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Aim: The aim of the current clinical trial is to evaluate the soft tissue trauma and to assess which forceps has caused less damage to the interdental bone and the extraction has been done In-Toto. Materials and methods: The study population included 30 patients who were referred to oral and maxillofacial surgery department for therapeutic extraction. The patients were randomly assigned to 2 groups: group 1, extraction of premolars using conventional premolar forceps; and group 2, extraction of premolars using atraumatic premolar forceps. It is a comparative split mouth study. Primarily fracture rate of upper premolar root was assessed by comparing these two forceps. In addition, the pain intensity levels for each patient were recorded during the application of forceps using VAS pain assessment tool. Results: A total 30 patients participated in the study, of which 16 were females and 14 were males, the age distribution was 11-27years. Participants were divided into two groups. Being a split mouth study same participant had application of two different forceps on either side of the quadrant. All the participants had their upper and lower 1st premolars extracted. There was a statistically significant difference in pain control of the two treatment groups with a p value of 0.007654 (p < 0.05). Conclusion: Within the limitations of the study, atraumatic premolar forceps had significantly shown better results in VAS scale compared to that of universal conventional premolar forceps. And clinically there was less to too little tissue damage noted where atraumatic premolar forceps were used for extraction. Araumatic tooth removal is of clinical signicance in preserving the buccal bone plate, which is mainly critical for orthodontic extractions and also for implant placement. [ABSTRACT FROM AUTHOR]

A completely edentulous state is when the patient is in a state of complete tooth loss. In the current world, an increasing demand for complete denture prosthesis is also seen. The lifestyle, food habits etc are thought to be major factors that are influencing the oral health of the current generation. Marked evidence has been cited between the relationship of various systemic diseases like diabetes and completely edentulous state. Hypertension is the state of elevated blood pressure. An evident association between hypertension and oral diseases has been established previously. The aim of our study was to find the association between hypertension and a completely edentulous state. The study was performed in a university setting, it reviewed patient records and analysed the data of 86000 patients between June 2019 and March 2020. A total of about 450 entries were selected. Of this after removing multiple entries a total of 372 patients data were obtained. The collected data were compiled and tabulated using Microsoft Excel, then reviewed and exported to SPSS for performing statistical analysis. In the study a total of 5 parameters were considered, but only for one parameter a statistically significant data was found, and this was the demographic profile of the completely edentulous patients, p value was found to be 0.0052 (p =0.005) hence proving the data to be significant. For the rest of the parameters the study considered, a statistically significant data was not obtained, but the data has remarkable clinical significance. In the study, completely edentulous male population were, 56%, the female population represented 43%. 27% of the completely edentulous patients in the study were hypertensive and that is not a negligible count. Within the limitations of the study, it can be stated that there is a relation between hypertension and a completely edentulous state. [ABSTRACT FROM AUTHOR]

Introduction: Surgical ciliated cyst (SCC) is a type of true epithelial lined antral cysts, which mostly occurs in maxilla from the sinonasal mucosa and gland, comprising 20% of all oral cysts in Japan. It is also called as postoperative maxillary cyst or postoperative paranasal cyst. The etiology is believed to be post trauma or surgery in the region of maxillary antrum. Patient concerns: Patient's concern is less evident in this cystic pathology, because this cyst even though an aggressive cyst, presents with fewer symptoms that can be uncomfortable to the patient or push them to seek medical attention. Often, this becomes an incidental finding during routine postoperative follow-up. Rationale: The rationale behind this report is to emphasize even a traumatic extraction of tooth can damage the floor of the sinus and lead to the cyst formation. Report: We report a case of SCC in a 76-year-old female of the left maxillary sinus possibly after a traumatic extraction of the tooth, for which enucleation of the cyst was done as a primary modality of treatment. Diagnosis: Diagnosis was made after a computed tomography (CT) scan and incisional biopsy. Diagnosis of such rare cases poses a great challenge due to its paucity in etiology, and it often requires a CT scan that becomes an essential gold standard investigation. Outcomes: Patient is currently under one year follow up and without any signs of recurrence. Lessons: It should be acknowledged that tampering trauma or with sinus mucosa can trigger the formation of a SCC of the maxilla, and it should always be considered as a possible sequel after any procedure of such potential in the maxilla. [ABSTRACT FROM AUTHOR]

Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. They are routinely used, and the adverse effects are comparatively less frequent that providers may overlook many of their pharmacotherapeutic principles. The purpose of this review is to provide an update on the essential aspects of local anesthetics and the toxic components of the same. Local anesthetic intoxication is a rare but catastrophic occurrence. This review also focuses on arriving at a protocol in handling toxicity crisis in dental practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to explore the prognostic significance and clinicopathological correlations of the Wnt pathway genes in a cohort of surgically treated patients with oral squamous cell carcinoma (OSCC) patients. Settings and Design: A prospective genetic study on patients with OSCC was carried out during the period from July 2014 to January 2016. Informed consent from patients and institutional ethical approval for the study was obtained and the guidelines were strictly followed for collection of samples. Subjects and Methods: Clinical data and mRNA expression analysis of ten genes in the canonical Wnt pathway were evaluated and their relationships with clinical and demographic variables were studied in 58 tissue samples. Wnt-3a, β-catenin, secreted frizzled-related proteins sFRP-1, sFRP-2, sFRP-4, sFRP-5, Wnt inhibitory factor 1, dickkopf-1, c-MYC, and cyclin-D1 from cancer (n = 29) and normal (n = 29) tissue samples were investigated using quantitative reverse transcription-polymerase chain reaction. Statistical Analysis: Descriptive statistics were used to summarize the sample characteristics and clinical variables. If the data were normal, then parametric tests were used; otherwise, nonparametric alternatives were used. All the analyses were carried out using SPSS version 23.0 (IBM SPSS Inc., USA). Results: Expression of sFRP-1, sFRP-2, and sFRP-5 in control samples and expression of c-MYC and cyclin D1 in cancer samples showed statistical significance. Significant expression of Wnt3A was observed among patients who had recurrence and were deceased. Conclusion: Wnt3A, β-catenin, and cyclin D1 are recognized as key components of Wnt/β-catenin signaling. However, in this study, there was no significant expression of all the three genes in OSCC. The proto-oncogene c-MYC showed statistically significant upregulation in cancer tissue samples suggesting that the OSCC among South Indian population is primarily not mediated by the canonical Wnt signaling pathway.

The process of healing underwent by hard and soft tissues is mediated by a wide range of intracellular as well as extracellular events that are maintained by the help of protein signals. It has been well known that platelets are responsible for the healing process through the formation of a blood clot and release of many growth factors that promote and maintain the process of wound healing. Platelet-rich fibrin (PRF) is a fibrin network in which mediators such as cytokines, essential growth factors, and cells are embedded and released after a certain period of time and serves as resorbable membrane. PRF is considered to be a healing biomaterial. Platelet concentrates have been used to improve healing of surgical wounds. The reason for the review was to discuss various new developments and practical applications of PRF in the field of oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Purpose: To assess the pain, swelling, infection, and alteration in sensation following the flapless placement of zygomatic implants guided by dynamic navigation., Materials and Methods: A randomized controlled trial was conducted on 20 patients. In group 1, the placement of the zygomatic implants was carried out without reflecting a mucoperiosteal flap (flapless). In group 2, a mucoperiosteal flap was raised (flapped). Two zygomatic implants were placed in each patient (one on each side) under local anesthesia, guided by dynamic navigation. Postoperative evaluations included pain (using the visual analogue scale [VAS]), swelling (using standard measurements), maxillary sinus infection, and alteration of sensation (using mechanical stimuli, thermal threshold detection, and a two-point discrimination test). The assessments were carried out at 2 days, 1 week, and then 1, 2, and 3 months postoperatively., Results: In group 1, all implants except for one were successfully osseointegrated. Immediate postoperative pain and swelling were both significantly greater in group 2 (P < .01). No alteration in sensation was detected in any case in the two groups. There were a total of three cases of chronic sinusitis: one in group 1 and two in group 2., Conclusions: The flapless placement of zygomatic implants guided by dynamic navigation and under local anesthesia improves postoperative recovery.

Introduction: Zygomatic implants are an effective solution for rehabilitation of edentulous atrophic maxillae. However, the conventional technique of zygomatic implant placement is invasive, requires a longer healing period and is economically cumbersome. Therefore, the flapless technique of insertion of zygomatic implants using dynamic navigation system has been introduced. This study aims to compare the cost-effectiveness of flapless insertion of zygomatic implants using dynamic navigation to the conventional flap technique., Materials and Methods: The study participants were divided into two groups: Group A ( n = 20) included patients treated by flapless insertion of zygomatic implants using dynamic navigation and Group B ( n = 20) included patients treated with zygomatic implants using the flap technique. An analysis of the effectiveness of the implants was done using the concept of quality-adjusted prosthesis years, and an analysis of the costs was done by evaluating the treatment costs at each step. The data were collected, and analysis was done using IBM SPSS software. The Kruskal-Wallis rank-sum test was employed to analyse variations in costs and effects between the two groups., Results: The study showed that the distribution of costs varies across both the categories of the procedure. Group B shows lesser cost-effectiveness as compared to Group A., Conclusion: The technique of flapless insertion of zygomatic implants is cost-effective. However, further studies considering factors such as time and cost of productivity evaluating the cost-effectiveness should be conducted., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Maxillofacial Surgery.)

