Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study.

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years ± 10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

Retrospective Analysis of Dental Implant Failure Rates in Patients with Compromised Health.

Objectives: The goal of the current research was to compare the failure rate of dental implants in medically compromised patients to healthy individuals. Materials and Methods: In this seven years retrospective study, 50 patients from Group A who were medically compromised had 63 implants, while 50 patients from Group B who were healthy had 67 implants. Over 1 mm of bone loss around the implant in the first year and over 0.2 mm of bone loss per year after that were considered failure rates. Result: Two (2.9%) of the dental implants in Group B and 18 (28.6%) in Group A, both failed. The average bone loss around the implant in Group A during the first year was 1.21 mm, compared to 0.3 mm in Group B. Conclusion: Uncontrolled diabetes mellitus group had greater implant failure.

Complications of Conventional Sinus Augmentation Techniques Versus Modified Osteotome Techniques in Dental Implant Surgery: A 3-Year Retrospective Clinical Study.

Introduction: Sinus Augmentation has proven to be a predictable and popular approach to overcome bone volume deficiency in the posterior maxilla for patients seeking dental implants. The most common surgical methods utilized for maxillary sinus augmentations are the lateral window approach and crestal osteotome technique, which may cause many complications like sinus membrane tear, bleeding, sinusitis, etc. the purpose of this study is to compare complications rates of different sinus lift techniques in dental implant surgery. Aims and Objective: To assess the intraoperative and postoperative complications between the conventional direct or indirect method with alternative sinus lift techniques using Modified Crestal and Lateral (CAS & LAS KIT) ®method (Osstem/Hiossen). Materials and Methods: This is a retrospective study where in all the sinus lift cases done during 3year duration in the center data was collected and analyzed a total of 61 sinus lift procedure was done and all the data is tabulated and analyzed. Results: Results show of the total 61 cases 25 (40%) male patients and 36(59%)female patients traditional techniques like summers osteotome and conventional direct or indirect method had 7 cases (33.3%-37.5%) complication rates compared to Modified Lateral osteotome had 2 complications (14.2%) & Modified Crestal osteotome had only 3 case(3.7%) infections, wound dehiscence, membrane tear etc. Conclusion: Modified Crestal & Lateral Osteotome (CAS KIT & LAS KIT) ® technique does reduce the incidence of complications like sinus membrane tear compared to conventional Direct and Indirect techniques, because of stopper system used in hydraulic lift and the special design of drill head of these instruments.

Maxillofacial Injuries as an Occupational Hazard of Farming in Rural and Semi-urban Population: A 3-Year Retrospective Epidemiological Study.

PURPOSE: The aim of the retrospective study is to conduct an epidemiological evaluation of farm-based/farm-related maxillofacial injuries to assess the pattern and severity of maxillofacial injuries sustained and to formulate prevention strategies. MATERIALS & METHOD: In this analytical retrospective study, records/case sheets of patients presenting with trauma sustained in farm-based settings in a government hospital catering to rural and semi-urban population from January 2014 to Dec 2017 were analyzed to assess the incidence, pattern, etiology and trauma configurations of maxillofacial injuries sustained. RESULTS: Out of a total of 11,736 trauma cases, 2484 patients suffered injuries in farm-based settings. Out of these, 334 patients had maxillofacial injuries. Mandibular condylar fracture along with parasymphysis fracture was the most common fracture configuration. Injuries while working with non-motorized machinery followed by working around farm livestock were the most common etiological factors in farm-related trauma. CONCLUSION: Maxillofacial injuries account for a significant percentage of injuries suffered in a farm-related environment. Through this study, we have identified the patterns of maxillofacial injuries occurring in such an environment, and the data thus obtained can be used to develop various ergonomic and safety interventions in terms of machinery design and handling along with implementation of training programs and enforcing strict safety guidelines to minimize maxillofacial trauma in farm-based settings.

Microbiological profile of aerobic and anaerobic bacteria and its clinical significance in antibiotic sensitivity of odontogenic space infection: A prospective study of 5 years.

