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Tricalcium silicate cements have long been used in dentistry for management of open apex. Biodentine was introduced to overcome the disadvantages of mineral trioxide aggregate (MTA). The aim of this systematic review was to compare the success rates of biodentine and MTA as a material of choice for the management of open apex in children with nonvital immature permanent teeth. PubMed/Medline, Scopus, EMBASE, Cochrane, and Google Scholar were searched until November 30, 2021, with the search terms young permanent teeth, immature permanent teeth, open apex, MTA, and biodentine. Based on the inclusion criteria, the articles were selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed for quality using a risk-of-bias assessment tool. The outcomes of the studies were qualitatively synthesized. A total of 379 studies were identified and after refinement only two studies met the eligibility criteria. Both the studies were performed in children with nonvital pulp status. One of the studies showed a clinical success of 91.66% for MTA and 100% for biodentine in revascularization cases while the other study showed 100% for both the materials in apexification cases. Radiographic success was 100% for both the materials at the end of the follow-up period in both the studies. Treatment modality can create heterogeneity that does not allow making a pooled conclusion for the two materials collectively, which is the case in this review where one study used revascularization, while the other used apexification. An overall high risk of bias was noticed for the selected studies. With high risk of bias and low quality of evidence, a strong definitive conclusion cannot be arrived at. Further studies with proper randomization and minimal risk of bias are required to provide a conclusive result. However, as per the included studies, biodentine can be a material of choice for revascularization while both MTA and biodentine can be used for apexification procedures.

Purpose 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). Materials and methods 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. Results 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. Conclusion 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.

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.

BACKGROUND Perioperative haemorrhage is an important concern during any surgical procedure. The purpose of this study was to assess the effect of tranexamic acid (TXA) irrigation on perioperative haemorrhage during the surgical removal of impacted mandibular third molar. METHODS In this double-blind, randomized controlled clinical trial, 120 participants who underwent surgical removal of horizontally impacted mandibular third molar were divided into 2 groups. The patients in the Group 1 received 0.9 % normal saline for irrigation during the procedure and the patients in the Group 2 received TXA irrigation with normal saline (1 mg / mL), age, gender, operation duration, amount of blood loss and visual assessment of surgical field were the variables that were studied. The use of TXA solution for irrigation was the predictive factor of the study. RESULTS Each group consisted of 60 patients. Group 1 consisted of 31 male patients (51.7 %) and 29 female patients (48.3 %) and group 2 consisted of 30 male patients (50 %) and 30 female patients (50 %). There was no difference in the distribution of the variables between the 2 groups, except for the duration of the operation. The mean operative time was 20.94 ± 0.61 minutes in group 1 and 26.17 ± 0.98 minutes in group 2 (P > .05) which was not statistically significant. The mean intraoperative blood loss was 44.47 ± 6.416 mL in group 1 and 84.73 ± 7.861 in group 2 (P < .05). The mean volume of irrigation was 100.08 ± 7.658 mL in group 1 and 140.33 ± 12.332 mL in group 2 (P < .05). CONCLUSIONS TXA is effective in reducing the risk of intraoperative blood loss in patients for whom substantial blood loss is anticipated. KEY WORDS Tranexamic Acid, TXA, Blood Loss, Third Molar Surgery, Impacted Tooth Removal.

Wound healing monitoring after every surgery is the most vital concern to deal with. The surgical removal of the teeth involves guttering of overlying bone, splitting the tooth (odontectomy), delivery of the tooth, irrigation of the socket, achieving haemostasis and closure of the soft tissue flap. This leads to big surgical insults resulting in post-operative inflammatory response like pain and swelling, difficulty in mouth opening, fever, etc. In some cases, other rare complications, including infection, nerve damage, have also been reported. The objective of this study is to evaluate the effects of submucosal injection of vitamin c (L-Ascorbic Acid) in wound healing after trans alveolar extraction of teeth. Thirty patients requiring trans alveolar extraction of teeth were included in this study. Patients were divided into two groups, Group S (Vit c) and Group B (Control). Healing of extraction socket was observed on 3rd and 7th post-operative days. The study group (Vitamin C) had better healing indices than the controls at 7th post-op day. There was no significant difference in 3rd post-op day. There was no significant reduction in pain on 3rd and 7th post-operative days. L-Ascorbic acid injection provides satisfactory post-operative healing following trans alveolar extraction of teeth. But it does not decrease the post-operative pain following surgery.

Tooth extraction is one of the most common procedures undertaken in the dental clinic. As with any surgical procedure, even a simple tooth extraction can result in complications. Post extraction complications can be annoying to the patient, thereby causing mild morbidity and have an impact on their quality of life. Complications are wide starting from common ones like alveolitis and root fracture, dry socket, infraction, halitosis, pain, trismus and uncommon ones like displacement of root fragments within the sinus and oral antral fistula. The aim of this study was to evaluate post-extraction complications among patients visiting saveetha dental college. This is a retrospective study. We reviewed patient records and analysed the data of 86000 patients between June 2019 and March 2020. From a pooled sample size of 23000 extractions done during this period, data of patients reporting for post-extraction complications were segregated and analysed. The statistical analysis was done using SPSS Version 20 by IBM. The results were analysed using the chi-square test. In this study, we observed that among a sample of 23000 simple extractions, only 42 patients had reported back with post-extraction complications (0.18%). These complications were more in males than in females. When compared between maxillary and mandibular arch, the mandible had more incidence with 54.16%. The most common complication was dry socket (58.34%). Pain as a complication was more in males than in females. Within the limits of the study, the incidence of post-extraction complication is more in males than females. Higher incidence of complication was seen in a mandibular arch (54.16%) than in maxillary arch (45.84%).

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.

Obstructive sleep apnea (OSA) is a common sleeping disorder. As the name suggests, it is associated with apneic and hypopneic breathing due to some kind of obstruction in the respiratory passage and thereby interferes with sleep. This review aims to give a concise overview on the disease, its pathophysiology, clinical presentation, diagnosis and various methods of management.

Surgery for orbital trauma is challenging. A good understanding of the orbit, its normal form, function, and the varying patterns of its disruption due to trauma is essential for its proper management. The aim of this chapter is to provide a comprehensive clinical overview of all facets of orbital trauma for the young surgeon. The chapter has been structured to include the basics of (i) anatomy, (ii) biomechanics of injury, (iii) classification and their clinical implications, (iv) surgical approaches and (v) management options available for individual types of fractures. Special features of this chapter include descriptions of clinical features exclusive to orbital trauma with a section for management of orbital emergencies. A detailed note is provided for the management of fractures of the orbital floor including guidelines for deep orbital dissection and elaboration of the principles of reconstruction. The role of computer assisted surgery, intra-operative navigation and patient specific implants has also been added to explain the recent advances in this field of surgery.

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 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.