Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis.

Background: Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. Aim: The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. Methods: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Results: Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. Conclusion: The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

Efficacy of Nasal Floor Augmentation on the Survival Rate of Dental Implants: A Systematic Review.

Aim: To systematically review the existing scientific literature, to summarize and assess the efficacy of the nasal floor augmentation on the survival rate of dental implants by systematically reviewing the available literature. Methodology: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD42027289143. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting efficacy of nasal floor augmentation and reporting outcomes in terms of survival rates of dental implants. Quality assessment of included comparative follow-up studies was done using the critical checklist put forward by the Joanna Briggs Institute (JBI) was used. Results: Only nine studies fulfilled the eligibility criteria and were included in the qualitative synthesis. Of those nine studies, five were case reports and four comparative follow-up studies. A total of 14 implants were placed in five patients with a survival rate of 100% in included case reports, while a total of 408 implants were placed in 130 patients with survival rates ranging from 89% to 100% in included comparative follow-up studies. No complications were observed during follow-ups, and the patients were satisfied with the functional and aesthetic results of the treatment. Quality assessment of included studies showed moderate to low risk of bias with overall high quality of studies. Conclusion: The results of this systematic review indicate that implant placement by nasal floor augmentation techniques can be considered as a predictable treatment modality. However, due to the scarcity of literature, more studies should be carried out on proving the efficacy of nasal floor augmentation on survival rate or success of dental Implants.

Efficacy of Platelet Rich Fibrin versus chitosan as a hemostatic agent following dental extraction in patients on antiplatelet therapy.

OBJECTIVES: The aim of this study is to compare the effectiveness of Platelet Rich Fibrin gel and Chitosan gel dressing in providing hemostasis in patients receiving Oral Antiplatelet Therapy and also to evaluate their surgical healing outcome following dental extractions. METHODOLOGY: A total of 60 patients under Oral Antiplatelet Therapy indicated for tooth extraction were included for treatment in the study without altering the oral antiplatelet regimens. Patients were allocated equally in two groups; Group A: where PRF gel was packed into the extraction socket, while Group B: Chitosan hydrogel was packed. Timing of hemostasis was noted for each patient of both the groups. Patients were examined for any pain/secondary bleeding/healing/soft tissue dehiscence/alveolar osteitis in the extraction site on first, third and seventh post-operative days. RESULTS: All extraction sockets with Platelet-rich fibrin achieved hemostasis in 2.64 min and sockets with Chitosan hydrogel achieved hemostasis in 1.182 min (p < 0.001). Post-operative pain in Group A sites (3.2, 1.4, 0.37 on 1st, 3rd & 7th day respectively) was significantly lower than the control sites (3.4, 1.67, 0.53 on 1st, 3rd & 7th day respectively) p-value 0.001, 0.001 respectively. CONCLUSION: In this study, Chitosan hydrogel dressing thus proved to be a superior hemostatic agent compared to PRF gel, that significantly shortens the clotting time following dental extraction in patients under antiplatelet therapy. But, PRF gel has superior wound healing properties than Chitosan with less postoperative pain following minor oral surgical procedures under local anesthesia.

Tuberculosis of the maxillary sinus masquerading as a facial abscess, a unique occurrence.

The incidence of tuberculosis is a frequent finding especially in developing countries owing to a significant population of the people belonging to the lower socioeconomic strata with poor hygiene and nutrition. Tubercular involvement of the paranasal sinuses is usually asymptomatic until it reaches an advanced state and when it involves the maxillary sinus, this initial period of quiescence often mimics the clinical presentation of a chronic sinus infection, which often leads to a diagnostic dilemma. Symptoms commonly reported are chronic sinusitis and rhinorrhea, both of which being nonspecific in nature leading to a quandary. We herewith present a 50-year-old patient who presented with symptoms of an odontogenic infection involving the right maxillary molars. Primary management did not yield to the resolution of presenting symptoms. On biopsy, through an endoscopic approach and subsequent histopathological examination, the diagnosis of tuberculosis was arrived at. The patient responded well to antitubercular drug therapy.

