Postanaesthetic Aseptic Palatal Necrosis - A Case Report.

RATIONALE: In dentistry, the most common procedure to be applied is administration of a local anaesthetic agent. It is impossible to practice dentistry without local anaesthesia. In the oral cavity, the palatal mucosa is tightly adherent to the palatal bone and there is little space for anaesthetic solution to be deposited. If local anaesthetic is forcefully injected by the syringe, it creates pressure on blood vessels and causes palatal necrosis. PATIENT CONCERN: Here, we present a case report of a 25-year-old male patient who reported to us with chief complaint of an ulcer on the palate. DIAGNOSIS: Patient was diagnosed with postanaesthetic aseptic palatal necrosis. INTERVENTION: The patient was managed conservatively using copious irrigation and a palatal acrylic splint. OUTCOME: On the 6th month follow-up, the lesion was completely replaced by healthy mucosa. TAKE-AWAY LESSONS: We should avoid forceful injection of local anaesthetic agent to prevent further postoperative complications.

Tratamento da Classe II com propulsor mandibular Herbst modificado ­ relato de caso / Class II treatment with modified Herbst ­ case report

A Classe II representa uma parte considerável dos problemas ortodônticos a serem tratados nas clínicas odontológicas. Para a correção desta má oclusão existem atualmente diversas formas de tratamento. Dentre os aparelhos ortopédico funcionais, o aparelho de Herbst tem se destacado devido a sua eficiência e praticidade por ser fixo e não necessitar da colaboração do paciente. O objetivo deste artigo é apresentar, através de um relato de caso clínico, o tratamento da má oclusão Classe II com aparelho de Herbst modificado com "splint" de acrílico inferior. A paciente do sexo feminino, apresentava inicialmente 11 anos e 11 meses, dentição permanente, retrusão mandibular e atresia das arcadas. Inicialmente, foi utilizado disjuntor maxilar e expansor inferior, seguido do aparelho de Herbst e finalizado com Ortodontia fixa. Ao final do tratamento o aparelho de Herbst modificado mostrou-se efetivo proporcionando uma relação molar Classe I, melhora do perfil da paciente e diminuição do espaço entre os lábios em repouso. (AU)

Class II represents a considerable part of orthodontic problems to be treated in dental clinics. To correct this malocclusion, there are currently several forms of treatment. Among the functional orthopedic devices, the Herbst device has stood out due to its efficiency and practicality for being fixed and not requiring the collaboration of the patient. The purpose of this article is to present, through a clinical case report, the treatment of class II malocclusion with a modified Herbst appliance with a lower acrylic splint. The female patient initially had 11 years and 11 months, permanent dentition, mandibular retrusion and atresia of the arches. Initially, a maxillary circuit breaker and lower expander were used, followed by the Herbst appliance and finished with fixed orthodontics. At the end of the treatment, the modified Herbst appliance proved to be effective, providing a class I molar relationship, improving the patient's profile and decreasing the space between the resting lips. (AU)

Mandibular fracture in a neonate.

Mandibular fractures in the neonate are rare. The aetiological factors are traumatic delivery, accidental fall, road traffic accidents, and attempted infanticide. The diagnosis is difficult due to facial oedema masking the clinical features and the absence of dentition. The treatment of fractures in the newborn represents a unique problem in terms of investigations, diagnosis, selection of anaesthesia, and method of fixation. The case of a 1-day-old infant referred for the management of a mandibular fracture sustained in an accidental fall is presented herein. During oral suctioning, the neonatologist observed continuous blood-stained secretions, which raised the suspicion of a trauma to the oral cavity. The infant was diagnosed as having a fracture of the mandibular symphysis with displacement. The fracture was reduced under local anaesthesia with sedation, and was stabilized with an acrylic splint, which was secured with circum-mandibular wiring. The patient was followed up for 1.5 years and the healing was satisfactory.

Acrylic splint Herbst and Hanks telescoping Herbst: a retrospective study of emergencies, retreatments, treatment times and failures.

