Linear and Whorled Nevoid Hypermelanosis - A Case of Pigmentary Mosaicism.

Linear and whorled nevoid hypermelanosis is a rare skin pigmentation disorder, characterized by linear streaks and whorls of hyperpigmented macules along Blaschko's lines. Lesions are commonly restricted to the trunk, neck, and extremities, sparing the face, palms, soles, and mucosae. Associated with this, certain cardiovascular, musculoskeletal, neurological, and developmental anomalies have been reported in the literature. Herein, we present a rare case of linear and whorled nevoid hypermelanosis involving the face, with musculoskeletal, genital, aural, and ocular abnormalities.

Hybrid Ameloblastoma Arising from a Treated Odontogenic Keratocyst of the Mandible: A Case Report With Literature Review.

Odontogenic Keratocyst (OKC) is an odontogenic cyst of developmental origin arising from remnants of the dental lamina. Malignant or benign transformations though rare have been noticed from their epithelium. Ameloblastomatous transformation from an OKC is extremely rare with such lesions being referred to as combined/"hybrid" odontogenic lesions. In this article, we present an intriguing case of a 60-year-old male who was operated on for OKC of the anterior mandible 3 years before, who came back with a complaint of swelling over the same site. Incisional biopsy revealed the acanthomatous type of ameloblastoma for which segmental resection with immediate reconstruction using recon plate was done. Excision biopsy revealed a plexiform variant as well, thus exhibiting a hybrid pattern. Surgeons should be aware of this hybrid presentation of ameloblastoma arising from the epithelium of OKC as the acanthomatous subtype is known for its notorious genetic behavior leading to recurrence and aggressive nature of this tumor.

Comminuted middle third orbito-zygomatic complex fracture leading to blindness due to unanticipated tyre rim explosion during service - A rare case.

An explosion is caused by conversion of solid, liquid into gas with resultant energy release. Blast injuries of large tyres are similar to injuries resulting from landmine explosions. Most of the patients were polytraumatised, initial evaluation and management should follow ATLS. Trauma following tyre blast results in severe soft tissue, orthopedic and head injuries. Head and face is the most commonly affected region followed by upper limb. A 40 year old male patient was watching a car tyre getting inflated with air. Unfortunately the tyre rim exploded on his face, which led to penetrating injury to the eye ball and comminuted middle third fractures. Patient was stabilized and primary hemostasis was achieved. Fractured maxilla was fixed by arch bar wiring and stabilized by using circum-suspension wiring bilaterally. Left eyeball was removed due to open globe injury and intraocular content loss. Unusual maxillofacial injuries are more common. Decision making and treatment of facial penetrating injuries depends on number of factors, which includes location and extent of injury, type of foreign body involved, proximity of vital structures, extent of injury to soft and hard tissue and the relative benefits and risk ratio for the patient. In this case report we have explained about the primary assessment and management of blast injuries.

Management of recurrent polymorphous low grade adenocarcinoma: a case report / Manejo de adenocarcinoma polimorfo recorrente de baixo grau: relato de caso

The Polymorphous Low Grade Adenocarcinoma (PLGA) is a common minor salivary gland carcinoma. It mostly affects the buccal mucosa and retromolar region, but the palate is an unusual site. As the carcinoma is low grade the recurrence is also uncommon. Our patient had a PLGA initially in the palate which was treated initially through surgical management but had a recurrence after four years. Hence we planned a partial maxillectomy along with level I nodes. Post-operatively follow-up is successful till date. So the management of a recurrent PLGA through careful surgery and post-operative follow ­up with prosthetic rehabilitation is discussed in this article... (AU)

Diabetic Retinopathy and Its Effect on Quality of Life: An Original Research.

