Surgical Removal of an Orthodontic Mini-Screw Displaced Into the Lateral Pharyngeal Space: A Case Report and Review of Pertinent Literature.

Oral and maxillofacial surgeons are often faced with the clinical challenge of foreign body displacement into the perioral tissues and soft tissues of the head and neck. This mainly occurs either because of trauma or inadvertently during dental treatment. In addition to the maxillary sinus, iatrogenic foreign body displacement during dental treatment could happen into one of the 16 distinct fascial spaces of the head and neck region. Commonly displaced foreign bodies related to dental treatment include tooth roots or fragments, local anesthetic needles, implants and restorations. The clinical sequelae of a displaced foreign body depend on its size, shape, anatomic location and proximity to vital structures. Although patients may remain asymptomatic for a considerable amount of time, retained foreign bodies result in persistent pain, recurrent infection and scarring of soft tissue due to inflammation, all of which may complicate delayed retrieval. In addition to the history, imaging modalities such as plain radiographs and computed tomography (CT) help in locating the displaced foreign body and its subsequent retrieval. Surgical retrieval may be attempted through intraoral, transcervical and endoscopic approaches. Additionally, surgery may be aided by real-time imaging such as fluoroscopy. The present report aims to detail a case of inadvertent displacement of an orthodontic mini-screw, commonly used as a temporary anchorage device (TAD), into the lateral pharyngeal space, while attempting placement in the mandibular retromolar area. The case report also describes the surgical retrieval procedure of the TAD screw using an intraoral approach and with fluoroscopy guidance using C-Arm radiographic imaging. This case is reported along with the pertinent review of literature, as it not only explains a rare complication of orthodontic mini-screw placement but also details a modality to remove displaced foreign bodies from fascial spaces of the head and neck, which are otherwise directly inaccessible.

Polyether-Ether-Ketone (PEEK) and Its 3D-Printed Quantitate Assessment in Cranial Reconstruction.

Three-dimensional (3D) printing, medical imaging, and implant design have all advanced significantly in recent years, and these developments may change how modern craniomaxillofacial surgeons use patient data to create tailored treatments. Polyether-ether-ketone (PEEK) is often seen as an attractive option over metal biomaterials in medical uses, but a solid PEEK implant often leads to poor osseointegration and clinical failure. Therefore, the objective of this study is to demonstrate the quantitative assessment of a custom porous PEEK implant for cranial reconstruction and to evaluate its fitting accuracy. The research proposes an efficient process for designing, fabricating, simulating, and inspecting a customized porous PEEK implant. In this study, a CT scan is utilized in conjunction with a mirrored reconstruction technique to produce a skull implant. In order to foster cell proliferation, the implant is modified into a porous structure. The implant's strength and stability are examined using finite element analysis. Fused filament fabrication (FFF) is utilized to fabricate the porous PEEK implants, and 3D scanning is used to test its fitting accuracy. The results of the biomechanical analysis indicate that the highest stress observed was approximately 61.92 MPa, which is comparatively low when compared with the yield strength and tensile strength of the material. The implant fitting analysis demonstrates that the implant's variance from the normal skull is less than 0.4436 mm, which is rather low given the delicate anatomy of the area. The results of the study demonstrate the implant's endurance while also increasing the patient's cosmetic value.

Effectiveness of Phone Call Follow-Ups in Improving Patient Compliance to Post-extraction Instructions: A Cross-Sectional Study.

