To evaluate the efficacy of topical insulin gel dressing versus collagen membrane dressing in managing facial soft tissue abrasions. To formulate topical insulin gel and to assess and compare the efficacy of topical insulin gel and collagen dressings. A total of 52 patients with bilateral and multiple facial abrasions were included in this study. A split face design experimental study was conducted using topical insulin gel and collagen dressing. Rate of wound healing and epithelization, reduction of wound size and complications were assessed and compared among the two groups over a period of 21 days. A statistically significant result was found in the insulin dressing site during initial days of wound healing. While both the dressing materials effectively reduced the wound size by 21 days, suggesting that both the dressing materials are effective in wound healing with minor differences in the initial response. Scarring was seen more in collagen dressing group compared to insulin gel group. Both the dressing materials were effective in reduction of wound size over the time but insulin gel dressings showed slightly superior quality of healing in terms of scar and texture when compared to other.

Abstract The cemento-ossifying fibroma is a neoplasm that belongs to a group of lesions referred to as benign fibro-osseous lesions. These lesions are characterized by the replacement of normal bone by fibrous tissue and varying amounts of newly formed bone and/or cementum-like material. The juvenile cemento-ossifying fibroma is particularly unique lesion because of its reported tendency to occur in children and adolescents, its more complex histologic features, and its tendency for more aggressive growth. The lesions are typically observed in patients younger than 15, rapidly increase in size, and generally do not produce pain or paraesthesia. The psammomatoid variant of juvenile cemento-ossifying fibroma are a distinct kind of fibro-osseous lesions, exhibiting specific histopathologic characteristics and a proclivity for locally aggressive behavior including invasion and destruction of surrounding anatomical tissues. Small lesions can be treated conservatively with curettage or enucleation. An open surgical method involving resection and reconstruction is suitable for removing large, irregularly shaped tumors. This case report presents a case of psammomatoid cemento-ossifying fibroma in a 19 years old male patient with disfiguration on the left side of the face, which was managed with surgical resection and reconstruction and no recurrence till date.

The aneurysmal bone cyst (ABC) is a benign, blood-filled bony lesion that commonly affects the vertebral column and long bones of the body.ABCs can appear in the head and neck on rare occasions.ABCs have the ability to grow quickly and weaken the associated bone, resulting in pathological fractures as an early symptom.ABCs are usually asymptomatic, but they can cause local pain and swelling.Only 2-3% of ABCs occur in the head and neck region, with the mandible and maxilla being the most common sites of occurrence.Aneurysmal bone cysts can be surgically or non-surgically treated.Surgical intervention, regardless of where the ABCs are located in the body is the mainstay of treatment.En-bloc resection is the gold standard of treatment for ABCs because it has the lowest risk of recurrence and also because majority of ABCs are found elsewhere other than head and neck.More delicate surgical techniques, such as curettage with bone grafting, are preferred due to the delicate nervous and vascular structures found in the head and neck region, as well as aesthetic considerations.The present paper highlights the screening, examination and management of two cases of ABC that were accidentally diagnosed during routine dental checkup.

Background: As per existing literature Local Anaesthetics (LA) had only peripheral action .In study by All saffar et.al poskulated that the opiorphins in saliva were elevated after the administration of Local Anaesthetic(LA) .To investigate the proposed central mechanism of LA this study was conducted. Purpose: To investigate the proposed Central mechanism of action of Local anaesthetic and association with salivary opiorphin's. Study Design: This was a prospective study done in the Department of Oral and Maxillofacial Surgery, FDS, Ramaiah University of Applied Sciences, Bangalore in patient milieu of 44 patients (22 males, 22 females), aged between 18-69years, indicated for prophylactic extractions under Local Anaesthesia between November 2019 to February 2021. Predictor: salivary opiorphin's assesses to be increased after administration of Local Anaesthetics. Main outcome variable(s): The mean levels of salivary opiorphin's were decreased and increased but ranged in normal limit. Analyses: The P value was 0.96, with no statistical significance. Results: The mean level of salivary opiorphin's before was 28.38ng/ml and 26.24ng/ml, after administration of local anaesthesia. Therefore, there was a mean decrease of 2.14ng/ml in salivary opiorphin levels after administration of LA. The P value was 0.96, with no statistical significance. Conclusion: Our study results indicate that local anaesthetics have only peripheral action. There was a mean decrease in opiorphin levels after administration of local anaesthesia. The change in opiorphin levels was not statistically significant; negating any association between administration of local anaesthesia (2% lignocaine hydrochloride) by IANB technique and salivary opiorphin levels.

A Supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch with anterior maxilla (mesiodens) and the maxillary third molar region (distomolar or paramolar) being the most frequent sites.Fourth molars or distomolars are situated distal to the third molars that are rarely erupted but usually detected on routine radiographic examination as an impacted tooth.The etiology of this anomaly has multiple theories but none of them are completely accepted.It is usually associated with genetic syndromes like labio-palatal cleft, cleidocranial dysostosis and Gardner syndrome, with lowest prevalence in healthy individuals.Occurrence of bilateral distomolar is seen only in 0.07% of population making it a rare condition.Supernumerary teeth are usually asymptomatic, but can sometimes lead to formation of cysts and tumors as well as crowding or delayed eruption of permanent teeth.More often such teeth are kept under periodic observation and are highly challenging to the operating surgeons in making decision whether to retain or remove during its early phase of presentation unless the above-mentioned conditions are noticed.The present paper reports a case of eumorphic bilateral impacted mandibular fourth molars associated with cystic changes in a non-syndromic young female patient which was managed by staged atraumatic removal of bilateral third and fourth molars using orthodontic traction system minimizing the damage to the adjacent vital structures.

Primary Intraosseous Squamous cell carcinoma (PIOSCC) arising from the lining of OKC in a 49-year-old female patient, quite aggressive in nature is presented here. Background: The occurrence of (PIOSCC) from an odontogenic cyst is rare with the incidence being 0.3–3%. Case description: In the present case histopathology was deceptive owing to the presence of spindle-shaped cells. This prompted us to use a panel of immunohistochemical markers such as CD34, Pancytokeratin, CK5/6, SMA, S100, and p63 to differentiate from sarcoma. Conclusion: The probable pathogenesis for such a transformation into malignancy could be attributed to the hypothesis of chronic inflammation. According to the English literature review, 34 cases have been reported until now, with the present case being the 35th case. Clinical significance: This report emphasizes the use of immunohistochemistry to arrive at a definitive diagnosis in scenarios of overlapping histological features.

The coronavirus pandemic of 2019 has increased the risk of occupational cross infections among dentists. Dental procedures are inherently risky in this scenario due to the need for close proximity with patients and generation of aerosols and splatters. Regulatory dental health bodies, including World Health Organization, Center for Disease Control, and American Dental Association, have devised guidelines for various forms Personal protective equipment for routine outpatient procedures during this pandemic and in the post-COVID-19 world. Stringent regulations are also advisable to conserve these resources at a time when the threat of COVID-19 is likely to persist indefinitely.

Self-tapping and self-drilling screws are two modalities available for plate fixation. When compared to self-drilling, self-tapping screws have a few drawbacks like screw loosening, thermal osteolysis, equipment dependent, and time-consuming. Aim: The aim of this study was to compare the efficacy of self-tapping and self-drilling screws with relation to plate retention and stability in internal fixation of mandibular fractures using 3D finite element analysis (FEA). Objectives: The objective of this study was to determine the influence of screw placement technique on stress concentration and deformation occurring at the screw-bone interface in self-drilling and self-tapping screws. Materials and Methods: A 3D computer-aided design modeling system was used to build a trilaminate mandibular bone, self-tapping screw and self-drilling screw, and a 2-holed miniplate with gap that were converted into finite element models using Hypermesh 13.0 software. Material properties and boundary conditions were assigned to these models. Pullout, torque, and torsional forces were applied to evaluate the stress concentration and deformation at the screw-bone interface. Results: The comparison of stress concentration and deformation values between the two types of screws was interpreted using ANSYS software version 14.5. Results of torque test, pullout test, and torsional test showed maximum Von Mises stress, and deformation around the screw-bone interface was higher in self-tapping screw than in self-drilling screw. Conclusion: Within the limitations of the 3D FEA, the findings provided significant evidence to suggest that self-tapping screws have a greater incidence of fatigue when compared to self-drilling screws as there was more stress distribution and deformation at their screw-bone interface.