Anxiety and Depression in Facial Injuries: A Comparative Study.

BACKGROUND: This study was performed to identify the presence of anxiety and depression in patients who had sustained facial injuries; additionally we aimed to identify other variables that may modify the psychological response to trauma that include gender and age. MATERIALS AND METHODS: The participants were 153 patients from multimodal trauma centers in Bangalore city who sustained disfiguring facial injuries were taken up. Of the 153 patients, 81 patients were male (51 less than 50 years of age and 30 more than 50 years of age) and 72 patients were female (40 less than 50 years of age and 32 more than 50 years of age) and 111 patients with non-disfiguring facial injuries out of which 54 were male patients and 57 were female patients. The assessments were carried out at 3 time intervals (the date of discharge [DOD], 1-month post-operatively and 6 months post-operatively) of the follow-up. The hospital anxiety and depression scale (HADS) was used to assess the anxiety and depression of the facial trauma patients. RESULTS: Statistically significant higher means of HADS both for anxiety and depression were present in patients with disfiguring facial injuries compared to non-disfiguring facial injuries, female patients compared to male patients after the 1-month and 6 months post-operatively, the mean anxiety and depression scores of males and female patients were significantly higher for those who aged less than 50 years compared to those who aged more than 50 years. CONCLUSION: The results of this study led to the conclusion that in comparison with patients who had facial disfiguring injuries and non-disfiguring facial injuries, the mean HADS scores were significantly higher in the disfiguring facial injury patient. This indicates increased Anxiety and Depression levels and this was observed at all three study intervals (DOD, 1-month and 6 months post-operatively). The HADS was higher in female patients who were lesser than 50 years age compared to male patients of the same age group, which implies higher anxiety and depression levels.

Post-traumatic Stress Disorder in Facial Injuries: A Comparative Study.

AIM: The aim of the study was to identify the presence of post-traumatic stress disorder (PTSD) in patients who had sustained facial injuries, additionally, we aimed to identify other variables that may modify the psychological response to trauma that include gender, age and presence of disfigurement post-treatment and visible scars/orthopedic injuries. MATERIALS AND METHODS: Participants comprised of 460 patients from several multinodal trauma centers in Bengaluru City, Karnataka, who had sustained facial injuries that had healed either with or without significant disfigurement or scarring and with visible/orthopedic injuries. One hundred and eleven patients of the chosen 460 had sustained nondisfiguring facial injuries while 153 patients sustained disfiguring facial injuries, 64 patients who sustained facial injury (i.e. 19.5%) were lost to follow-up and were not included in the study. One hundred and thirty-two had sustained orthopedic/visible injuries; however, in this group, 18 (i.e. 13.6%) patients were lost to follow-up and were excluded from the study. The impact of events scale (IES) was used to check the presence of PTSD. RESULTS: Statistically significant higher means of IES were present in patients with disfiguring facial injuries compared to nondisfiguring facial injuries, female patients compared to male patients, patients with disfiguring facial injuries compared to orthopedic/visible injuries and patients who were younger than 50 years of age compared to patients who were older than 50 years of age and the results observed were similar at all three study intervals (date of discharge (DOD), 1 month and 6 months postoperatively). CONCLUSION: Patients with disfiguring facial injuries had significantly higher PTSD levels compared to patients with nondisfiguring facial injuries, patients with orthopedic/visible injuries had statistically significant lower IES scores which could not be strictly termed PTSD when compared to patients with disfiguring facial injuries who had high scores of IES corresponding to high levels of PTSD and these results were observed at all three study intervals (DOD, 1 and 6 months postoperatively). Female patients with disfiguring facial injuries had significantly higher PTSD levels compared to male patients (at all the study intervals) and patients younger than 50 years of age had significantly higher PTSD levels compared to older patients.