INTRODUCTION: The Herbst appliance has been reported to be one of the most efficient for the correction of class II malocclusions. However, there are many complications that make its use difficult for clinicians and patients (splint loosening, telescope breakage, splint breakage, low comfort). The aim of this study was to evaluate and compare emergencies, retreatments, failures and overall treatment time of two types of Herbst appliances: the HT Herbst and the acrylic splint Herbst. MATERIALS AND METHODS: Two hundred and eight patients with Class II malocclusion were selected consecutively in a private practice. They were treated either with an acrylic splint Herbst (155 pt, mean age 10.3 ± 3.7) or with a HT Herbst (53 pt, mean age 11.3 ± 4.2 years). Tables were used for each patient to record the following complications, if present: detached Herbst, broken and repaired Herbst, broken and rebuilt Herbst (emergencies), Herbst that had to be re-made for lack of patient cooperation (retreatments) and appliances that had to be removed (failed treatment). RESULTS: Results showed that the HT Herbst and the acrylic splint Herbst have the same retreatment probability and the same treatment time. Moreover, the HTH has a lower risk of functional impairment: the acrylic splint Herbst has an emergency probability that is twice as high as the HTH. On the other hand, the HTH has a failure frequency that is nearly 6 times higher than the traditional Herbst although the statistical analysis could not provide any certain conclusion about it. CONCLUSION: In cases where a higher relative risk of failure for the traditional Herbst was confirmed, the HTH proved to be a better appliance than the traditional Herbst.

Use of acrylic splint for the stabilization of bony components after rhinoplasty: a new technique.

INTRODUCTION: Adequate stabilization of the osteotomised bony components and/or nasal grafts requires proper post operative care in order to maintain its position till the initial healing phase. An ideal splint should be light, adaptable, easy to remove and inexpensive. TECHNIQUE: This paper presents the author's experiences with use of self cure acrylic resin (DPI-RR) in fabrication of nasal splint following rhinoplasty. Special care should be taken during the final setting stage to irrigate the splint, especially on its undersurface, to counter the effects of the exothermic reaction. CONCLUSION: The Acrylic nasal splint is easy to fabricate, less time consuming, hygienic and cost effective. Our experience with the acrylic splint in over 250 cleft and aesthetic rhinoplasties shows that the acrylic splint fulfils all the criteria of an ideal splint.

Manejo de las fracturas mandibulares en pacientes pediátricos / Management of mandibular fractures in pediatric patients

Describimos el manejo de las fracturas mandibulares en niños durante tres años en un grupo de pacientes atendidos en la universidad de Thamar en la republica de Yemen entre 2006-09, de acuerdo a nuestras experiencias y a las condiciones del país. Se identificó el lugar de la fractura, mediante estudio clínico y radiográfico, además de analizar los traumas asociados, las causas que las produjeron y el tipo de tratamiento empleado en cada caso. Se encontraron en 21 casos (14 varones y 7 niñas). El tratamiento más utilizado fue la férula de acrílico y los alambres circunmandibulares lográndose excelentes resultados al ser este un método fácil y poco invasivo para los folículos dentales, ayuda a los niños por ser pacientes poco cooperativos y evita las complicaciones nutricionales

We describe a pediatric mandibular fractures management in Thamar University, Yemen Republic, during three years 2006-09, according our experience and conditions in this country. The anatomical site of the mandibular fracture was identified by clinical and radiograph examination, also we analyzed the associated injuries. The treated fractures were separated into those whose fractures were reduced with acrylic splint and circummandibular wires. A total of 24 fracture sites in 21 pediatric patients (14 males and 7 females). We demonstrated that the use of acrylic splint in the stabilization and fixation of a mandibular body fracture is a reliable and noninvasive procedure also the children are uncooperative patients, with this method of treatment can eat without nutritional complications

Management of traumatic bone cyst in a 3-year-old child: a rare case report.

The following case report describes a case of traumatic bone cyst (TBC) with classical clinical features occurring as a rare combination in a very young female patient with a traumatic etiology and its management using acrylic splint postsurgery. How to cite this article: Banda NR, Nayak UA, Vishwanath KH, Sharma DS, Khandelwal V. Management of Traumatic Bone Cyst in a 3-Year-Old Child: A Rare Case Report. Int J Clin Pediatr Dent 2012;5(3):213-216.

Pediatric facial injuries: It's management.