INTRODUCTION: Odontogenic infections are mixed aerobic-anaerobic microbial flora. Infections caused by anaerobic bacteria are serious and life-threatening. The microbial specificity in odontogenic infections is technique sensitive depending on the sampling and culturing of specimens. MATERIALS AND METHODS: A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 5 years by surgical intervention and intravenous antibiotics. This study evaluates the pathogenic potential and virulence factors of aerobes and anaerobes as well as its synergistic interrelations with other infectious flora, by culturing of specimens and testing antibiotic sensitivity in standard microbiological methodology in correlation with patient demographic factors. RESULTS: Of the 100 patients of odontogenic space infection, males were more affected, between third and fourth decades. Caries is the most common etiology with involvement of mandibular molars. Submandibular and buccal space is commonly involved. The most common microorganisms isolated being Staphylococcus aureus and Streptococcus viridans are facultative anaerobes which belong to aerobes and Peptostreptococcus predominated among obligate anaerobes. The empirical antibiotic regimen followed is amoxicillin plus clavulanic acid with Metronidazole, followed by surgical treatment. Clindamycin was preferred as the second line of choice in patients resistance to penicillin drugs with comparable efficacy in it. CONCLUSION: Our study expanded the knowledge base of the microbial flora associated with odontogenic infections, with special reference to anaerobes. Successful management of odontogenic space infection lies in decompression, removal of etiological factors, and also in selecting appropriate antimicrobial therapy depending on microbial flora isolated, for recovery of patients and preventing complications associated with fascial space infection.

Efficacy of Various Routes of Dexamethasone Administration in Reducing Postoperative Sequelae Following Impacted Third Molar Surgery.

AIM: To compare the efficacy of intravenous (IV), intramassetric (IM) submucosal (SM) routes & oral routes of dexamethasone administration post impacted third molar removal surgery. TYPE OF STUDY: Prospective randomized comparative clinical study. MATERIALS AND METHOD: This prospective comparative study included 60 patients with Class II and position B type of impaction (according to Pell and Gregory's classification). Patients were randomly divided into 4 groups. Group A, B, C & D patients received 8mg dexamethasone immediately post-surgical tooth removal via the IV, SM and IM route & oral respectively. Assessment of swelling, mouth opening and pain was done at intervals of 1st, 3rd and 7th post-op days. RESULTS: The average age of the patients was 27 years. The mean time taken was 20 mins 40 seconds. The IV group showed minimal swelling and better pain control on the 3rd post op day (statistically significant). All 4 routes showed comparable mouth opening results. CONCLUSION: IV administration of dexamethasone post third molar surgery has been the traditional way because of its faster onset of action and increased efficacy; IM and SM routes are also comparably effective although oral route had the best patient acceptance.

Directional Approach to Enantiomerically Enriched Functionalized [7]Oxa-helicenoids and Groove-Based Selective Cyanide Sensing.

Several regioselective functionalized mono- and disubstituted [7]oxa-helicenoids have been synthesized in the enantiomerically enriched (90-99% ee) form. These functionalized helicenoids exhibited pronounced spectral and chiroptical properties suitable for sensing applications. In particular, corresponding helicenoid's mono and dialdehydes have been effectively used as chemodosimeters for selective detection of cyanide anions over other anions, while simple aromatic aldehydes do not function as cyanide sensors. The groove available in the helical host plays a crucial role in the sensing. The enantiomerically enriched nature of the sensors allows the use of electronic circular dichroism as an uncommon detection tool for cyanide anions, along with conventional fluorescence and NMR methods.

Benzyne-Mediated Nonconcerted Pathway toward Synthesis of Sterically Crowded [5]- and [7]Oxahelicenoids, Stereochemical and Theoretical Studies, and Optical Resolution of Helicenoids.

Synthesis of [5]- and [7]oxahelicenoids via Diels-Alder reaction of sterically crowded bichromenes with benzyne is presented. Studies carried out on Diels-Alder addition product establish the unusual preference for a stepwise mechanism over the concerted reaction pathway. This high yielding general synthetic protocol affords unexpected anti cycloadducts [5]- and [7]oxahelicenoids, as confirmed by crystallographic analysis. To rationalize these intriguing antiaddition products, the reaction mechanism was elucidated by means of DFT analysis. Additionally, hydroxy-functionalized [7]oxahelicenoid has been resolved in its optically pure forms.

Single Miniplate Fixation for Mandibular Symphysis and Parasymphysis Fracture as a Viable Alternative to Conventional Plating Based on Champy's Principles: A Prospective Comparative Clinical Study.

To compare long term and short term outcomes of fixing mandibular symphysis and parasymphysis fractures with single mini plate and conventional fixation using two mini plates. STUDY DESIGN: in this prospective clinical comparative study, 30 patients with fracture in study region were randomly divided into two groups. Group A patients received single 2.5 mm titanium miniplate and Group B patients received two 2 mm titanium miniplates as per Champy's lines of osteosynthesis. Patients were followed up at intervals of 1, 12 and 24 weeks. Parameters assessed were: duration of surgery, fracture stabilization, paresthesia, occlusion and wound dehiscence. Statistically significant difference was observed in mean duration of surgery and wound dehiscence (P < 0.05). No significant difference was observed with respect to other parameters. Single 2.5 mm miniplate for mandibular symphysis and parasymphysis fractures is a time saving and cost effective technique with post-operative outcomes similar to conventional 2 plate fixation.

