows extension of BCS to patients otherwise denied for the same based on earlier recommendations for mastectomy. Oncoplastic techniques and intraoperative margin assessment with frozen section are vital in attaining adequate margins and also decrease chance of local recurrence and revision surgery for positive margins.

Factors Affecting the Survival Rate of Dental Implants: A Retrospective Study.

AIMS AND OBJECTIVES: Dental implants have emerged as new treatment modality for the majority of patients and are expected to play a significant role in oral rehabilitation in the future. The present study was conducted to assess various factors affecting the survival rate of dental implants. MATERIALS AND METHODS: The present retrospective study was conducted in the Department of Prosthodontics. In this study, 5200 patients with dental implants which were placed during June 2008-April 2015 were included. Exclusion criteria were patients with hormonal imbalance, patients with chronic infectious disease, patients receiving immunosuppressive therapy, pregnant women, drug and alcohol addicts, and patients with severe periodontal diseases. Parameters such as name, age, gender, length of implant, diameter of implant, location of implant, and bone quality were recorded. Data were tabulated and statistically evaluated with IBM SPSS Statistics for Windows, Version 20.0., IBM Corp., Armonk, NY, USA. RESULTS: Out of 5200 patients, 2800 were males and 2400 females. Maximum implants failures (55) were seen in age group above 60 years of age (males - 550, females -700). Age group <40 years (males - 750, females - 550) showed 20 failed implants. Age group 41-60 years (males - 1500, females - 1150) showed 45 failed implants. The difference was nonsignificant (P = 0.21). Maximum implant failure was seen in implants with length >11.5 mm (40/700) followed by implants with <10 mm (20/1650) and 10-11.5 mm (60/2850). The difference was significant (P < 0.05). Maximum implants failure (30/1000) was seen in implants with diameter <3.75 mm followed by implants with diameter >4.5 mm (16/1600) and implants with diameter 3.75-4.5 mm (50/2600). The Chi-square test showed significant results (P < 0.05). Mandibular posterior showed 3.3% implants failure, maxillary posterior revealed 2.2%, maxillary anterior showed 2.1%, and mandibular anterior showed 1% failure rate; this difference was significant (P < 0.05). Type I bone showed 0.3% implant failure, Type II showed 1.95%, Type III showed 3%, and Type IV revealed 0.8% failure rate; this difference was significant (P < 0.05). CONCLUSION: Age, length of implant, diameter of implant, bone quality, and region of implant are factors determining the survival rate of implants. We found that implant above 11.5 mm length, and with diameter <3.75 mm, placed in the mandibular posterior region, in Type III bone showed maximum failures.

"An unusual presentation of colonic mucormycosis mimicking carcinoma colon- a surgeon's perspective".

INTRODUCTION: Mucormycosis caused by order mucorales, an ubiquitous saprophytic mold found in soil and organic matter worldwide, is a rare but invasive opportunistic fungal infection. Gastrointestinal mucormycosis is the most uncommon clinical presentation being particularly rare, accounted for 4-7% of all cases. PRESENTATION OF CASE: We report an unusual presentation of mucormycosis of ascending colon that was simulating carcinoma colon. DISCUSSION: GI mucormycosis most commonly involves the stomach (57.5%), followed by the colon (32.3%) and the ileum (6.9%). Initial presentations may be abdominal pain and distension, fever, and diarrhoea. Colonic mucormycosis presenting as a mass with altered bowel habit, melena and abdominal pain in our case is extremely difficult to differentiate it from carcinoma colon. A definitive diagnosis of mucormycosis is almost always ascertained by histopathological evidence of fungal invasion of tissue. CONCLUSION: Knowing these unusual presentations of this disease, surgeon need to maintain a high index of suspicion and perform timely and appropriate diagnostic evaluation to improve patient outcome. Prompt diagnosis, reversal of predisposing conditions, and aggressive surgical debridement remain cornerstones of therapy for this deadly disease.