Aim:The aim of this case report is to document an aggressive odontogenic myxoma (OM) of the mandible causing dramatic displacement of the unerupted third molar up to the coronoid process, a rare entity.Background: The OM is an aggressive neoplasm that can cause significant destruction of the jaws.They present as large multilocular lesions often causing thinning of the cortical plates and displacement of teeth.The OM has a high rate of recurrence that brings into significance their mode of management that varies from curettage to radical excision depending on the surgeon's school of thought.Case description: An OM of the mandible in a 17-year-old patient is described here with cone-beam computed tomography (CBCT) and orthopantomograph (OPG) findings.The OM had displaced the unerupted mandibular third molar to the coronoid process that makes this case interesting to report.Conclusion: Intensity of alcian blue and safranin O staining reveal the hyaluronic acid, glycosaminoglycans (GAG's), and proteoglycan content of OM.The pattern of picrosirius red staining under polarizing microscope indicates aggressive potential of OM.Clinical significance: The article highlights the use of appropriate differential stains like alcian blue, safranin O, and picrosirius red that facilitate in arriving at precise biologic behavior of OM.Original research studies to validate intensity and pattern of special stains with odontogenic lesions are mandated to establish a significant correlation.

Aim: This in vivo study compared clinical, histological, and radiological differences in bone formation in human extraction sockets grafted with demineralized freeze-dried bone allograft (DFDBA) and platelet-rich fibrin (PRF), with nongrafted sockets and bone–implant contact (BIC) at 3 and 6 months after implant placement. Settings and Design: Randomised controlled trial. Materials and Methods: The study comprised thirty posterior teeth sockets in either arch in patients ranging from 25 to 60 years. The patients were divided into two equal groups – Group I: control group wherein no graft was placed and the extraction socket was left to heal normally and Group II: test group in which DFDBA and PRF were placed after extraction. 12–16 weeks after extraction, a trephine biopsy was done just prior to implant placement, followed by implant placement. Cone-beam computed tomography (CBCT) at 3 and 6 months after implant placement was done to assess BIC. Statistical Analysis Used: Descriptive and Inferential statistical analysis was done. Parametric test: Independent t-test was used for intergroup analysis and dependent t-test for intra-group analysis. Results: Lower buccal bone levels were seen in the control group versus test group at all intervals though moderately significant. Lingual bone levels significantly reduced at all the three intervals for the control group as compared to the test group. Ridge width in both groups reduced in a time span of 6–7 months without any significant difference. Better bone conversion was noted in the preserved sockets. The preserved sockets also showed better BIC 3 months after implant placement and loading. Conclusion: Indigenously developed DFDBA material shows promising results as an osteoinductive material.

