Use of Transgingival Lag Screw Osteosynthesis in the Management of Alveolar Process Fracture.

The purpose of this study is to check the efficacy of transgingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single-arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this study, 20 mixed age group patients with alveolar process fracture were included. All the patients were treated by a 2.0-mm transgingival screw fixation under local or general anesthesia. All the patients were evaluated for fracture stability, anatomical reduction, bone loss and bone resorption of alveolar process, tooth loss, and wound infection at 3 months of follow-up. A simple descriptive statistical analysis was done to evaluate the parameters and it was shown that the treatment of alveolar process fracture with two or three lag screws provides adequate fracture stability and anatomical reduction with no signs of bone loss and tooth loss, and wound infections were noted post lag screw fixation. The study concludes that transgingival lag screw fixation is a suitable alternative for alveolar process fractures in all the age groups and two to three lag screws are generally sufficient to fix fractured alveolar process either under local anesthesia or general anesthesia.

Cardiovascular Changes Due to Dental Anxiety During Local Anesthesia Injection for Extraction.

AIM OF THE STUDY: The present study evaluated the cardiovascular changes related to anxiety of the patient undergoing local anesthesia injection for extraction in Indian population. METHODOLOGY: In total, 100 Indian male patients were enrolled in the prospective study. Anxiety was measured at 15 min before local anesthetic delivery using Corah's Dental Anxiety Scale (DAS). Cardiovascular response data including blood pressure, heart rate, oxygen saturation and electrocardiographic changes were measured at five time points from 5 min before to 15 min after the administration of anesthetic. RESULTS: The mean anxiety scale score before administration of anesthetic was 8.24 (± 3.55) with a range from 4 to 20. Younger age was associated with a higher anxiety scale score. Severe preoperative anxiety (DAS > 12) was associated with significantly increased heart rate and blood pressure during administration of anesthetic. Significant ECG change was present at the time and 5 min after local anesthesia administration. Pain on injection was also associated with increased heart rate and blood pressure during anesthetic administration. CONCLUSION: The present study shows that significant cardiovascular changes do occur due to dental anxiety at the time of local anesthesia administration for tooth extraction in Indian population.

Is skip metastases associated with tumor thickness and tumor size in tongue carcinoma patients?

OBJECTIVE: To assess the correlation of skip metastases associated with increase in tumor thickness and size of the tumor. MATERIAL AND METHODS: A retrospective analysis was carried out from August 2009 to August 2015. In this study, a total number of 33 carcinoma tongue patients having T1, T2, and T3 sizes with N0 and N+ clinical necks who were treated by supraomohyoid neck dissection, extended supraomohyoid neck dissection, and modified radical neck dissection were analyzed. The data was assessed using Shapiro-Wilk W test, Nagelkerke R2 regression model, mean, and standard deviation. RESULTS: Metastasis to lymph nodes was present in 75% of patients. Level I and level II were the commonest sites to be involved, i.e., 20 patients. Three patients had skip metastasis out of which two patients had metastasis at level III (6%), and one patient had skip metastasis at level IV (3%). CONCLUSION: The incidence of skip metastasis increases with tumor thickness and tumor size in tongue carcinoma patients. CLINICAL RELEVANCE: The article reveals the positive relationship between tumor thickness, tumor size, and skip metastasis. The analysis shows tumor thickness as a higher predictor for skip metastasis with odds ratio of 5.5 compared to the tumor size having odd ratio 2.

Structurofunctional analysis based on postinsertion problems with complete dentures in Moradabad, North India: A cross-sectional study.

BACKGROUND: Complaints with complete dentures is a common and expected phenomenon. However the type and character of complaint varies between population and is influenced by the socio economic condition, prevalent dental awareness etc. This study attempts to find the most common complaints with complete dentures, their causes and also presents a classification of the same. METHOD: A cross-sectional analytical study was conducted by performing a survey on a sample of population over an 18 month period utilizing a customized questionnaire. The complaints were divided into four categories viz. discomfort, retention, esthetics and miscellaneous. Consequently each denture was evaluated for structural and functional defects. The findings were classified into error in denture base, physiopsychological, error in occlusion and teeth selection. The data was statistically analyzed. RESULTS: Error in denture base was the predominant cause of complaints. However physiopsychological and error in occlusion and teeth selection were also important second factors in certain groups of complaints. Highest number of complaints (23.07%) belongs to discomfort in mandibular posterior region. While the least number of complaints are concerned with speech as reported by both males and females (both at 2.02%). CONCLUSION: Discomfort with complete dentures was the largest complaint reported followed by loss of retention with esthetics and miscellaneous complaints. Discomfort in mandibular posterior region was the most frequent complaint reported while speech related complaints were least in number. Most common cause of complaints was error in denture base.

Is a deep subfascial approach better than the subfascial apporach to temporo-mandibular joint in terms of facial nerve injury and quality of life?