BACKGROUND: Facial injuries in children always present a challenge in respect of their diagnosis and management. Since these children are of a growing age every care should be taken so that later the overall growth pattern of the facial skeleton in these children is not jeopardized. PURPOSE: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. MATERIALS AND METHODS: Sixty child patients with facial trauma were selected randomly for this study. On the basis of examination and investigations a suitable management approach involving rest and observation, open or closed reduction and immobilization, trans-osseous (TO) wiring, mini bone plate fixation, splinting and replantation, elevation and fixation of zygoma, etc. were carried out. RESULTS AND CONCLUSION: In our study fall was the predominant cause for most of the facial injuries in children. There was a 1.09% incidence of facial injuries in children up to 16 years of age amongst the total patients. The age-wise distribution of the fracture amongst groups (I, II and III) was found to be 26.67%, 51.67% and 21.67% respectively. Male to female patient ratio was 3:1. The majority of the cases of facial injuries were seen in Group II patients (6-11 years) i.e. 51.67%. The mandibular fracture was found to be the most common fracture (0.60%) followed by dentoalveolar (0.27%), mandibular + midface (0.07) and midface (0.02%) fractures. Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

Management of mandibular body fractures in pediatric patients: a case report with review of literature.

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children.

Dental Considerations in the Management of Glanzmann's Thrombasthenia.

Glanzmann's thrombasthenia, is one of the rarest congenital, genetically inherited platelet disorder. It has an incidence of about 1:1,000,000, but is more common in populations with increased consanguinity. Glanzmann's thrombasthenia is characterized by deficiency or dysfunction of glycoprotein (GP) lib and Ilia, which are the receptors of fibrinogen. Both sexes are equally affected. Typical mucocutaneous bleeding occurs at birth or early infancy. Obtaining appropriate dental history of excessive bleeding after dental extraction, unexplained spontaneous mucocutaneous bleeding, gingival bleeding during teething or shedding of deciduous teeth and petechiae, ecchymoses or purpura on mucous membranes can play an important part in diagnosis. Hence, the pediatric dentist plays a very crucial role for prompt diagnosis and management of Glanzmann's thrombasthenia. Presenting here is a known case of Glanzmann's thrombasthenia, of a 6-year-old girl who required to undergo dental extraction and its successful management using an "acrylic-splint" along with the placement of "Calgigraf-Ag Foam".

The Availability and Fabrication of Acrylic Splints

PURPOSE: The primary objective in applying surgical splints is the restoration of normal occlusal relations through proper positioning of the teeth and bony structures. The splints were fabricated by specially educated physicians and personnel with dental training or a dental laboratory. The aim of this article is to introduce the easy availability and fabrication method of acrylic splints. METHODS: Acrylic is the most easily, rapidly, and cheaply obtained material among various splints. Acrylic splints are especially rigid, strong, easily adjustable and repairable, translucent, light-weighted, and well tolerated by the oral mucosa. Thus, the use of acrylic occlusal splints have been popularly applied. RESULTS: Surgical prosthetic splints have been used in the following; treatment of complex facial bone fractures, correction of maxillomandibular disharmonies, segmental maxillary osteotomies, reconstruction of the mandible, treatment of mandibular fractures in children, night guards in sleep bruxism, and repairment of TMJ dysfunctions. CONCLUSION: The use of acrylic splints have been popularly applied because of its good aspects and various purposes. However, its use is restricted because the process is time consuming, costly, and absolutely dependent on a dental technician in plastic surgery. This article presents the easy construction of splints made directly by the operator so that it may help analyze the patient's occlusion on dental casts and aid in building an operation plan.

Clinical Experiences of Acrylic Splint on Pediatric Mandile Fracture

The goal of open reduction in mandibular fracture is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. Many cases of mandibular fracture are treated by intermaxillary fixation using arch bars after open reduction. In this study, after open reduction of fracture, 23 patients were grouped according to acrylic splint appliction. All patients was younger than 15 years old. Open reduction was performed by miniplate or interosseous wire fixation. After open reduction, 8 patients were applied with acrylic splint and 15 patients were applied with arch bar for intermaxillary fixation. Physical examination and postoperative panoramic x-ray were reviewed for the evaluation of occlusion. In the group where acrylic splint was used, 75% of the patients showed excellent subjective satisfaction and 25% showed good satisfaction. In the group where the acrylic splint was not used, 33% showed excellent and good satisfaction, 27% fair satisfaction and 1 patient showed poor satisfaction. On long-term follow- up, the group where acrylic splint was applied showed better occlusion compared to the group where acrylic splint was not applied.