Aim The aim of this study was to compare the treatment outcome following fixation of midface fractures with microplates to that of miniplates. Materials and Methods The prospective study included 30 patients with confirmed diagnosis of midface fractures (Le Fort I, II, III, ZMC fractures or combination) and who gave written informed consent. The patients were categorized into microplate (1.2 mm) group and miniplate (2.0 mm) group with 15 patients in each group using computer-generated randomization. The clinical parameters like occlusion, stability of fixation, chewing efficiency, pain, infection, paresthesia, plate exposure, palpability, aesthetic outcomes and patient’s perspective were assessed on postoperative day 1, day 3, after 1 week, 1 month and after 3 months. Results There was no statistically significant difference between the two groups in terms of occlusion, stability of fixation, chewing efficiency, pain, infection, paresthesia, plate exposure, aesthetic outcomes and patient’s perspective. One patient in microplate group and five patients in miniplate group complained of plate palpability ( P = 0.16), suggesting clinically significant difference but statistically no significant difference. Conclusion Microplate osteosynthesis gives equivalent results compared to miniplate osteosynthesis, in the fixation of midface fractures in terms of stability and function and clinically superior in terms of aesthetics.

Background: Odontogenic infections are the most common source for spreading facial space infections. The infections of these potential spaces in the facial planes include acute cellulitis of the soft tissue with or without true abscess formation. Aggressive incision and drainage (I&D) of all the involved spaces is considered necessary to assure fast resolution of the infection and to eventually maintain a patent airway. An adequate level of anesthesia has been a critical component of the treatment plan. Skin in front of, above, below the ear and anterior aspect of neck is supplied by cervical plexus. A superficial cervical plexus block is an option worth considering in these cases. The injection site is usually far enough away from the intended area for I&D to be performed safely. Material and methods: The study protocol involved incision and drainage of facial space infection involving submandibular, submental, sublingual and/or pharyngeal spaces, performed under MAC and superficial cervical plexus block with concomitant inferior alveolar nerve block. Clinical parameters evaluated were intraoperative pain (During incision, drainage, drain fixation and immediately after the procedure in recovery room), amount of sedation required during the procedure and complications if any. Results: During incision 80% patients scored the pain on VAS to be 2, and rest two patients gave a score of 3 and four. During exploration and drainage of the involved spaces the average pain score was 4.4 where 60% patients scored it below 4, 30% scored it to be 5 and one patient had extreme pain and scored it to be 9. The pain scores during drain fixation was 2 or less in 90% cases and 3 in remaining 30%. Immediately after the incision and drainage all the patients had a significant pain relief in the recovery room and scored the pain to be 4 or less on VAS scale. 9 of 10 patients did not have any complications during the procedure. One patient had seizure and cardiac arrest during exploration of the space, emergency tracheostomy was done and I&D was completed successfully. Conclusion: Bilateral SCPB with inferior alveolar nerve block provides significant intraoperative pain control for drainage of submandibular, submental, sublingual and or pharyngeal space infections. It offers an effective alternate to general anesthesia which is easy to learn, has low complication rate and a high success rate, thereby reducing the total length of hospital stay and overall cost of the treatment.

The purpose of this study was to compare the mechanical behavior of combination of microplate and miniplate with two standard miniplates for fixation of mandibular fractures in the interforaminal region on the basis of bite force and other clinical parameters. A prospective randomized study was conducted on 20 patients with mandibular fracture requiring open reduction and internal fixation (ORIF) who were randomly categorized into Group A and Group B with 10 patients in each group. Ten healthy persons whose age and gender matched with study groups were included in control Group C. Pre- and postoperative bite force was measured at specified intervals in both the study groups and was compared with the control group. The bite force values were comparatively less in Group A than Group B, although there was no statistically significant difference. Also, bite force values were less in both the study groups when compared with the control group. No statistically significant difference was found in other clinical parameters such as infection, fracture mobility, and hardware failure. The results were suggestive that the use of microplate and miniplate combination in management of minimally displaced mandibular fractures in the interforaminal region provides stable fixation comparable to two miniplate combination.

•Necrotizing fasciitis (NF) is a rare soft tissue infection, primarily involving the superficial fascia and resulting in extensive undermining of the surrounding tissues. It’s a rare entity to have a NF in the lip region as it is an area of tremendous vascularity.•A 65 year old female patient reported with acute swelling of the right side of the face associated with severe pain, fetid odour and fever. Keeping infection in mind, we treated her with antibiotics but the changes that took place eventually is worth noting.•Therefore this case gives us a light on the rarity of infection leading to necrosis and an alert on the changes in behavior pattern of the microorganisms.