Background Dental extraction is a commonly performed oral surgical procedure. The manner in which post-extraction instructions are given to patients may impact their understanding and adherence to instructions. This study aimed to evaluate the effectiveness of phone call follow-ups over conventional verbal and written post-extraction instructions in terms of patient compliance in Riyadh, Saudi Arabia. Methodology After obtaining informed consent, patients undergoing dental extraction at the Department of Oral and Maxillofacial Surgery were randomly enrolled into one of the three groups based on the mode by which post-extraction instructions were administered. Group A received verbal and written instructions only, and Group B and Group C received additional phone call follow-up on the first postoperative day and the first and third postoperative days, respectively. After seven days, all patients answered a questionnaire to quantify the level of compliance on a score out of 10, which was the outcome variable. The nature of receiving post-extraction instruction was the primary predictor variable. Age, gender, and type of extraction (surgical or non-surgical) were secondary predictors. Descriptive statistical analysis and statistical comparison of mean compliance scores between the groups and the effect of interaction between primary and secondary predictors on the outcome variable were carried out at a 95% significance level (p < 0.05). Results A total of 135 patients (75 males and 60 females; mean age = 36.2 years) were included in the study. While the overall mean compliance score was 8.36 ± 1.08, Group C (9.14 ± 0.78, n = 42) had a significantly higher level of compliance than Group B (8.48 ± 1.01, n = 40) and Group A (7.64 ± 0.83, n = 53) (one-way analysis of variance (ANOVA) F = 34.937; p < 0.001). Similarly, the level of compliance in Group B was significantly higher than that in Group A (p < 0.01). There was no significant statistical relationship between the secondary predictors and the compliance scores. Similarly, two-way ANOVA revealed no statistically significant effect of interaction between the primary and secondary predictor variables on the compliance scores. Individually, the least complied instruction, across all groups, was "rinsing with saline once every six hours for four days," and "biting on a gauze pack for 30 minutes" was the most complied instruction. Conclusions Phone call follow-up after teeth extraction improves patient compliance with post-extraction instructions through reinforcement and education. While a single phone call follow-up one day after extraction along with verbal and written instructions increased patient compliance significantly, a second phone call follow-up on the third postoperative day yielded the best level of compliance.

Bone Regeneration Using PEVAV/ß-Tricalcium Phosphate Composite Scaffolds in Standardized Calvarial Defects: Micro-Computed Tomographic Experiment in Rats.

Bone regeneration using beta-tricalcium phosphate (ß-TCP) can be practiced using a biocomposite scaffold. Poly(ethylene-co-vinylalcohol)/poly(δ-valerolactone)/ß-tricalcium phosphate (PEVAV/ß-TCP) composite scaffolds showed promising in vitro results. This study evaluated the bone regenerative potential of PEVAV/ß-TCP biocomposite scaffolds in standardized calvarial defects in a rat model over 4 and 10 weeks. Bilateral calvarial defects (5 mm in diameter and about 1.5 mm thick, equivalent to the thickness of the calvaria) were created in 40 male Wistar albino rats. The defects were grafted with either commercially available ß-TCP (positive control), PEVAV/ß-TCP 70, or PEVAV/ß-TCP 50, or left empty (negative control), depending on the group to which the animal was randomly assigned, to be covered before flap closure with resorbable collagen membrane (RCM). At 4 and 10 weeks post-surgery, the collected rat calvaria were evaluated using micro computed tomography (micro-CT) analysis, to assess the newly formed bone volume (NFBV), newly formed bone mineral density (NFBMD), and remaining graft volume (RGV). The results showed that calvarial defects grafted with the PEVAV/ß-TCP biocomposite exhibited higher NFBV than did control defects, both at 4 and 10 weeks post-surgery. Furthermore, calvarial defects grafted with PEVAV/ß-TCP 70 showed the highest NFBV among all grafting conditions, with a statistically significant difference recorded at 10 weeks post-surgery. The PEVAV/ß-TCP composite scaffold showed potentiality for the regeneration of critical-sized calvarial bone defects in a rat model.

Guided bone regeneration with osteoconductive grafts and PDGF: A tissue engineering option for segmental bone defect reconstruction.

Regeneration and reconstruction of segmental bone defects (SBD) is a clinical challenge in maxillofacial surgery and orthopedics. The present study evaluated efficacy of guided bone-regeneration (GBR) of rat femoral SBD using osteoconductive equine-bone (EB) and beta-tricalcium phosphate (beta-TCP) grafts, either with or without platelet-derived growth-factor (PDGF). Following ethical-approval, 50 male Wistar-Albino rats (aged ~12-15 months and weighing ~450-500 g) were included. A 5 mm femoral critical-size SBD was created and animals were divided into five groups depending on the graft material used for GBR (EB, EB + PDGF, Autograft, beta-TCP, beta-TCP + PDGF; n = 10/group). Following 12-weeks of healing, animals were sacrificed and femur specimens were analyzed through qualitative histology and quantitative histomorphometry. There was new bone bridging femoral SBD in all groups and qualitatively, better bone formation was seen in autograft and EB + PDGF groups. Histomorphometric bone-area (BA %) was significantly high in autograft group, followed by EB + PDGF, beta-TCP + PDGF, EB, and beta-TCP groups. Addition of PDGF to EB and beta-TCP during GBR resulted in significantly higher BA%. After 12-weeks of healing, EB + PDGF for GBR of rat femoral segmental defects resulted in new bone formation similar to that of autograft. Based on this study, GBR with EB and adjunct PDGF could be a potential clinical alternative for reconstruction and regeneration of segmental bone defects.

Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature.

Salivary gland tumors (SGT) comprise 3% of all head and neck tumors, are mostly benign, and arise frequently in the parotid gland. Pleomorphic adenoma (PA) is the commonest SGT, representing 60-70% of all benign parotid tumors. Clinically, parotid PA presents as irregular, lobulated, asymptomatic, slow-growing preauricular mass, involving both superficial and deep lobes, and could grow to gigantic proportions. Histologically, PA has epithelial and mesenchymal elements in chondromyxoid matrix and is managed surgically. Based on a review of 43 cases reported in English literature since 1995, giant parotid PA is reported as large as 35 cm (diameter) and 7.3 kg (resected weight). Although rare, 10 cases of malignant transformation were reported in the review. Surgical management included extracapsular dissection (ECD), superficial parotidectomy, and total parotidectomy for benign tumors, and adjuvant radiation or chemotherapy for malignant tumors. We further present the case of a 36-year-old healthy male with slow-growing and asymptomatic giant parotid PA, of 4-year duration. The patient presented with firm, lobulated preauricular swelling, provisionally diagnosed as PA based on radiographic and cytological findings. The tumor was resected through ECD, and the patient had uneventful postoperative recovery and a 7-year recurrence-free follow-up period. Histological examination revealed epimyoepithelial proliferation punctuated by chondromyxoid areas, with extensive squamous metaplasia and keratin cysts. To the best of knowledge from indexed literature, giant parotid PA is rarely reported in Saudi Arabia. In addition to its rarity, this case is reported for its benign nature despite atypical histological presentation, successful surgical management without complications, and long-term recurrence-free follow-up. Based on this report, clinicians must be aware of atypical histological presentations associated with PA and plan suitable surgical management and follow-up to avoid morbidity. Nevertheless, attempts must be made to diagnose and manage these lesions at an early stage and before they reach gigantic proportions.

Enhancing the Surface Quality of Micro Titanium Alloy Specimen in WEDM Process by Adopting TGRA-Based Optimization.

The surface measures of machined titanium alloys as dental materials can be enhanced by adopting a decision-making algorithm in the machining process. The surface quality is normally characterized by more than one quality parameter. Hence, it is very important to establish multi-criteria decision making to compute the optimal process factors. In the present study, Taguchi-Grey analysis-based criteria decision making has been applied to the input process factors in the wire EDM (electric discharge machining) process. The recast layer thickness, wire wear ratio and micro hardness have been chosen to evaluate the quality measures. It was found that the wire electrode selection was the most influential factor on the quality measures in the WEDM process, due to its significance in creating spark energy. The optimal arrangement of the input process parameters has been found using the proposed approach as gap voltage (70 V), discharge current (15 A) and duty factor (0.6). It was proved that the proposed method can enhance the efficacy of the process. Utilizing the computed combination of optimal process parameters in surface quality analysis has significantly contributed to improving the quality of machining surface.

The Efficacy of Recombinant Platelet-Derived Growth Factor on Beta-Tricalcium Phosphate to Regenerate Femoral Critical Sized Segmental Defects: Longitudinal In Vivo Micro-CT Study in a Rat Model.

