Comparison between Different Combinations of Alendronate, Platelet-rich Fibrin, Hydroxyapatite in Bone Regeneration in Endodontic Surgeries Using Cone-beam Computed Tomography.

AIM: To compare different combinations of alendronate, platelet-rich fibrin (PRF), and hydroxyapatite in bone regeneration in endodontic surgeries using cone-beam computed tomography (CBCT). METHODS AND SUBJECTS: During this study, 28 patients were selected who were found to have pathology in the periapical area in the anterior region, The study subjects were categorized into four categories, each consisting of seven subjects, Category one-there was no placement of any material; category two-PRF; category three-hydroxyapatite along with PRF; category four-alendronate along with PRF, Root canal treatment followed by endodontic surgery in each patient was carried out, Volumetric analysis of the lesions was carried out before surgery and 12 months after surgery using CBCT, Analysis of variance (ANOVA) test and Tukey post-hoc test were used for statistical analysis. RESULTS: There was a maximum change in the volume of lesions in the study subjects in which PRF was used along with hydroxyapatite in comparison to other combination of materials, There was no significant difference when PRF was placed along with alendronate in comparison to study subjects when PRF was placed alone, The difference was not significant when PRF was placed in defects of bone in comparison to study subjects when no materials were placed in the defects of bone. CONCLUSION: It can be concluded from the current research that PRF along with hydroxyapatite is a better option for the healing of defects of bone in surgeries performed in the area around the root apex in endodontic patients, But further studies should be carried out with a large sample size and for a longer duration. CLINICAL SIGNIFICANCE: It is a very important consideration that there should be healing of the lesion after surgery around the root apex by actual bone regeneration, The healing of the larger lesions does not take place easily as compared with the lesions having a small size, This is because there is healing by secondary intention where there is formation of scar instead of actual healing by formation of bone, There are several methods by which proper bone regeneration can be obtained.

Aerobic microbiology and culture sensitivity of head and neck space infection of odontogenic origin.

CONTEXT: Head and neck space infections source, age, gender, tooth involved, fascial spaces involved, microbiological study of aerobic flora, and antibiotic susceptibilities. AIMS: The aim of the present study is to identify causative aerobic microorganisms responsible for deep fascial spaces of head and neck infections and evaluate the resistance of antibiotics used in the treatment of such. SETTINGS AND DESIGN: Prospective study in 100 patients. MATERIALS AND METHODS: This prospective study was conducted on 100 patients who reported in the outpatient department and fulfilled the inclusion criteria to study aerobic microbiology and antibiotic sensitivity in head and neck space infection of odontogenic origin. Pus sample was obtained either by aspiration or by swab stick from the involved spaces, and culture and sensitivity tests were performed. STATISTICAL ANALYSIS USED: Chi-square test and level of significance. RESULTS: Result showed aerobic Gram-positive isolates were 73% and aerobic Gram-negative isolates were 18%. Nine percent cases showed no growth. Streptococcus viridans was the highest isolate in 47% cases among Gram-positive bacteria, and in Gram-negative, Klebsiella pneumoniae was the highest isolate of total cases 11%. Amoxicillin showed resistance (48.4%) as compared to other antibiotics such as ceftriaxone, carbenicillin, amikacin, and imipenem had significantly higher sensitivity. CONCLUSIONS: Amoxicillin with clavulanic acid showed (64.8%) efficacy for all organisms isolated, whereas ceftriaxone showed (82.4%) efficacy and could be used in odontogenic infections for both Gram-positive and Gram-negative microorganisms. Substitution of third generation cephalosporin for amoxicillin in the empirical management of deep fascial space infections can also be used. Carbenicillin, amikacin, and imipenem showed (93.4%) sensitivity against all microorganisms and should be reserved for more severe infection. Newer and broad-spectrum antibiotics are more effective in vitro than older narrow spectrum antibiotics.

Trends of maxillofacial fractures in the Garhwal Himalayas at Government Medical College, Srinagar, Uttarakhand.

CONTEXT: Evaluation of Maxillofacial fractures in hilly region of Garhwal Himalyas and its relation with age, gender, anatomical location, seasonal variation and treatment provided. AIMS: The aim of the present study is to analyze the pattern of maxillofacial fractures in the Garhwal Himalayan region of India and to compare the results with similar studies in India and the rest of the world. SETTINGS AND DESIGN: This was a prospective study conducted on 102 patients with 128 facial fractures. MATERIALS AND METHODS: This study was conducted on 102 patients who were admitted for the treatment of maxillofacial fractures in the Department of Dentistry at Government Medical College, Srinagar, Uttarakhand, India. STATISTICAL ANALYSIS USED: All analyses were performed using Chi-square test and level of significance. RESULTS: Peak incidence was noted in the second to fourth decades of life. Male: female ratio was 4:1. Road traffic accident was the main etiology (42.2%), followed by fall (37.2%) and assault (11.8%). Among other etiology of injury, distinguishing feature was bear bite, which was only seen in winters causing 5.9% of total injury. Fall was reported high in females whereas road traffic accident in males. Mandible was fractured in 73.5% of patients while mid-face in 26.5% of patients. Open reduction with internal fixation was the choice of treatment in 60.8% of cases. Nearly 79.4% of patients were treated under local anesthesia. The mean duration of hospitalization was (standard deviation 5.2 days) 5.3 days. CONCLUSIONS: Road traffic accidents still remain the main cause of maxillofacial fractures in developing countries such as India. In hilly area, road traffic accident can be minimized by better wide roads with guide walls/parapet, strict law enforcement for overspeed, overload, and to use seat belts while driving, and use of helmet while riding two-wheeler. Open reduction internal fixation remains the first choice of treatment in facial fractures due to early return of function with minimal morbidity and better nutritional status in patients compared to closed reduction.

Evaluation of two socket healing procedures with and without mesenchymal stem cells: A comparative study.

AIMS AND OBJECTIVES: Successful preservation of the edentulous ridge after extraction may eliminate or reduce the need for ridge augmentation procedures. It is proved that grafting of fresh extraction sockets with bone grafts promotes ridge preservation. An objective method of maintaining height and width of alveolar ridge using mesenchymal stem cells (MSCs) seeded on collagen membrane was implemented in this study. METHODOLOGY: Ten bilaterally symmetrical extraction sockets scheduled for extraction were selected for this study. Involved teeth were extracted atraumatically and the sockets were curetted. MSCs seeded on collagen membrane were placed in the extracted socket on one side. On the other side, only collagen membrane was placed inside the socket. Both the sockets were closed primarily with nonresorbable sutures. Buccolingual and mesiodistal widths of the ridges at three different levels (2 mm below cementoenamel junction [CEJ], 5 mm below CEJ, and 8 mm below CEJ) were assessed immediately after extraction and postoperatively at 3 and 6 months. RESULTS: There was statistically significant observation in maintaining the alveolar ridge width in the grafted site when compared to the nongrafted site. CONCLUSION: Socket healing procedure using MSCs and collagen membrane was successful in maintaining width of alveolar socket.