Purpose: The location, configuration, and variations of mandibular canal such as bifid/ trifid/double mandibular canals play a significant role in performing surgical procedures in the mandible. The study was aimed to assess the prevalence of bifid mandibular canals using cone beam computed tomography (CBCT) images. Materials and Methods: A retrospective study on CBCT images of full skull or mandible of patients, taken during the period from May 2014 to April 2016, was carried out. Images with any gross pathology involving mandible were excluded. CBCTs were examined by a single examiner for presence, type of bifid mandibular canal, and the relationship of bifid mandibular canal with the third molar. Results: A total of 408 CBCTs were examined, out of which 23 exhibited bifid mandibular canal with the prevalence of 5.63%. Type 2BC was the most common type of bifid mandibular canal. All the CBCTs showing Type 1U and 1B bifid mandibular canals, 33.3% of Type 2UC and 25% of Type 2BC bifid mandibular canals exhibited Class B relationship with the third molar. Conclusion: Suspicion of bifid mandibular canal on a screening orthopantomogram should be confirmed by CBCT. Assessment of the type of bifid mandibular canal will help in treatment planning of mandibular surgical procedures.

Chondrosarcomas are malignant tumors arising from cartilage cells that tend to maintain their essentially cartilaginous nature throughout their evolution. Chondrosarcomas are rare in the head and neck region and these lesions predominantly occur in the maxilla and are found in descending order of frequency in the body of the mandible, the ramus, the nasal septum and the paranasal sinuses. The case reported here is a multifocal grade I chondrosarcoma, mimicking a benign tumor in its clinical presentation with the unique feature of being multifocal involving right body and symphysis of the mandible. The patient also exhibited a diffuse reactionary bone lesion in the posterior maxilla bilaterally and a myxomatous area in the left body of mandible. The lack of literature with regard to a standard treatment protocol for such a diffuse presentation has led to the present case report.

ABSTRACT Aim The aim of the study was to report a unique case of glandular odontogenic cyst (GOC) in an unusual location of anterior maxilla. Materials and methods Considering the age, sex, and location of the lesion, a minimally invasive surgical procedure was opted considering esthetics, such as decompression followed by enucleation and fresh frozen bone (FFB) grafting. To arrive at the diagnosis, cytokeratin (CK)-19 was employed to differentiate from suspected intraosseous mucoepidermoid carcinoma. Results With the evidence of pre- and post treatment histopathological changes, the lesion appeared less aggressive justifying the treatment executed. Conclusion Glandular odontogenic cyst is a locally aggressive jaw cyst, which has a high rate of cortical perforation and recurrence that poses both diagnostic and therapeutic challenges. Clinical significance Treatment of decompression, followed by enucleation may be considered as an effective option in comparison to aggressive surgical intervention. How to cite this article Kumari K, Sowmya SV, Vineeth K, Rao RS, Lalitha RM, Augustine D, Haragannavar VC, Nambiar S, Abraham M. Staged Minimally Invasive Surgical Approach in the Management of Glandular Odontogenic Cyst. World J Dent 2018;9(1):48-52.

Background: Trismus is a problem commonly encountered by the dental practitioner. It has a number of potential causes, and its treatment will depend on the cause. However, there are very few reports of trismus due to fibrodysplasia ossificans progressiva (FOP) following third molar surgery. Clinical Presentation: FOP is a rare human genetic disorder with characteristic clinical features like progressive formation of extraskeletal bone or heterotopic ossification and congenital malformation of the great toes. Clinical Significance: It is troublesome to the maxillofacial surgeon, that minimal manipulation and minor surgery can induce bone formation in soft tissues of the head and neck region, particularly the masticatory muscles and the temporomandibular joint. This paper presents a case of severe trismus following third molar extraction, intractable by routine treatment methods, which was later diagnosed as FOP.