Assessment of Pain, Swelling, Trismus Following Impacted Lower Third Molar Surgery, With Pre-Operative Single Dose Oral Dexamethasone: A Prospective, Randomized Double Blind Controlled Clinical Trial

Background: The removal of the lower impacted third molar teeth is always associated with varying degrees of inflammation that may have a social impact for the patients. To control these symptoms associated, it is necessary to provide an adequate anti-inflammatory therapy. The present study was undertaken to evaluate the therapeutic effect of pre-operative single dose of 8 mg oral Dexamethasone on pain, swelling, trismus following impacted lower third molar surgery. Materials and Methods: This study was conducted at MGPGI puducherry. Hundred patients with bilateral mandibular molar impaction were included in the study. Patient was allocated randomly as study and control group. Study group received 8 mg oral Dexamethasone one hour prior the surgical extraction. Patients with contraindication to the use of steroids were excluded from the study. Pain, facial contour and mouth opening were measured preoperatively and at 2nd and 5th days postoperatively.Results: On 2nd post-operative day, no statistically significant differences were noted in pain for both the groups. However, low pain scores were obtained with the use of Dexamethasone compare to placebo group. Dexamethasone group showed shows statistically significant reduction in swelling and trismus compared with the control group at all intervals.Conclusion: Dexamethasone 8 mg given orally one hour preoperatively is effective in minimizing pain, swelling, and trismus after removal of impacted lower third molar teeth.

Multidisciplinary Approach in a Child with Complex Trauma of Maxillary Permanent Central Incisors

The present case report describes a multidisciplinary approach involving endodontic, restorative, surgical and periodontal treatment and rehabilitation of a central incisor with crown-root fracture (CRF) in an 11-year-old child. Although in the future possible sequelae and complications should be considered since it is an extensive trauma, the prognosis of the present case is favorable, with the occurrence of repair, evidenced by clinical, radiographic and tomographic success, after one year and six months of follow-up. It was concluded that the association of prolonged flexible splint, biological endodontic treatment, gingivoplasty and restorative/rehabilitative procedures seem to be an adequate and conservative management for CRF cases.

Evaluation of Tissue Response in Sites Sutured with Cyanoacrylate and Submitted to Low Power Laser Therapy: A Randomized Clinical Trial

This study aimed to qualitatively evaluate the inflammatory response in sites sutured with nylon and 2-octyl cyanoacrylate and submitted to low-power laser therapy. Background: 2-octyl cyanoacrylate acts as both a bonding agent for incisional wounds and a substitute for conventional suture methods after topical application, forming an occlusive layer that prevents the entry of any exogenous agent into the wound. Tissue reactions such as granuloma formation are cited in the literature as possible outcomes following 2-octyl cyanoacrylate use. Methods: Thirty wistar rats, were randomized into groups of five, of which fifteen were sutured with 2-octyl cyanoacrylate and another fifteen with nylon thread. In the postoperative period, all the animals were submitted to low power laser therapy in a single centralised region, with light perpendicular to the surgical wound, applied every 48 hours via the ArGaAl laser, with a wavelength of 685nm, a dose of 4J/cm2 and power level of 35mW. All the animals were kept in separate cages, under similar conditions, and provided with water and ad libitum feed. Animals were euthanized at 1 day (D1), 3 days (D2) and 7 days (D3). Tissue samples were removed from the central region of the wound and the slides were stained with hematoxylin and eosin. Results: Histological sections were analysed by evaluating inflammatory parameters and in accordance with a previously standardized scale. Similar inflammatory reactions were observed between sutured wounds with nylon and cyanoacrylate, with no statistically significant differences observed. Conclusions: Results suggest that there is no difference in the association between 2-octyl cyanoacrylate and laser therapy and nylon sutures with and the same As-Ga-Al laser application dosage

The Role of Virtual Surgical Planning in Increasing the Predictability in Orthognathic Surgery