Eagle's syndrome, a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, is clinically characterized by throat and neck pain radiating into the mastoid region. The diagnosis can be made through a thorough history, correct clinical and pathological correlation and radiographic examination. The elongated styloid process can be treated conservatively or surgically. Conservative treatment options include transpharyngeal injections of steroids and lignocaine, nonsteroidal anti-inflammatory drugs, diazepam, and the application of heat. The surgical management of Eagle's syndrome consists of two major approaches: the transoral and the transcervical approaches. In this paper, we present a comparative study of two cases of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy and transoral styloidectomy, their surgical time, intraoperative difficulties and complications, and recovery time. In conclusion, the management of Eagle's syndrome requires a comprehensive approach that includes a thorough preoperative evaluation of the length of the styloid process via imaging and digital palpation. The choice of surgical approach, whether extraoral or transpharyngeal, should be based on factors such as the surgeon's experience and the patient's comorbidities, as well as the length and palpability of the styloid process. Our comparative study of two cases treated with transcervical and transoral styloidectomy demonstrated that the extraoral method offers a direct and well-controlled approach for excessive styloid processes, while the transpharyngeal approach is preferred for cases where the process can be easily identified by palpation. Therefore, proper patient selection and preoperative planning are essential to achieving successful outcomes with minimal complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Aravindan et al.)

Objectives: The assessment of the accuracy of flapless placement of zygomatic implants in edentulous maxilla using dynamic navigation., Methods: A randomized controlled trial was carried out on 20 patients. Patients were randomized into two groups, the flapless (Group 1; n=10) and the conventional (Group 2; n=10). In each case two zygomatic implants were inserted under local anaesthesia, one on the right and one on the left side guided by a dynamic navigation system. The surgical procedure was identical in the two groups except for the reflection of the mucoperiosteal flap which was eliminated in the flapless cases. Postoperative CBCT scans were used to assess the accuracy of the placement of zygomatic implants., Results: Osseointegration was achieved for all the implants, except one case in the flapless group. Statistically significant differences in the accuracy of the position of the zygomatic implants was found between the flapless and the conventional groups, measured at the apex and the entry points of the implants (p < 0.01). The average apical and coronal deviations were 5 mm and 3 mm, respectively; the angular deviation was 6°, and 2 mm vertical apical disparity was detected between the planned and the achieved surgical position. Perforation of the Schneiderian membrane was noted in three cases, one in flapless group and two in the conventional group., Conclusions: Flapless placement of zygomatic implants guided by dynamic navigation offered satisfactory safety and accuracy., Clinical Significance: This is the first clinical trial to prove the feasibility and accuracy of flapless placement of zygomatic implant with minimal morbidity. The study highlights the innovative reflection of the Schneiderian membrane under guided surgical navigation. The procedure can be performed under local anaesthesia, which offers clinical advantages. Adequate training on the use of dynamic navigation is mandatory before its use in clinical cases., Competing Interests: Declaration of Competing Interest All authors disclose that we do NOT have any financial or personal relationships with other people or organizations that could inappropriately influence the submitted work., (Copyright © 2023. Published by Elsevier Ltd.)

Zygomatic implants are routinely used for the rehabilitation of the midface and edentulous maxilla; the procedure is carried out under general anaesthesia and requires the direct lifting of the Schneiderian membrane. A prefabricated surgical guide is usually used to direct the position of the zygomatic implants during surgery. This proof-of-concept study explored an innovative flapless approach for placement of zygomatic implants guided by dynamic navigation. Under local anaesthesia eight zygomatic implants were placed using a flapless technique. The preplanned position of zygomatic implants was transferred to the operating theatre using dynamic navigation, which guided the sinus lift procedure and the planned osteotomy. Operative complications were recorded, the accuracy of the implant position was measured and postoperative morbidities including pain and swelling were evaluated. Surgical complications were minimal, the Schneiderian membrane was intact in all the cases except one, which required the application of resorbable collagen membrane. Satisfactory accuracy was achieved regarding the precision of implant position and angulation. One of the patients developed maxillary sinusitis three months following surgery. Postoperative pain and swelling were minimal. The dynamic navigation guided flapless placement of zygomatic implants under local anaesthesia is a feasible technique with minimal surgical complications and postoperative morbidities., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To report a unique case presentation of a complex-compound odontome with 526 denticles., Background: Odontoma is a hamartoma of the jaws that has both epithelial and mesenchymal components differentiating to form enamel and dentin. It is of compound and complex types. Rarely, the features of both the types are present together in what is called the compound-complex type of odontoma., Case Description: The case report discussed here is that of a 7-year-old boy who presented with a compound-complex odontoma in the right posterior mandibular region., Conclusion: Timely diagnosis and prompt surgical treatment aid in preventing complications and bony expansion. Thus, proper histopathological examination is essential for the confirmation of odontoma. Recurrence of odontoma is rare and usually has a favorable prognosis if diagnosed early., Clinical Significance: The odontome contained 526 denticles, the maximum reported in the literature so far, making this a case of extreme clinical significance., How to Cite This Article: Marimuthu M, Prabhu AR, Kalyani P, et al. Complex-compound Odontome with 526 Denticles: A Unique Case Report. Int J Clin Pediatr Dent 2022;15(6):789-792., Competing Interests: Source of support: Nil Conflict of interest: None Patient consent statement: The author(s) have obtained written informed consent from the patient's parents/legal guardians for publication of the case report details and related images., (Copyright © 2022; The Author(s).)