Background and Objectives: Beta-tricalcium phosphate (beta-TCP) has been used for bone regeneration. The objective of this study was to assess longitudinally, the regeneration of critical sized segmental defects (CSSD) in rat femur using beta-TCP with or without recombinant platelet-derived growth factor (PDGF) through in vivo micro-computed tomography (micro-CT). Materials and Methods: Following ethical approval unilateral femoral CSSD measuring 5 mm was surgically created, under general anesthesia, in 30 male Wistar-Albino rats (aged 12-18 months; weighing 450-500 g). CSSD was stabilized using titanium mini-plate (4 holes, 1.0 mm thick with 8 mm bar). Depending upon biomaterial used for regeneration, the animals were randomly divided into: Control group (N = 10): CSSD covered with resorbable collagen membrane (RCM) only; Beta-TCP group (N = 10): CSSD filled with beta-TCP and covered by RCM; Beta-TCP + PDGF group (N = 10): CSSD filled with beta-TCP soaked in recombinant PDGF and covered by RCM. Longitudinal in vivo micro-CT analysis of the CSSD was done postoperatively at baseline, 2nd, 4th, 6th, and 8th weeks to assess volume and mineral density of newly formed bone (NFB) and beta-TCP. Results: Significant increase in NFB volume (NFBV) and mineral density (NFBMD) were observed from baseline to 8-weeks in all groups. Based on longitudinal in vivo micro-CT at 8-weeks, beta-TCP + PDGF group had significantly higher (p < 0.01) NFBV (38.98 ± 7.36 mm3) and NFBMD (3.72 ± 0.32 g/mm3) than the beta-TCP (NFBV-31.15 ± 6.68 mm3; NFBMD-2.28 ± 0.86g/mm3) and control (NFBV: 5.60 ± 1.06 mm3; NFBMD: 0.27 ± 0.02 g/mm3) groups. Significantly, higher reduction in beta-TCP volume (TCPV) and mineral density (TCPMD) were 1 observed in the beta-TCP + PDGF group when compared to the beta-TCP group. Conclusion: Addition of recombinant PDGF to beta-TCP enhanced bone regeneration within rat femoral CSSD and increased resorption rates of beta-TCP particles.

Lateral Periodontal Cyst Treated with Enucleation and Guided Bone Regeneration: A Report of a Case and a Review of Pertinent Literature.

Lateral periodontal cyst (LPC) is an uncommon developmental odontogenic cyst arising on the lateral surface of tooth roots. Commonly reported in mandibular canine-premolar or maxillary anterior regions, it presents as a well-circumscribed or tear drop-shaped radiolucency with a sclerotic border. Associated teeth are asymptomatic and vital, and roots may be displaced without resorption. Histopathologically, cystic lining resembles reduced enamel epithelium along with glycogen-rich clear cells and epithelial plaques. Unilateral variant of LPC has low recurrence and is managed by enucleation. A 43-year-old male patient reported with asymptomatic swelling in the left mandibular canine and first premolar region. Both teeth were vital, and radiographs revealed well-circumscribed radiolucency between the roots. Following consent, surgical enucleation and guided bone regeneration (GBR) with xenograft and resorbable collagen membrane were done under local anesthesia. The immediate postoperative period was uneventful, and complete bone fill of cystic cavity and healing of periodontal tissues was observed after a one-year follow-up. Histopathologic examination confirmed the diagnosis. LPC should be a differential diagnosis in cystic lesions lateral to the surface of a tooth and without any associated inflammation. Based on this case report, unicystic LPC can be successfully managed through surgical enucleation with GBR for better periodontal healing.

Guided Bone Regeneration of Femoral Segmental Defects using Equine Bone Graft: An In-Vivo Micro-Computed Tomographic Study in Rats.

Background and objectives: Guided bone regeneration (GBR) is commonly used for osseous defect reconstruction. The objective of this study was to evaluate in real-time (in-vivo) the efficacy of equine bone graft for GBR in segmental critical-size defects (CSD) of the femur in a rat model. Materials and methods: Following ethical approval, 30 male Wistar-Albino rats (age 12-14 months/weight 450-500 grams) were included. Under general-anesthesia, a mid-diaphyseal segmental CSD (5 mm) was created in the femur and stabilized using titanium Miniplate(4 holes,1.0 mm thickness). Depending upon material used for GBR, animals were randomly divided into three groups(n = 10/per group). Negative control-Defect covered with resorbable collagen membrane(RCM); Positive control-Defect filled with autologous bone and covered by RCM; Equine bone-Defect filled with equine bone and covered by RCM. Real-time in-vivo Micro-CT was performed at baseline, 2, 4, 6 and 8 weeks to determine volume and mineral density of newly formed bone (NFB) and remaining bone graft particles (BGP). Results: In-vivo micro-CT revealed increase in volume and mineral density of NFB within defects from baseline to 8-weeks in all groups. At 8-weeks NFB-volume in the equine bone group(53.24 ± 13.83 mm3; p < 0.01) was significantly higher than the negative control(5.6 ± 1.06 mm3) and positive control(26.07 ± 5.44 mm3) groups. Similarly, NFB-mineral density in the equine bone group(3.33 ± 0.48 g/mm3; p < 0.01) was higher than the other (negative control-0.27 ± 0.02 g/mm3; positive control-2.55 ± 0.6 g/mm3). A gradual decrease in the BGP-volume and BGP-mineral density was observed. Conclusion: The use of equine bone for GBR in femoral segmental defects in rats, results in predictable new bone formation as early as 2-weeks after bone graft placement.