Purpose: To evaluate our surgical outcomes by comparing our surgical plan to the outcome of the surgery and evaluate our efficacy using Virtual Surgical Planning and Medical Modeling software. Our aim is to determine the quality and validity of Virtual Surgical Planning when comparing pre-surgical plans with post-surgical outcomes. Patients and Methods: A cohort study was conducted for patients who underwent orthognathic surgery at a single institution. Utilizing virtual plans and models, select points for the virtual plans were compared and superimposed with that of the actual surgical movements. The primary predictor variable were the pre-surgical virtual plans of movements; the outcome variable consisted of the actual post-surgical movements. Statistical analysis was computed via IBM SPSS Version 25 software utilizing a paired t-test assuming equal variance with alpha (p<0.05). The sample of patients included those who had pre-operative and post-operative cone beam computed tomography scans, a virtual surgical plan, CAD/CAM splints, and LeFort I osteotomy and bilateral sagittal split osteotomy.Results: The study consisted of ten patients between the ages of 18-51 years old. Pre and post surgical plans were superimposed and four points of measurement were compared along 3 dimensional planes. There were no statistical significant associations between the virtually planned and post surgical planned values.Conclusion: Our results suggest that the use of virtual surgical planning in orthognathic surgery yields favorable and accurate surgical outcomes regarding rotational movements with minor degrees of discrepancies.

A An Evidence Based Practice Guidelines for Dental Professionals to Manage Anticoagulant Therapy Patients Seeking Dental Care. A Review Article

Patients with specific cardiovascular disorders are commonly treated by anti-coagulant medications. Hence, these anti-coagulant drugs might affect greatly the oral health care procedures and the course of dental treatments, Dental Professionals are therefore responsible to treat such patients in a harmonious way as adequate hemostasis is challenging as part of routine oral surgery and other dental procedures. The objective of this review was to discuss the evidence-based practice guidelines based on available literature to manage patients with anti-coagulants therapy seeking invasive dental procedures. According to the available literature, The evidence-based guidelines for anticoagulants such as Warfarin are well established. However, there is an insufficient evidence available for new oral anticoagulants drugs. Nevertheless, risk assessment and the standard INR value should be considered in relevance to consultation with the patient’s physician must be taken into an account before any elective surgical procedures.Anticoagulant therapy must not be interrupted in patients undergoing minor surgical procedures. However, Local hemostatic measures are of utmost considerations and are effective in achieving hemostasis.

Di George syndrome: Catch 22 (A case report)

The deletion of chromosome 22q11.2 is described as Velocardiofacial Syndrome orDi George Syndrome. CATCH 22 stands for cardiac defect, abnormal faces, thymichypoplasia, cleft palate, hypocalcaemia.Other defects seen are velopharyngeal insufficiency with or without cleft palate,immune problems, feeding difficulties, hypocalcaemia, learning disabilities,behavioral abnormalities and lastly characteristic facial features.A high prevalence ofdental caries, abnormalities of tooth shape, eruption and number, and enamel defectssuch as hypomineralisation and hypoplasia are also seen in these patients.A case of 7year old child with Veligocardiofacial syndrome is discussed in thisarticle. Facial dysmorphism and common dental manifestations is typically noticeablein patients with this syndrome. Enamel aberrations related to hypocalcemia mayresult in a higher frequency of dental caries. The dentists need to be aware of thedental features of this condition in order to refer them to the adequate specialists.

Association of Dietary Practices and Dental caries among adolescent in Lahore: A cross sectional survey

