Comparison of Safety, Efficacy, Patient Compliance and Cost-Effectiveness of Transdermal, Oral and Intramuscular Diclofenac for Pain Control Following Oral Surgical Procedures.

PURPOSE: To evaluate transdermal diclofenac in terms of analgesic efficacy, safety, compliance and cost-effectiveness and to compare it with oral tablets and intramuscular (IM) injections following surgical removal of impacted mandibular third molars. SUBJECTS AND METHODS: A prospective, single-centre, multi-arm parallel, randomized study on subjects undergoing extraction of impacted mandibular third molars was conducted between January 2016 and December 2017. The study included 90 participants, 30 in each group. Participants received the standard once daily (OD) dosages of diclofenac in each group for three post-operative days and were advised to consume paracetamol 500 mg as rescue analgesics if the pain was not alleviated. Outcome measures such as demographics, duration of surgery, post-operative pain, the number of rescue analgesics taken, adverse drug reactions experienced and overall global assessment for three post-operative days were recorded by the participants on a questionnaire. RESULTS: Transdermal and oral forms achieved similar analgesia on all 3 days. Injectable diclofenac had significantly better pain control on the second and third post-operative days compared to tablets and on the third day compared to transdermal diclofenac. A higher number of rescue analgesics was consumed in oral group on day 1. Gastritis and vomiting were seen in 36.66% and 10% cases, respectively, in oral group. 100% of those in IM group had pain on injection. 6.6% complained of dry skin due to patch, while 3.33% had rash and pruritus. Transdermal group had better overall global assessment by patients with 16.67%, 46.67% and 20% participants reporting excellent, very good and good pain control, respectively. The cost in INR was maximum for the transdermal group. CONCLUSION: Transdermal diclofenac is an excellent alternative to oral and parenteral routes of drug administration in oral surgical procedures with adequate analgesic efficacy, good compliance and fewer side effects.

Immediate dental implant placement with or without autogenous bone graft: A comparative study.

INTRODUCTION: Immediate dental implants are the most accepted contemporary treatment option for the replacement of missing teeth. One pitfall of immediate implant use, however, is the inevitable residual space that remains between the implant and the socket wall, called the jumping distance, which may lead to bone resorption and formation of a bony defect, decreasing the implant stability. When this jumping distance is more than 2 mm, use of bone grafts is recommended. However, the use of grafts when the jumping distance is <2 mm is not defined in the literature. AIM: To evaluate the peri-implant hard and soft tissue changes following immediately placed implants with a jumping distance of 2 mm with or without autogenous bone grafts. SETTINGS: The study was conducted between January 2016 and December 2017 in the Department of Oral and Maxillofacial Surgery. SUBJECTS AND METHODS: This was a prospective, single-center, two-arm, parallel, randomized study on patients undergoing replacement of missing anterior teeth with immediate implants. There were two groups: the study group which received bone graft and the control group which did not receive any graft. Temporary prosthesis was placed following implant placement which was replaced with definitive prosthesis 4 months later. Patients were followed up for a period of 9 months. The alveolar bone loss was evaluated radiologically using cone-beam computed tomography, and pain, suppuration, mobility, and periodontal probing depth were evaluated clinically. RESULTS: There were 16 participants in the study group and 17 in the control group. The alveolar bone loss was greater in the study group; however, pain, suppuration, and mobility showed no difference between the groups. CONCLUSION: The immediate implants placed with or without bone grafts had similar alveolar hard and soft tissue changes when the jumping distance was <2 mm.

The incisive papilla as a guide to maxillary anterior teeth position for complete dentures.

CONTEXT: The incisive papilla as a guide for complete dentures. AIMS: To evaluate incisive papilla as a guide to maxillary anterior teeth position for complete dentures. SETTINGS AND DESIGN: To measure the linear distances from the incisive papilla to the maxillary central incisors in Odia population and compare it to other ethnic groups. SUBJECTS AND METHODS: The subjects were selected following inclusion & exclusion criteria. The impressions of maxillary & mandibular arches were taken and poured with die stone to produce the cast. The incisive papilla & incisors were marked on casts with a pencil. The photographs of casts were traced on an acetate tracing paper. The anterior-most points of maxillary incisors, anterior, middle & posterior-most points of incisive papillae were marked on the tracing as A, I1,M, I2 respectively. The A to M and A to I2 distances were measured, analysed and compared with Caucasians, Southern Chinese, and Dravidians. STATISTICAL ANALYSIS: Independent sample "t" test and Analysis of Variance followed by the post-hoc Bonferroni test were used. RESULTS: A sample of 100 subjects in the age group of 20 to 40 years with was selected. The A to M measurements of Odia population differed significantly from Caucasians but were similar to Southern Chinese population. The A to I2 measurements of Odia population differed significantly from Caucasians & Dravidians but were similar to Southern Chinese. CONCLUSION: The linear measurements from incisive papilla to maxillary incisors of the Odia population are similar to that of Southern Chinese but differ significantly from Caucasians and Dravidians.