Diagnostic challenges of an unusually large schwannoma of the mandible: Report of a case.

Schwannomas are slow-growing, benign neoplasms arising from the Schwann cells and are commonly reported as peripheral tumors in the head and neck region. Central intramandibular schwannomas are extremely rare lesions. We report a case of intramandibular schwannoma in a 70 year old male patient. Panoramic radiography revealed a large, multilocular radiolucent lesion with distinct borders involving the right mandibular body and ramus. A complete excision was achieved by removing the tumor followed by reconstruction of the mandible. The clinical, radiological, and histopathological features are discussed within the context of this case.

Detection of Visually Imperceptible Blood Contamination in the Oral Surgical Clinic using Forensic Luminol Blood Detection Agent.

AIM AND OBJECTIVES: Oral surgical procedures can cause spread of infections in the clinics through visually imperceptible, splattered, and aerosolized blood. The aim of this study was to evaluate visually imperceptible blood contamination of clinical surfaces and personal protective equipment (PPE) in an oral surgery clinic using luminol. MATERIALS AND METHODS: Following ethical approval, oral surgical procedures were performed under local anesthesia in a disinfected clinic, and PPE was used by the oral surgeon, dental assistant, and patients. After the procedure, clinical surfaces and PPE were evaluated for traces of visually imperceptible blood contamination using luminol. Data regarding blood contamination and the duration of the procedure were collected. Nonparametric tests, with 95% significance level (Epi Info, Stat Calc 7, CDC, Atlanta, USA), were used to identify statistical interactions between the duration of the procedure and the frequency of blood contamination. RESULTS: Blood contamination was detected in flooring below surgical field (86.67%), instrument tray, operating light, dental chair, and suction unit (100%). Except head caps and shoe covers, blood contamination was detected in all the PPE used by the clinical personnel, and the eyewear and chest drapes used by patients. An increase in the surgical time beyond 40 min significantly increased the risk of blood contamination in the handcuffs of the clinical personnel (P < 0.01). DISCUSSION AND CONCLUSION: Visually imperceptible blood contamination of the clinical surfaces and PPE is associated with minor oral surgical procedures. This mandates the cleaning and disinfection of all clinical surfaces before and after minor oral surgical procedures and PPE for clinicians and patients during every procedure.

Undergraduate Implant Dentistry Training In Saudi Dental Schools.

BACKGROUND: Implant dentistry training at the undergraduate level has been introduced only recently in Saudi dental schools and there is only limited data available about it. The objective of the present study was to evaluate the current status of undergraduate dental implant education in Saudi Dental Schools. METHODS: A two-part questionnaire-based study was conducted in Saudi university dental schools targeted towards undergraduate program directors to assess the quantity and quality of implant dentistry training being integrated into the curriculum. In addition, interns were asked to assess the degree of exposure and their satisfaction regarding implant dentistry education. RESULTS: Five program directors (83.3%) and 195 interns (82.9%) responded to the questionnaires. Implant dentistry was taught to the undergraduate students in multidisciplinary departments with teaching hours ranging from 22-30 hours. Only three schools exposed students to laboratory (workshop) or clinical training. There was agreement among the program directors in respect of the didactic contents. Majority of the interns reportedly acquired knowledge regarding implant dentistry based on theoretical (96.1%), laboratory (33.5%) and/or clinical (30%) training. While 50% of the interns agreed to acquire knowledge by assisting and observing dental implant procedures, only 52.8% of the interns expressed satisfaction regarding implant dentistry training obtained during their undergraduate period. CONCLUSIONS: The present study revealed variability in undergraduate implant dentistry training offered at Saudi dental schools. In order to optimize this and to produce competent dentists, learning guidelines for such courses should be developed and implemented by competent authorities.

Biomarkers as Independent Predictors of Bone Regeneration around Biomaterials: A Systematic Review of Literature.