Sui Generis Helicene-Based Supramolecular Chirogenic System: Enantioselective Sensing, Solvent Control, and Application in Chiral Group Transfer Reaction.

A novel dioxa[6]helicene-based supramolecular chirogenic system (1) as a specific chiral recognition host for enantiopure trans-1,2-cyclohexanediamine (2) is reported. Host 1 with an inherent free phenolic group and a (1S)-camphanate chiral handle on the opposite terminal rings of the helicene chromophore acted as an efficient turn on fluorescent sensor for S,S-2 with an excellent enantioselective factor, α = K SS /K RR = 6.3 in benzene. This specific host-guest interaction phenomenon is found to be solvent-dependent, which leads to an enantioselective chiral (camphanate) group transfer to the diamine guest molecule. In the case of R,R-2, the de value is up to 68% even at room temperature. Intriguingly, the induced helicity in dioxa[6]helicene diol 6, upon supramolecular hydrogen-bonding interactions, is of opposite sense with positive helicity for S,S-2 and negative helicity for R,R-2, as shown by circular dichroism spectroscopy and in combination with theoretical calculations. This chiral supramolecular system is found to be an excellent host-guest pair for enantiomeric recognition of 2, based on their electronic and steric factors.

Comparison of 'sutureless' Transconjunctival and Subciliary Approach for Treatment of Infraorbital Rim Fractures: a Clinical Study.

PURPOSE: The aim of the study is to compare subciliary incision and 'sutureless' transconjunctival incision in the treatment of infraorbital rim fractures. MATERIALS AND METHOD: In this prospective study, 40 patients with fractures of the infraorbital rim were selected and divided into 2 groups using random sampling technique. Group A patients were treated using 'sutureless' transconjunctival technique and group B patients were treated using subciliary approach. The following parameters were compared a) time taken, intraoperative ease of access, exposure achieved; b) clinical outcome and postoperative complications; c) Aesthetic outcome at intervals of 15 days, 1 month and 3 months. RESULTS: Total time taken for completion of surgery was lesser in group A patients. The presence of subconjunctival ecchymosis (at 1 month interval) and neurological deficit was found to be statistically significant (P<0.05) in the 'subciliary' group of patients. The transconjunctival approach showed better esthetic results and fewer post-operative complications. CONCLUSION: The subciliary approach gives good exposure of the infra-orbital rim and is better suited to reduce extensively displaced fractures of the infra-orbital rim. The transconjunctival approach is comparatively faster, gives better esthetic results and fewer post-operative complications but is technique sensitive and requires an additional lateral canthotomy in cases where more exposure is needed.

Primary actinomycosis of vulva with inguinal lymphadenopathy.

Actinomycosis is a chronic suppurative granulomatous infection of subcutaneous tissues caused by bacterium Actinomyces israelii. It is a normal commensal of the oral cavity, gastrointestinal tract, respiratory tract, and vagina. Infection is first established locally by breach of mucosal barrier during various procedures, aspiration, trauma, or human bite. Rarely, it may spread through hematogenous and lymphatic system. We present a case of actinomycosis involving the vulva, extending to the inguinal region along with inguinal lymphadenopathy. Involvement of vulva by actinomycosis is uncommon in literature.

Tailor-Made Supramolecular Chirogenic System Based on Cs-Symmetric Rigid Organophosphoric Acid Host and Amino Alcohols: Mechanistic Studies, Bulkiness Effect, and Chirality Sensing.

A Cs-symmetric, rigid, achiral organophosphoric acid host with differentiable tautomeric structures has been developed for induced circular dichroism (ICD) studies of vicinal amino alcohols. The structural features of the host and the substituent bulkiness of the guest, together, decide the preferred mode of hydrogen binding on equilibration with a resultant ICD signal. An unequivocal rule correlating the absolute configuration of the guest amino alcohol with the ICD outcome is proposed.

Ophthalmic Complication Following Posterior Superior Alveolar Nerve Block for Tooth Extraction! A Rare Occurrence.

One of the most commonly asked question by a patient who comes for extraction especially in the rural areas is whether the procedure will cause problems to the eye!! In reality however, ophthalmic complications following routine maxillary molar extractions are practically unheard of. When they occur they can be extremely unnerving not just to the patient but also to the surgeon. Patients generally panic which makes it tougher for the clinician to assess the situation. We present a case of a 26 year old female patient developing ophthalmic complication following local anesthesia administration during extraction of upper left maxillary third molar. In this article, ophthalmic complications arising from posterior superior alveolar nerve block are discussed and management guidelines are highlighted.

Amniotic membrane as a biological scaffold after vestibuloplasty.