INTRODUCTION: Diabetes is associated with the vascular and the neuronal damage of the eye leading to diabetic retinopathy (DR). The circadian rhythms and also the quality of life (QoL) are known to be impacted by the photosensitive retinal ganglion cells, which are seen to be affected in the DR. Hence, we aim to find a relation between the DR and its impact on the life quality. MATERIALS AND METHODS: Thousand participants were equally divided into two groups of case and controls (DR). The control group was further divided into three subgroups based on the severity of the disease as proliferative and nonproliferative (mild, moderate, and severe). The impact on the QoL was assessed using the Short Form Health Survey-36. The collected data were analyzed for the various grades of the severity of DR on the quality of the life. RESULTS: There was a notable change between the case and the controls and the QoL deteriorated with the severity of the disease. However, these findings were insignificant statistically. CONCLUSION: DR impacts the QoL of the patients, and the severity of the disease is proportional to the worsening of the disease. Further, research is warranted for the association.

Beak and bumper - Physics forceps: Evaluation of new technique in extraction.

PURPOSE: The history of dentistry is not short; it started from ancient Egypt to ancient Romans and ancient Greeks. When it comes to extraction, all of them have made their own discoveries and progress. The progress they made also helped dentistry to move ahead in evolution of new extraction technique - the Physics Forceps. We have assessed the viability in using the Physics Forceps for routine dental extraction in our study for a period of 1 year. MATERIALS AND METHODS: The study was conducted on 241 patients indicated for extraction based on our inclusion criteria using Physics Forceps after obtaining informed consent and University Ethics Committee approval. Tooth fracture, buccal alveolar bone fracture, and soft tissue injury around the tooth to be extracted were studied. RESULTS: In our present study of 241 patients, 57.67% were females and 42.32% were males, out of which 93.77% had no tooth fracture, 3.32% had crown fracture, 1.65% had root fracture, and 1.24% had apex fracture. Further, 85.47% had no buccal alveolar bone fracture and 14.53% had buccal alveolar bone fracture. Using proper technique, 96.26% of patients had no soft tissue damage, and minimal damage was seen in 3.73% of patients. DISCUSSION: Extraction by Physics Forceps is a very good technique of extraction. No or very minimal tooth fracture and soft tissue injury were noted. Though the forceps is costly, it represents a valuable addition to regular armamentarium for a general dentist for routine extraction. Physics Forceps is a dental extractor rather than a forceps.

Management of Frontal Sinus Injuries.

PURPOSE: The purpose of the present study is to report an overview of fracture patterns and surgical approaches for 15 patients who were treated in our Indhira Gandhi Institute of Dental Sciences, Pondicherry, India from 2010 to 2015. METHOD AND MATERIAL: Fifteen people were included in the study, which were diagnosed with anterior table fracture of the frontal sinus and were randomly admitted in our institution. All patients were evaluated preoperatively with axial and coronal computed tomography scans before operating. The parameters used to classify the patients were age, mode of injury, associated injury, and details of fracture, surgical approaches, fixation, and conservative management. RESULTS: Analysis of 15 patients based on parameters showed that the ages of patients varied between 22 and 36 years due to road traffic accident as the common etiology. There were associated fractures in the maxillofacial region seen in 11 patients and the rest were isolated frontal sinus fractures. Conservative management was opted in six patients and for others, surgical approach to the fracture site was done through existing laceration and by bicoronal approach. Three of the cases showed comminuted fracture of anterior and posterior table. The overall contour of the frontal bone was good in all the patients. None of the patients required any immediate reoperation or developed any delayed abscess or mucocele formation. CONCLUSION: Decision-making regarding the best time to treat, the surgical approach and the technique depends on the severity and the extent of the fracture and associated complications. Our protocol was to follow up and observe the undisplaced fractures and operate anterior wall defects. If there was a fracture involvement of posterior frontal wall, treatment can be planned along with neurosurgical consultation and then operate depending on the associated complications.

A Comparative Study Between Bupivacaine with Adrenaline and Carbonated Bupivacaine with Adrenaline for Surgical Removal of Impacted Mandibular Third Molar.