BACKGROUND: Biomarkers are detected during bone formation and resorption associated with the dynamics of bone metabolism and are gaining importance as preferential indicators of bone healing in comparison with conventional methodologies. Current literature suggests that the usage of bone turnover markers for monitoring bone regeneration in association with biomaterials is limited. AIM: To systematically review literature and evaluate whether bone-biomarkers can independently predict bone regeneration following implantation of various bone biomaterials. MATERIALS AND METHODS: An electronic search was conducted in PubMed (MEDLINE) database from 1980 to January 2017. The articles for systematic review were selected based on formulated inclusion and exclusion criteria Results: Upon database searching, 443 articles were retrieved and thoroughly reviewed based on the inclusion and exclusion criteria. In all, 41 studies were finally included for evaluation out of which 4 were clinical studies and the remaining 37 studies utilized animal models. On further evaluation, 12 studies reported the presence of biomarkers in association with cellular response during bone regeneration around bio-materials. Moreover, biomarkers related to enzyme activity and matrix protein derivatives were enhanced during bone-matrix deposition as reported in 14 studies. Inorganic skeletal matrix biomarkers indicative of bone mineralization showed positive expression in eight studies. CONCLUSION: Several biomarkers appear to be useful for the assessment of bone regeneration around biomaterials. Although biomarkers are capable of independently predicting bone regeneration, lack of substantial evidence in the literature limits their true clinical utility. CLINICAL SIGNIFICANCE: Noninvasive and inexpensive methods of isolating and characterization of biomarkers from cellular and extracellular skeletal matrix during bone regeneration have proven value in evaluating success of bone biomaterials.

Periodontal therapy as an adjunctive modality for HbA1c reduction in type-2 diabetic patients.

OBJECTIVES: This study aimed to evaluate the role of nonsurgical periodontal therapy in improving glycemic control among type 2 diabetes mellitus (T2DM) patients. MATERIALS AND METHODS: Adult T2DM patients with mild-to-moderate periodontal disease, reporting to a tertiary care diabetes center in South India, from January to June 2014, were enrolled in the study. Medical management of T2DM along with diet and physical exercise was an inclusion criterion. Patients with factors affecting periodontal health and an inability to follow-up were excluded from the study. All patients underwent nonsurgical periodontal therapy (scaling, root planing, and irrigation of chlorhexidine [0.12%]). Periodontal status and glycated hemoglobin A1c (HbA1c) were assessed preoperatively and 6 months posttreatment. Dental status, diabetic history, and demographic characteristics were recorded to evaluate confounding roles. RESULTS: A total of 266 T2DM patients (91 females/175 males; mean age 47.65 ± 5.93 years/range 25-55 years), fulfilling the inclusion criteria, were enrolled. The mean pre- and post-treatment HbA1c levels were respectively, 8.44 ± 1.87 and 7.98 ± 1.81, with a mean reduction of 0.46 ± 0.26 (P < 0.001). Significant HbA1c reduction (P < 0.001) was observed in patients with good pretreatment glycemic control (0.54 ± 0.26; 7.9%), regular follow-up (0.51 ± 0.28; 6.2%), and good oral hygiene (0.60 ± 0.49; 8.0%). CONCLUSION: Nonsurgical periodontal therapy is associated with significant HbA1c reduction among T2DM patients with mild-to-moderate periodontitis after a 6-month follow-up period.

Perceptions of dental interns in Saudi Arabia toward implant placement in medically compromised patients.

BACKGROUND AND AIM: Increasing incidence of medically compromised patients seeking dental treatment and implant rehabilitation, necessitates greater knowledge toward managing such patients. The objective of the present study was to evaluate the perceptions of dental interns in Riyadh, Saudi Arabia, toward dental implant therapy for medically compromised patients. MATERIALS AND METHODS: Using a convenience random sampling technique, a cross-sectional questionnaire-based study was conducted to evaluate the perceptions of the interns from dental schools in Riyadh, Saudi Arabia. Data pertaining to demographic details of the participants, academic grade point average (GPA), clinical implant training and experience and perceptions about dental implant therapy for medically compromised patients were collected. RESULTS: The survey response rate was 82.9% (n = 174/210; Males-129/Females-45). Less than half of the interns (n = 82/174; 47.1%) had performed dental implants, out of which 41.5% (n = 34/82) had placed implants in medically compromised patients. Most medical illnesses except controlled diabetes mellitus and hypertension were perceived by the interns as contraindications for dental implant placement. CONCLUSION: Based on the results of the present study, it could be concluded that courses with a greater emphasis toward management of dental patients with medical problems and undergraduate implant training for such patients would result in better knowledge and perception among dental interns regarding dental implant placement in medically compromised patients.

Antibiotic protocol for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients: A 10 years prospective study.