A Comparative Study of Post-traumatic Stress Disorder, Anxiety, Depression and Change in Sexual Functioning of Patients with Facial Injuries and Patients with Extremity Injuries.

BACKGROUND: This study was performed to identify and compare the presence of and the levels of post-traumatic stress disorder (PTSD), anxiety, depression and if any change in sexual functioning is present in patients with disfiguring facial injuries, nondisfiguring facial injuries and visible extremity injuries. MATERIALS AND METHODS: A total of 378 patients from multi modal trauma centers in Bengaluru city were included for the study. A total of 153 patients were those who had disfiguring facial injuries, 111 patients with nondisfiguring facial injuries and 114 patients had sustained a visible extremity injury that was not covered by clothing (disfigurement /scarring). The assessments were carried out at three time intervals (the date of discharge, 1 month postoperatively and 6 months postoperatively) of the follow-up. The impact of events scale (IES), the hospital anxiety and depression scale (HADS) and changes in sexual functioning questionnaire (CSFQ) were used. RESULTS: Statistically significant higher means of IES, HADS (both for anxiety and depression) were present in patients with disfiguring facial injuries compared to patients with nondisfiguring facial injuries and visible extremity injuries and this was present at all three study intervals (date of discharge,1 st postoperative month and 6th postoperative month). There was a statistically significant change in the means of CSFQ scores of visible extremity injuries compared to other groups at the date of discharge bordering on sexual dysfunction, there was a raise in CSFQ scores among all three groups at the 1st postoperative month and the 6th postoperative month which was above the dysfunction cut-off. CONCLUSION: The results of this study led to the conclusion that in comparison with patients who had sustained disfiguring facial injuries, nondisfiguring facial injuries and visible extremity/ orthopedic injuries, the mean IES scores, HADS scores for both anxiety and depression of the facial disfiguring injury patients was higher at all three study intervals (date of discharge,1st postoperative month and 6 months postoperatively), indicating higher PTSD levels, anxiety and depression in patients with disfiguring facial injuries, CSFQ scores were above the cutoff suggested at the 1st month and 6th month postoperative indicating no sexual dysfunction in all the three groups.

A comparative evaluation of the vertical root fracture resistance of endodontically treated teeth using different root canal sealers: an in vitro study.

OBJECTIVE: The objective of this study is to evaluate the vertical root fracture resistance of endodontically treated teeth obturated with - Tubli-Seal EWT/Gutta-percha, AH Plus/Gutta-percha, Epiphany SE sealer/Epiphany point. STUDY DESIGN: Sixty-five single rooted premolars were decoronated and root length was 14 mm for each specimen. Fifty five teeth were enlarged up to ISO size 40 master apical file with stainless steel K-files using standardized preparation and remaining ten teeth were served as negative control. Then teeth were randomly assigned into different groups depending on sealer used for obturation as follows: Group 1: Negative control-no instrumentation was performed. Group 2: Positive control-gutta-percha with out the use of any sealer. Group 3: Experimental group-gutta-percha and Tubli-Seal EWT root canal sealer. Group 4: Experimental group-gutta-percha and AH Plus. Group 5: Experimental group-epiphany SE sealer and epiphany points. After 72 hours, the specimens were embedded in autopolymerizing resin leaving 7 mm of each root exposed and were subjected to fracture testing under universal testing machine at a crosshead speed of 1.0 mm per minute until the root fractured. Results were statistically analyzed using one-way ANOVA and independent t-test. RESULTS: Showed that Epiphany SE sealer/Epiphany points showed highest mean fracture resistance and Tubli-Seal EWT group showed the least fracture resistance of all the materials tested. There was no statistically significant difference among experimental groups. CONCLUSION: Epiphany SE sealer/Epiphany points demonstrated highest fracture resistance values than the other materials tested and intact tooth had highest resistance against vertical root fracture. CLINICAL SIGNIFICANCE: Epiphany SE sealer/Epiphany points may be one of the materials of choice in the endodontic treatment of teeth.