The goal of this study was to evaluate the incidence of postoperative wound infection and timing of mandibular third molar removal in bilateral sagittal split osteotomy (BSSO). This wis a prospective, single-blinded, randomized, split-mouth clinical trial. All patients were divided into two groups: Group I, where pre-operative removal of the third molars were done 6 months prior to BSSO and Group II, where intra-operative removal of contralateral third molars were done for the same patients during the osteotomy. The primary outcome variable studied was postoperative infection rate and the secondary outcome variable was bad split during BSSO. Among the seventy five patients (150 sites), one site in group II developed infection whereas none of the sites in group I developed infection (p = 1.000). No sites had bad split in both the groups. The results from the present study show that there is no difference between the presence or absence of mandibular third molars on post-operative wound infection following bilateral sagittal split osteotomy, and the authors hence suggest removing third molars during BSSO for patient comfort., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction., Methods: A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7., Results: The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus., Conclusions: Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars., (Copyright © 2021 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Cyst-like lesion in the coronoid process of the mandible is a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged woman reported a one-year history of non-bloody, pus discharge from the right angle of the mandible. There was a history of prior surgery comprising teeth removal two years ago for a painful swelling on the right side of her face, following which her symptoms regressed but in the due course, she developed a chronic sinus with draining abscess. Radiographic findings, in combination with clinical symptoms, are critical in the diagnosis and evaluation of cysts and cyst-like lesions of the jaws. The orthopantomograph (OPG) revealed a cyst-like lesion in the coronoid process of the mandible with an extra-oral sinus tract leading to the epicenter of the cyst-like radiolucency, and so this, in combination with the patient's atypical symptoms, presented a diagnostic challenge. This case report explores the events which led to the diagnosis of osteomyelitis and shows several unique learning points., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Rajendiran et al.)

Purpose: The aim of this study was to analyze and compare the healing of scalpel and diathermy incision wounds in the oral mucosa., Materials and Methods: This is a prospective split-mouth study conducted from January 2015 to April 2017 among patients undergoing either Le Fort I or anterior maxillary osteotomy (or both). The study groups were classified based on the different techniques used to make the incision (group A, incision made by a scalpel; group B, incision made by diathermy). Wound healing was assessed on the first, third, seventh, and tenth postoperative days using the Southampton scoring system. Data were statistically analyzed using the Student t test for continuous variables and the χ 2 test for categorical variables, and P < .05 was considered significant., Results: Among the 113 participants included in the study, the age range was 16 to 35 years and male patients comprised 50.4%. The rates of postoperative complications of wound healing were 68.1% (n = 77) in group A and 77% (n = 87) in group B. Wound healing showed a statistically significant difference between the techniques (P < .001)., Conclusions: The findings of this study suggest that wounds caused by scalpel incisions healed better than those caused by diathermy incisions in the oral mucosa., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The repair of unilateral cleft lip nose deformity remains a challenging endeavor for reconstructive surgeons for many reasons, one of which is the timing of rhinoplasty, whether to be synchronous or staged with cleft lip repair and the technique for rhinoplasty. Many authors now favor primary rhinoplasty with the cleft lip repair. Various surgical techniques have been used, most commonly the closed and open rhinoplasty techniques. In this randomized controlled prospective study, we compare the closed rhinoplasty technique with open rhinoplasty during primary unilateral cleft lip repair. Thirty-six patients with unilateral complete cleft lip and nose deformity were selected. Out of this 19 patients were assigned randomly and operated with open rhinoplasty and 17 patients with closed rhinoplasty. The cleft lip repair was done using modified, Millard's rotation-advancement technique in both the groups. Follow-up assessment was done after 6 months. Quantitative and qualitative analysis were done. Statistical analysis of the data was done using SPSS 11.0. Post-operatively, the alar base width difference between the open and closed rhinoplasty techniques was statistically significant. There was no statistically significant difference in other parameters compared.