AIMS OF STUDY: The aim of the study was to establish the long term efficacy of a perioperative antibiotic protocol combined with antibacterial mouthwashes in preventing osteoradionecrosis (ORN). MATERIALS AND METHODS: Irradiated head and neck cancer patients reporting for dental extractions were prospectively enrolled to the study between January 2002 and December 2009. Selection criteria for the patients included the presence of nonrestorable tooth/teeth in the field of radiation, latency period of 6 months since completion of radiotherapy, radiation dosages >60 Gy, and availability for follow-up. Starting from 10 days preextraction, the patients were prescribed 8th hourly oral amoxicillin 500 mg along with 12th hourly mouthwashes using 10 ml of undiluted chlorhexidine gluconate 0.2% solution. The same prescription was continued for 7 days postextraction. All patients were followed-up at regular intervals until December 2013. RESULTS: A total of 89 patients (55 male and 34 female) underwent extractions of teeth which were present in the radiation field. Mean age of the patients was 41.8 years (range 36-54 years) and extractions were done between 12 and 33 months (mean - 15 months) postradiation therapy. Altogether, 232 teeth were extracted (maxilla - 78/mandible - 154) at an average of 2.6 teeth per patients. After a mean follow-up period of 63 months (range 48-123 months) there were no reported cases of ORN. CONCLUSION: Based on the results of this study, perioperative oral antibiotics in combination with antibacterial mouthwashes are effective in preventing ORN following dental extractions in irradiated patients.

Efficacy of Mucograft vs Conventional Resorbable Collagen Membranes in Guided Bone Regeneration Around Standardized Calvarial Defects in Rats: An In Vivo Microcomputed Tomographic Analysis.

The aim of this in vivo microcomputed tomographic (µCT) study was to compare the efficacy of Mucograft (MG) vs resorbable collagen membranes (RCMs) in facilitating guided bone regeneration (GBR) around standardized calvarial defects in rats. Forty female Wistar albino rats with a mean age and weight of 6 to 9 weeks and 250 to 300 g, respectively, were used. With the rats under general anesthesia, the skin over the calvaria was exposed using a full-thickness flap. A standardized calvarial defect with a 4.6-mm diameter was created in the left parietal bone. For treatment, the rats were randomly divided into four groups (n = 10 per group): (1) defects covered with MG (MG group); (2) defects covered with an RCM (RCM group); (3) defects filled with xenograft bone particles and covered by MG (MG + bone group); and (4) defects filled with xenograft bone particles and covered by an RCM (RCM + bone group). Primary closure was achieved using interrupted resorbable sutures. The animals underwent high-resolution, three-dimensional µCT scans at baseline and at 2, 4, 6, and 8 weeks after the surgical procedures. Data regarding volume and bone mineral density (BMD) of newly formed bone (NFB) and bone particles revealed an increase in the volume of NFB in all the groups from baseline to 8 weeks. The MG group had the lowest volume of NFB (mean ± standard deviation [SD], 1.32 ± 0.22 mm(3)). No significant differences in mean ± SD values for volume of NFB were observed between the RCM (3.50 ± 0.24 mm(3)) and MG + bone (3.87 ± 0.36 mm(3)) groups, but their values were significantly lower than that of the RCM + bone group (2.95 ± 0.15 mm(3), F = 131.91, dfN = 2, dfD = 27, P < .001). Significant differences in BMD of NFB between the groups (F = 332.46, dfN = 3, dfD = 36, P < .001) and during different data collection periods (F = 97.04, dfN = 3, dfD = 36, P < .01) were observed, with the RCM group having the highest mean ± SD BMD of NFB (0.42 ± 0.05 g/mm(3)). Significant differences in the bone particle volume between the RCM + bone and MG + bone groups (F = 91.04, dfN = 1, dfD = 18, P < .05) and at different data collection periods (F = 314.12, P < .01) were observed, with the RCM + bone group displaying greater reduction in both volume (36.8%) and BMD (19.7%) of bone particles. The present in vivo µCT study demonstrated that RCM is better than MG in enhancing new bone formation in rat calvarial standardized defects when used in combination with mineralized particulate graft material.

Guided Bone Regeneration Using Biphasic Calcium Phosphate With Adjunct Recombinant Human Bone Morphogenetic Protein-2 With and Without Collagen Membrane in Standardized Calvarial Defects in Rats: A Histologic and Biomechanical Analysis.