Unusual association of Meckel's diverticulum with double appendix - A rare finding.

INTRODUCTION: Appendix duplication is an extremely rare congenital anomaly that is seen in 0.004-0.009% of appendectomy specimens. Duplicated appendix may be associated with number of congenital anomalies. PRESENTATION OF CASE: In this case report, we are presenting a rare case of duplicated vermiform appendix with a co-existing Meckel's diverticulum. DISCUSSION: Anomalies of appendix are rare and duplication of vermiform appendix is extremely rare. In 1936, Cave classified appendiceal duplication for the first time which was modified by Wallbridge in 1963 into three types. Concomitant malformations or duplications of the large intestine or the genitourinary system may be present, especially in types B1 and C probably due to their similar embryological origin. Here we are presenting a very rare case report of type B1 appendix anomaly associated with Meckel's diverticulum. CONCLUSION: Surgeons should be aware of these conditions because of the possible clinical implications.

Unusual presentation of follicular carcinoma thyroid with special emphasis on their management.

INTRODUCTION: Follicular carcinoma of thyroid usually behaves in an indolent manner with low metastatic potential. Distant metastases as initial presentation is rare in follicular carcinoma; especially in young patients. PRESENTATION OF CASE: We report the clinical, pathological features and the management of three different cases of follicular carcinoma of the thyroid with unusual presentations at the time of diagnosis. First case presented as thyroid abscess, second case with a large skull swelling in a pre-exiting goiter and the third case with a swelling in the sternum. DISCUSSION: Follicular carcinoma of thyroid is the second category of well-differentiated thyroid cancer that constitutes about 10% of all thyroid malignancies. Blood borne metastasis is common with spread to lung, bone and other solid organs. In less than 10% cases of follicular carcinoma, there is evidence of lymphatic involvement. The patients' presentations above are highly unusual. CONCLUSION: Recognizing these cases has a significant impact on clinical decision-making and prognosis of the patients. Treatment in these patients should be individualized and an alternative therapeutic approach should be considered.

Multiple fibroadenomas in bilateral breasts of a 46-year-old Indian woman - A case report.

INTRODUCTION: Fibroadenomas are among the most common tumours of the female breast, occurring most frequently in women of child-bearing age, especially those under 30 years. PRESENTATION OF CASE: We report a case with a total of 27 fibroadenomas presenting bilaterally of a 46-year-old woman. The histopathologic and immunophenotypic features of the fibroadenomata are described. DISCUSSION: Most fibroadenomas are present as single mass, however the presence of multiple fibroadenomata can be seen in 15-20% of the patients. It has been reported that the average number of masses in cases of multiple fibroadenomas is 3-4 in a single breast but occurrence of more than five fibroadenomas in an individual patient is much less common. CONCLUSION: There are few reports of multiple fibroadenomas. We report this case hoping to expand the literature and to provide insight to aetiology of multiple fibroadenoma formation and advice on management.

Ocimum sanctum Linn. A reservoir plant for therapeutic applications: An overview.

The medicinal plants are widely used by the traditional medicinal practitioners for curing various diseases in their day to day practice. In traditional system of medicine, different parts (leaves, stem, flower, root, seeds and even whole plant) of Ocimum sanctum Linn. have been recommended for the treatment of bronchitis, malaria, diarrhea, dysentery, skin disease, arthritis, eye diseases, insect bites and so on. The O. sanctum L. has also been suggested to possess anti-fertility, anticancer, antidiabetic, antifungal, antimicrobial, cardioprotective, analgesic, antispasmodic and adaptogenic actions. Eugenol (1-hydroxy-2-methoxy-4-allylbenzene), the active constituents present in O. sanctum L. have been found to be largely responsible for the therapeutic potentials. The pharmacological studies reported in the present review confirm the therapeutic value of O. sanctum L. The results of the above studies support the use of this plant for human and animal disease therapy and reinforce the importance of the ethno-botanical approach as a potential source of bioactive substances.