Vestibuloplasty techniques are widely carried out to make the denture bearing area more suitable and adequate to receive the intended prosthesis. One of the major challenges after a vestibuloplasty procedure is to reduce post operative discomfort, scar contracture and subsequent loss in sulcular depth. A raw bony surface, as is obtained after Clark's vestibuloplasty is prone not only to infections and increased pain, but also to increased scarring during the healing phase. Skin grafts have been most commonly used to cover the exposed periosteal surface but they have their own disadvantages. There is a constant search for biocompatible membranes/materials which would satisfy most criteria required of a biological scaffold. Amnion is the innermost layer of the placenta with certain unique properties. Here we discuss the efficacy of amniotic membrane as a biological dressing after vestibuloplasty.

An unusual complication of late onset allergic contact dermatitis to povidone iodine in oral & maxillofacial surgery - a report of 2 cases.

BACKGROUND: Povidone iodine (PVP-I) is a chemical complex of polyvinylpyrrolidone (also known as povidone or PVP) and elemental iodine. Iodine containing compounds are widely and commonly used as antiseptics and disinfectants. They are available in various forms like aqueous solution, tincture, aerosol, ointment, or foam. Skin irritation to them is due to the oxidative effects of iodine. Because of the low free iodine concentration in povidone-iodine, skin irritation is less frequent from short contact (1). CASE: We report two cases, both with no history of allergy to any drugs, who developed an allergic reaction 24 hours after the usage of povidone iodine as a pre-operative antiseptic to prepare (scrub) the lower third of face before surgical removal of third molars. This case report was granted an exemption by the ethical committee of our institution review board. The Helsinki declaration doesn't apply to this case presentation. CONCLUSIONS: PVP-1 is the most commonly used antiseptic scrubbing solution prior to most surgeries. However, allergic contact dermatitis due to PVP-I has not been extensively documented or reported and hence under evaluated, compared to other commonly encountered allergens. There is almost general agreement to the proposition that PVP-I is a very rare sensitizer (2,3) though there are some conflicting reports on the matter. However, sometimes when prolonged skin contact with PVP-I occurs when used as a pre-operative antiseptic agent, it can cause allergic dermatitis (4,5). Does this finding make pre-operative testing for allergies to PVP-1 necessary in all patients? A point to ponder.

Carcinoma ex pleomorphic adenoma: Diagnostic dilemma and treatment protocol.

Carcinoma ex pleomorphic adenoma (CXPA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It often poses a diagnostic challenge to clinicians and pathologists. The entity is difficult to diagnose preoperatively. Pathological assessment is the gold standard for making the diagnosis. Treatment for CXPA often involves an ablative surgical procedure, which may be followed by radiotherapy. We report a case of a 65-year-old lady with a history of recurrent swelling in the left preauricular region and a history of surgery 10 years back, in the same region. Preoperatively, a diagnosis of pleomorphic adenoma of the parotid gland metastasizing to the cervical lymph node was made, but postoperatively it was reported as CXPA adenoma of the parotid gland. A radical parotidectomy involving en bloc resection of the facial nerve along with deep and superficial lobes of the parotid was performed followed by radiotherapy. The fact that pleomorphic adenomas are classified as benign tumors should not overshadow the wide range of biological behaviors associated with these tumors. On account of the potential for malignant transformation, surgical treatment must be properly performed. Surgery followed by radiotherapy should be considered as the standard care for a patient with carcinoma ex pleomorphic adenoma.

A comparative Study of the Masticatory Efficiency in Complete Dentures Using Acrylic and Metal Occlusal Posterior Teeth-Photocolorimetric Analysis.

Masticatory efficiency is always compromised in complete denture patients. The denture teeth with compromised occlusal anatomy and material further compound the inherent limitations of complete dentures. To compare the masticatory efficiency of patients with complete denture using acrylic and metal occlusal posterior teeth. Ten edentulous patients with well-formed ridges were selected. Complete dentures using acrylic and metal occlusal posterior teeth were fabricated. The masticatory efficiency was calculated using photo colorimeter. Complete dentures with 20° acrylic resin posterior teeth were fabricated for ten edentulous patients and masticatory efficiency was measured using raw beetroot as test food on a photocolorimeter after 10, 15, 20 strokes. The acrylic resin posterior teeth were replaced with metal occlusal posterior teeth on the same denture base. The masticatory efficiency was measured by the same method. The mean average percentage of masticatory efficiency with acrylic resin teeth and metal occlusal teeth were first calculated and statistical analysis was done using students unpaired t test. The average masticatory efficiency with acrylic teeth was 46.46% and metal occlusal teeth was 65.62, 't' = 5.38. The difference between the mean average masticatory performance percentage with acrylic teeth and metal occlusal teeth was significant at 1% i.e. P < 0.01. Within the limitation of this study the average percentage value of masticatory efficiency improves considerably when metal occlusal teeth replace normal acrylic teeth without any alteration in position or relation.