This study aimed to assess the efficacy of biphasic calcium phosphate (BCP) with adjunct recombinant human bone morphogenetic protein-2 (rhBMP-2), with and without collagen membrane (CM), in regeneration of standardized rat calvarial defects. Thirty female Wistar albino rats with a mean age of 12 weeks and mean weight of 300 g were used. The skin over the calvaria was exposed using a full-thickness flap. A standardized defect measuring 4.6 mm in diameter was created in the parietal bone. The defects were randomly divided into the following groups: (1) no treatment (control group); (2) BCP soaked in rhBMP-2 and then covered with a resorbable CM; and (3) BCP soaked in rhBMP-2. Following euthanasia, histologic, histomorphometric, and biomechanical assessments of the calvarial specimens were performed to assess bone regeneration. The results showed islands of newly formed bone (NFB) between the defect edges in the control group. NFB was observed bridging the defect edges and around the remnants of BCP in the rhBMP-2 + BCP + CM group and only around the BCP remnants in the rhBMP-2 + BCP group. Histomorphometric analysis revealed a significantly higher mean ± standard deviation (SD) percentage of NFB per defect in the rhBMP-2 + BCP + CM group (46.12 ± 2.56) compared with the control (11.79 ± 0.75) and rhBMP-2 + BCP (26.65 ± 1.48) groups. Although no differences were found in the hardness and elastic modulus (EM) of NFB between the rhBMP-2 + BCP + CM (hardness: 687.78 ± 4.74 MPa; EM: 27.71 ± 0.063 GPa) and the rhBMP-2 + BCP (hardness: 637.65 ± 6.32 MPa; EM: 21.49 ± 0.095 GPa) groups, the biomechanical parameters of NFB in the control group (hardness: 286.17 ± 9.49 MPa; EM: 12.62 ± 0.048 GPa) were significantly less. The experiment demonstrated the efficiency of rhBMP-2 + BCP in GBR, wherein the presence of CM leads to a greater percentage of new bone formation within standardized calvarial defects.

Real-Time Assessment of Guided Bone Regeneration in Standardized Calvarial Defects in Rats Using Bio-Oss With and Without Collagen Membrane: An In Vivo Microcomputed Tomographic and Histologic Experiment.

In vivo microcomputed tomography (µCT) enables real-time assessment of bone regeneration. The aim of this µCT and histologic experiment was to assess guided bone regeneration (GBR) around standardized calvarial defects in rats using particulate graft material (Bio-Oss) with and without collagen membranes (CMs). Eighteen female Sprague-Dawley rats aged 6 weeks and weighing 300 g were used. With the rats under general anesthesia, calvaria were exposed and a full-thickness standardized defect was created on the parietal bone. For treatment, rats were randomly assigned to the following three groups: (1) CM group; (2) Bio-Oss group; and (3) Bio-Oss + CM group. Bone volume and bone mineral density (BMD) of newly formed bone (NFB) and remnant bone particles were measured at baseline and 2, 4, 6, and 10 weeks after the operations using real-time in vivo µCT. At 10 weeks, all animals were sacrificed and calvarial tissues were assessed histologically. In the CM group, a significant increase in mean ± standard deviation (SD) BMD of NFB was observed at 6 weeks (0.32 ± 0.02 g/mm(3)) (P < .01) compared with baseline. In the Bio-Oss group, mean ± SD volume (3.03 ± 0.14 mm(3)) (P < .05) and BMD (0.14 ± 0.01 g/mm(3)) of NFB significantly increased at 6 weeks compared with baseline (P < .01). In the Bio-Oss + CM group, mean ± SD volume (0.98 ± 0.19 mm(3)) and BMD (0.13 ± 0.01 g/mm(3)) of NFB significantly increased at 4 weeks compared with baseline (P < .01). In th Bio-Oss + CM group, mean ± SD volume (3.5 ± 0.7 mm(3)) and BMD (0.44 ± 0.03 g/mm(3)) of remnant bone particles were significantly reduced at 10 weeks compared with baseline values (5.8 ± 0.96 mm(3) and 1.3 ± 0.02 g/mm(3)) (P < .05). Although histologic analysis revealed NFB in all the study groups, the Bio-Oss + CM group exhibited the most. The results of this study revealed that, in real time, new bone formation starts as early as 4 weeks in standardized calvarial defects undergoing GBR with Bio-Oss + CM, compared with new bone formation at 6 weeks in defects undergoing GBR with Bio-Oss alone.