Objective: This study was designed to determine the prevalence of dental caries (DMFT) in 15 years age children and to determine its association with dietary practices. Methodology: This study was conducted in the schools of Lahore having summer camp in July 2015. Study participants were 15 years old students attending summer camp by simple random technique. Written permission was taken before their examination and interview. Self-structure questionnaire was used to collect information regarding the dietary practices. DMFT index was used to measure dental caries. Data entered and analyzed using SPSS version 20. Data was assessed by percentage and frequency, descriptive part was used for demographic variables, and for dietary habits. Chi square test of association between dietary practices and dental caries was applied. P-value ≤0.05 was taken as significant. Results Total participants were sixty (n=60). Out of these 80% of the subjects of the study were males and remaining were females. Total 58.3% respondents were caries free in this study while caries positive were 41.7 %. Average DMFT score examined was 1.2. In Logistic Regression for the Prediction of Caries Status on Basis of Dietary Habits, three variables were usage of toffees, chocolates and sandwiches. These three played most important role in the production of caries status. Final regression model for calculating probability was Z= -10.665+1.479 Toffees+ 1.183 Chocolates+1.582Sandwiches. Conclusion: Findings of this study have shown that some of the dietary habits have significant relation with caries or tooth decay status like chewing gum, candies, soft drinks, sweets, toffees, chocolates and sandwiches have strong negative impact or relationship with teeth decay.

Hard and Soft Peri-Implant Tissue Augmentation using Ridge Split with Guided Bone Regeneration and Free Gingival Autograft.

Horizontal ridge deficiency, particularly in the mandibular arch, poses a challenge for implant supported rehabilitation. Ridge split, along with expansion, allows simultaneous implant placements in such defects, and avoids the delay which usually follows hard tissue augmentation procedures. A 53 year old female with missing mandibular anterior teeth and a bucco-lingual ridge deficiency was treated using the ridge split technique and simultaneous implant placement. Demineralized freeze dried bone allograft (DFDBA) along with anorganic bovine bone (ABB) was packed in the expanded crypt and covered by a collagen membrane. Following successful implant osseointegration, soft tissue augmentation by a vestibular deepening procedure with a strip of autogenous free gingival graft was performed. Prosthetic rehabilitation was done using a cement retained prosthesis after the healing phase. The case was then followed up for 3 years where stable results were noted. Condensed treatment time and a predictable outcome was achieved by using this technique.

Angiomyolipoma of the Oral Cavity: A Rare Case Report

Angiomyolipoma (AML) is a rare, benign tumor composed of thick-wall blood vessels, smooth muscle component and mature adispose tissue. Differentiation from other benign and malignant mesenchymal lesions of oral cavity depends on recognition of these three histologic components, and immunohistochemical (IHC) techniques are also helpful. This tumor arise from perivascular epithelioid cells (PEComas) and kidneys followed by liver are the main locations of this soft tissue tumor. AMLs are rarely found in oral cavity and few case reports of oral AML have been reported in the literature. We report the first case of concurrent occurrence of AML of the tongue and peripheral giant cell granuloma of the gingiva in a 59-year-old patient. Clinically it was presented as a painless nodular mass with a smooth surface on the dorsal of the tongue. Based on histopathologic features and IHC staining the diagnosis of oral AML was done. The other lesion was a small sessile mass in interdental papillae of the lower incisors and microscopic examination showed the histologic features of a peripheral giant cell granuloma. Concurrent occurrence of PGCG which is a reactive mucosal hyperplasia and AML in our patient, could show the probable role of local trauma in the pathogenesis of these lesions.

Closure of an Oroantral Communication Using Leucocyte-Platelet Rich Fibrin: A Novel Technique Using Regenerative Medicine

Oroantral communication (OAC) is a common complication following extraction of maxillary posterior teeth because of the close anatomic proximity of the roots to the maxillary sinus. The most frequent methods described in the literature to close an oroantral communication involve buccal or palatal rotational advancement flap surgery or use of the buccal fat pad. These surgical procedures require advanced surgical skill and are associated with donor sit morbidity, such as avascular flap necrosis that can lead to soft tissue graft failure to close the OAC, infection and extreme postoperative patient discomfort that affects patient quality of life. This paper describes a novel technique using leucocyte platelet-rich fibrin matrix obtained from the patient’s own venous blood that leads to predictable soft tissue regeneration and closure of the OAC. This regenerative medicine procedure is clinician friendly, less traumatic compared to traditional methods of OAC closure with minimal postoperative recovery for the patient.