3-D Miniplates Versus Conventional Miniplates in Treatment of Mandible Fractures.

AIM: To study whether the use of 3-D miniplate, when compared with conventional miniplate, gives better clinical outcomes with fewer complications in patients with fracture mandible. MATERIALS AND METHODS: A prospective study was conducted in the Department of Oral and Maxillofacial Surgery, Trauma Care Centre, on 40 patients. They were randomly divided into Group-I and Group-II with 20 patients in each group. In Group-I, 3-D miniplate was used and in Group-II, conventional miniplate was used. Parameters such as fracture stability, occlusal status, mouth opening, nerve paresthesia, infection, pain, swelling, and complications were evaluated on 1st, 7th postoperative day, 1st month and 3rd month. RESULTS: Fracture stability and occlusion were clinically better in Group-I than in Group-II on each follow-up; however, it was not statistically significant. Infection rate was lesser in Group-I than in Group-II (p = 0.003). Mouth opening was more in Group-II than in Group-I on immediate (p = 0.001) and 7th post-op day (p = 0.002). Overall complications were lesser in Group-I than in Group-II (p > 0.005). CONCLUSION: There is no major difference observed in clinical outcomes between 3-D miniplate and conventional miniplate. Either method of fixation can be used successfully in treatment of mandible fractures with comparable rates of complications.

Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection.

AIM: To evaluate whether the use of electrothermal bipolar vessel sealing system reduces the blood loss and operating time, with lesser complications as compared to suture ligation in selective neck dissection in patients with oral cancer. MATERIALS AND METHODS: The study was conducted in the Department of Oral and Maxillofacial Surgery of our institute from January 2015 to December 2016. The sample consisted of 60 patients, divided into Groups I and II with 30 subjects in each. In Group I electrothermal bipolar vessel sealer and in Group II suture ligation were used. The outcome measures recorded were: blood loss, operating time, quality of surgical field, postoperative pain on days 1, 2, and 3, drainage volume at 24, 48, and 72 h, edema, complications, and duration of hospital stay. RESULTS: There were 36 males and 24 females with a mean age of 50.76 ± 12.6 years. Blood loss was significantly less for Group I than for Group II (p = 0.001); the operating time was significantly less in Group I than in Group II (p = 0.001); Group I had better quality of surgical field (p = 0.001); less pain on postoperative evening, day 2 and day 3 (p < 0.05); and less drainage volume at 24 and 48 h (p < 0.05). Postoperative edema, complications, need for perioperative blood transfusion, and duration of hospital stay postsurgery were similar in both groups. CONCLUSION: The electrothermal bipolar vessel sealer was efficacious in terms of reducing blood loss and operating time while providing a better surgical field and patient compliance without increasing the perioperative morbidity.

An eye for a lost eye: A case of self-inflicting gunshot injury.

Maxillofacial defects due to gunshot injuries can have detrimental functional and psychological effects on the patient. These occur predominantly in young males, although all are at risk. Military, civil, accidental or self-inflicted injuries employing guns of varying caliber and ballistic properties may produce a defect or deformity which encompasses the entire spectrum of reconstructive surgery. Patients with facial defects have major difficulties to re-establish their mastication, speech, soft-tissue projections and therefore social integration. Successful prosthetic rehabilitation is crucial for better quality of life in case of large facial deformities. We present a case of 24-year-old male with gunshot injury to the left side face leading damage to the eye, which was rehabilitated with oculo-facial prosthesis.

Resurgence of tuberculosis: a rare case of primary orbitomaxillary tuberculoma.

BACKGROUND: Extrapulmonary sites of tuberculosis, which represent 15% of all sites, most commonly involve lymph nodes and bones. Facial bones and paranasal sinuses are rarely involved in the process. Tuberculosis of maxilla is an extremely rare condition, which usually presents with involvement of anterior wall of the maxillary sinus. Symptoms may include nasal discharge with partial nasal obstruction and mild pain. It still remains an underdiagnosed entity. CASE REPORT: We report a case of tuberculoma of the whole left maxilla extending into the orbit, with no previous history of pulmonary tuberculosis. Tuberculosis of paranasal sinus is a rare entity and is nearly always secondary to pulmonary or extrapulmonary tuberculosis, but this report describes the incidence of primary infection of extrapulmonary site. CONCLUSIONS: Any chronic granulomatous lesion present over the maxillofacial region which does not respond to initial antibiotic therapy may be suspected as tubercular infection and should be ruled out with priority.