OBJECTIVES: To compare the effectiveness of bupivacaine with adrenaline with that of carbonated bupivacaine with adrenaline on pain, onset of anesthesia and duration of anesthesia following surgical removal of impacted mandibular third molar. STUDY DESIGN: All the patients who underwent surgical removal of impacted mandibular third molar and who fulfilled our inclusion and exclusion criteria from 1st June 2013 to 30th June 2014 were included in our study. Patients who were diagnosed as having impacted mandibular third molar were randomly allocated to two groups namely group A (bupivacaine with adrenaline), group B (carbonated bupivacaine with adrenaline). Pain during deposition of local anesthetic, onset of anesthesia and duration of anesthesia were compared between the two groups. The collected data were subjected to statistical analysis by Chi Square test, Mann-Whitney U test. RESULTS AND CONCLUSION: The efficacy of carbonated bupivacaine with adrenaline is more compared with bupivacaine with adrenaline in decreasing pain on deposition of local anesthetic solution and in rapid onset of anesthesia. The duration of anesthesia for carbonated bupivacaine with adrenaline and bupivacaine with adrenaline had no significant difference. The use of carbonated bupivacaine with adrenaline will reduce the patient discomfort both intra-operatively and post-operatively.

Dental caries: A complete changeover, PART III: Changeover in the treatment decisions and treatments.

Comprehensive management of dental caries should involve the management of disease as well as the lesion. Current decision making process in cariology is influenced by numerous factors such as the size/ depth/ activity of the carious lesion and age/ the caries risk status of the patient. Treatment decisions should involve planning the non-operative/ preventive treatment for non-cavitated or early cavitated lesions and also formulating operative treatment for cavitated lesions. Apart from these two responsibilities, a clinician should also be knowledgeable enough to decide when not to interfere in the caries dynamics and how frequently to recall the patient for follow-ups. The non-operative treatment prescriptions vary in dose, intensity and mode of delivery according to the caries risk status. Minimal invasion and maximal conservation of tooth structure has become the essence of current operative treatments. This part of the series elaborates on the paradigm shift in the management of dental caries.

Dental caries: A complete changeover (Part II)-Changeover in the diagnosis and prognosis.

Realization that dental caries is a reversible, dynamic biochemical event at a micron level has changed the way the profession recognizes the caries disease and the caries lesion. The diagnosis of dental caries poses challenges due to the complex interaction of multiple endogenous causal factors. The most appropriate diagnostic aid for this purpose is the risk model of caries risk assessment. The analyses of the biological determinants provide clues to the dominant causal factor. The detection of a carious lesion has undergone a rigorous revision and revolution in order to identify the earliest mineral change so that it can be controlled without resorting to invasive management options. Apart from detection, it became mandatory to assess the extent of the lesion (noncavitated/cavitated), assess the activity status of the lesion (active/arrested), monitor the lesion progress (progression/regression over a period of time), and finally to predict the prognosis of the lesion as well as the disease. The prognosis of the disease can be best assessed by analyzing the predictor factors in caries risk assessment. The ultimate objective of such a meticulous and methodical approach aids in devising a tailor-made treatment plan, using preventing measures precisely and restorative measures minimally. This ensures the best oral health outcome of the patient.

Classification and management of dental caries. New concepts.

There has been a tremendous change in the understanding of carious lesion in all aspects from pathogenesis to prevention. The profession has also seen a revolutionary change in the material science and technology. In spite of these changes, the caries classification provided by Dr. G. V. Black remains unchanged, deterring the radical changes needed in the understanding of caries as a disease process. This article propose a new classification of dental caries to suit the present day changes in the related area. The article opens by highlighting the changes and limitations in the existing classification. The logical and advantageous outcome of the new classification is projected at the end emphasizing the need to change in conservative dentistry and education.

Crystal growth technique for composite resin bonding. A SEM study.

This study aimed to compare the surface structure of the exposed enamel and dentine treated with acid etching and various concentrations of crystal growth agents (CGA) under Scanning Electron Microscope (SEM). Fifteen maxillary central incisors which fulfilled the inclusion and exclusion criteria were used as samples. The acid used for etching the enamel was 37% orthophosphoric acid and CGA's were 2%, 5% and 10% for micacid saturated with ammonium sulfate. The samples were divided into 5 groups and expect control group others were subjected to various surface treatments. They were observed under SEM at X 1000 magnification. The acid etched enamel surface structure was similar to the previously published reports. Maximum crystal growth on enamel and dentin were observed with 5% CGA. The surface irregularity produced by crystals were similar to acid etched surface.