PURPOSE: The objective of the study was to compare the deep subfascial approach to subfascial approach in terms of facial nerve injury and quality of life. MATERIALS AND METHODS: A randomized study was performed from August 2013 to March 2017 on 24 patients with unilateral TMJ ankylosis. The subjects were randomly allotted to either Group I (12, Deep Subfascial) or Group II (12, Subfascial). All patients were evaluated objectively for facial nerve injury post-operatively and subjectively for quality of life in the form of a questionnaire post-operatively for 6 months. The data were analyzed using simple descriptive statistics, mean standard deviation, Wilcoxon paired t test, Friedman's test, and Mann Whitney U test. RESULTS: The comparison of the difference between the groups for postoperative facial nerve function at various time intervals did not give any significant differences (p > 0.05). In terms of quality of life there was a significant difference at 1 month post-operatively (p < 0.05) amidst the two approaches, however, 6-month follow-up revealed that there is no significant difference between the two approaches (p > 0.05). CONCLUSION: The study reveals that both the approaches are safe in terms of facial nerve injury and quality of life long term.

Is Superselective Neck Dissection Safer Than Supraomohyoid Neck Dissection for Oral Carcinoma Patients With N0 Neck in Terms of Shoulder Morbidity and Recurrence Rate?

PURPOSE: To estimate the clinical and functional results of patients who underwent distinctive types of neck dissection, with particular emphasis on shoulder function, rate of recurrence, and quality of life in patients with N0 neck. MATERIALS AND METHODS: A randomized clinical trial was conducted from August 2014 to March 2017 in which 20 adult patients with T1 to T3 lesions of the oral cavity and N0 neck were included. Patients were randomly allocated to group I (n = 10; selective neck dissection) or group II (n = 10; superselective neck dissection). All patients were evaluated objectively for degree of arm abduction and subjectively for quality of life using a questionnaire completed pre- and postoperatively at 6 months. Also, locoregional recurrence was investigated for 2.5 years. Data were scrutinized by applying mean and standard deviation, unpaired t test, Mann-Whitney U test, and Kaplan-Meier test. RESULTS: Mean values of the Arm Abduction Test and quality-of-life scores were statistically significant (P < .05) for group II compared with group I at all intervals. Data analyzed for locoregional recurrence showed a statistically significant difference between groups (P < .05), with group II having the better outcome. CONCLUSION: The results showed less shoulder morbidity and improved quality of life for superselective neck dissection (group II) compared with selective neck dissection (group I). Furthermore, group II was better for locoregional recurrence, which determines the oncologic safety of the procedure.

Effectiveness of platelet-rich fibrin in the management of pain and delayed wound healing associated with established alveolar osteitis (dry socket).

OBJECTIVE: To assess the efficacy of platelet-rich fibrin (PRF) on the pain and healing of the extraction socket related with established alveolar osteitis (dry socket, AO) after the removal of maxillary and mandibular molars. MATERIALS AND METHODS: One hundred consecutive adult patients with age group ranging from 18 to 40 years along with established dry socket after maxillary and mandibular molar extractions who have not received any treatment for the same were included in this single-arm clinical trial. PRF was placed in the maxillary and mandibular molar extraction sockets after adequate irrigation of the socket. All the patients evaluated for the various study variables which include pain, degree of inflammation, and healthy granulation tissue formation (wound healing) at the 1st, 3rd, 7th, and 14th post-PRF placement day in the alveolar socket. Data were analyzed using Shapiro-Wilk's test, Chi-square test and/or Student's t-test, Friedman's test, Wilcoxon signed-rank test, and Bonferroni test, with the significance level set at P < 0.05. RESULTS: There was significant reduction in pain associated with AO at the 3rd and 7th post-PRF placement day in the extraction socket along with mark decrease in the degree of inflammation at the 3rd post-PRF placement day, and there was better wound healing by the end of the 2nd week. CONCLUSION: The use of PRF in this clinical trial illustrates the promising results in terms of reduced pain and better healing in the patients with sustained AO.

Effect of Addition of Antifungal Agents on Physical and Biological Properties of a Tissue Conditioner: An In-Vitro Study.

Purpose: Tissue conditioners are used for healing of abused oral tissues. They may harbour microorganisms causing oral diseases such as candidiasis compromising the health of the patient. Also, addition of antifungal agents into tissue conditioner may alter its properties. This study compares the anti-fungal property and mechanical properties of tissue conditioner containing different antifungal agents. Methods: Three antifungal agents, one synthetic - fluconazole, and two natural - oregano oil and virgin coconut oil were added into the tissue conditioner (Viscogel) in different concentrations. The antifungal property, tensile bond strength and viscoelasticity of Viscogel containing these antifungal agents were assessed after 24 hours, three days and seven days. Results: While, the highest antifungal activity was shown by Viscogel containing fluconazole, the maximum tensile bond strength was found to be of Viscogel alone (control). Although Viscogel alone and in combination of fluconazole showed deterioration in viscoelasticity, Viscogel in combination of natural agents showed no significant changes over the period of seven days. Conclusion: Incorporation of the natural agents in the tissue conditioner can be used as an effective alternative to systemic or topical synthetic antifungal agents.

Vertical and horizontal proportions of the face and their correlation to phi among Indians in Moradabad population: A survey.

PURPOSE: The purpose was to examine the existence of divine proportions among the Indian faces in Moradabad population. MATERIALS AND METHODS: Totally, 100 patients (50 males; 50 females) aged 25-45 years were selected for the study. All facial photographs were analyzed based on the method of Ricketts assessing the divine proportions in vertical and transverse facial planes. Six horizontal and seven vertical ratios were determined, which were then compared with the phi ratio. RESULTS: The horizontal ratio results showed that three male and female ratios were not significantly different from each other (P > 0.05), and interchilion/nose width ratio was highly significant (P < 0.001). The horizontal mean ratios for females as well as males were highly significant from the phi ratio (P < 0.001) except for interchilion/interdacryon ratio, which was significant (P < 0.05) for females and not significant (P > 0.05) for males. The vertical ratio results showed that there was a highly significant difference (P < 0.001) for forehead height/stomion-soft menton ratio and no significant difference for two ratios between the mean ratios of males and females. All the vertical mean ratios for both the groups were highly significant (P < 0.001), except for the intereye-soft menton/intereye-stomion ratio, which was significant (P < 0.05) for female group and not significant (P > 0.05) for the male group. CONCLUSION: Although, the golden proportion is a prominent and recurring theme in esthetics, it should not be embraced as the only method by which human beauty is measured to the exclusion of others factors.

Comparative evaluation of retention of prefabricated and conventional cast post: An in vitro study.

BACKGROUND AND OBJECTIVES: This study was conducted to evaluate the retention of various prefabricated posts and to compare them with that of the conventional cast post. MATERIALS AND METHODS: A sample of 60 freshly extracted single-rooted human mandibular first premolars were sectioned horizontally, 1 mm coronal to the cemento-enamel junction and randomly divided into four groups consisting of carbon fiber posts, glass fiber posts, stainless steel posts and cast metal posts. Cast metal post was the control group. Each group contained 15 specimen. The post space of 9 mm depth was prepared using specific drill supplied by the manufacturer. Resin patterns of the prepared post spaces were fabricated for 15 specimen and were cast in nickel chromium base metal alloy. All the posts were cemented with self-adhesive resin cement and mounted in acrylic cylinders. The teeth were subjected to tensile pull-out test using a universal testing machine. The force required to dislodge each post from the teeth was recorded. The data was analyzed using one-way analysis of variance and Bonferroni test. RESULTS: The bond strength of all the prefabricated posts was significantly lower than the conventional cast post. Among the prefabricated posts highest bond strength was obtained for prefabricated stainless steel post and lowest for carbon fiber posts. There was no significant difference in the mean bond strength obtained for stainless steel and glass fiber post. CONCLUSION: Though no single prefabricated post could achieve results close to the control group, most retentive among the experimental group were the stainless steel posts. However, conditions where nonmetallic posts are indicated most preferred type of post can be the glass fiber posts.

Effect of Preparation Taper, Height and Marginal Design Under Varying Occlusal Loading Conditions on Cement Lute Stress: A Three Dimensional Finite Element Analysis.

To assess the effect of preparation taper, height and margin design under different loading conditions on cement lute stress. A 3-D FE model of an upper second premolar and molar was developed from CT scan of human skull using software programmes (MIMICS, Hypermesh and ANSYS). 10° and 30° taper, 3 and 5 mm preparation height and shoulder and chamfer finish lines were used. Type 1 Glass ionomer cement with 24 µm lute width was taken and the model was loaded under 100 N horizontal point load, vertical point load distributed axial load. The maximum shear stress and Von Mises stress within the cement lute were recorded. The maximum shear stresses ranged from 1.70 to 3.93 MPa (horizontal point loading), 0.66 to 3.04 MPa (vertical point loading), 0.38 to 0.87 MPa (distributed loading). The maximum Von Mises stresses ranged from 3.39 to 10.62 MPa (horizontal point loading), 1.93 to 8.58 MPa (vertical point loading) and 1.49 to 3.57 MPa (distributed loading). The combination of 10° taper and 5 mm height had the lowest stress field while the combination of 30° taper and 5 mm height had the highest stress field. Distributed axial loading shows least stress, better stress homogenization and gives a favorable prognosis for the fixed prostheses. Smaller preparation taper of 10° is biomechanically more acceptable than a 30° taper. It is desirable to decrease taper as height increases. The chamfer margin design is associated with greater local cement stresses toward the margins that could place the cement at greater risk for microfracture and failure.