Ashwini Deshpande

Keratocystic odontogenic tumour (KCOT)—a cyst to a tumour

PurposeThe World Health Organization (WHO) has reclassified ‘odontogenic keratocyst’ (OKC) to ‘keratocystic odontogenic tumour’ (KCOT) in 2005. Currently, this tumour is classified as a benign neoplasm of odontogenic origin and not as a cyst. This article reviews and discusses history, classification scheme, aetiology and pathogenesis, molecular and genetic basis, incidence, epidemiology and site, clinical features, imaging, histopathology, immunohistochemistry, treatment options, prognosis, recurrence and malignant transformation of KCOT, with emphasis on understanding the basis of reclassification as ‘keratocystic odontogenic tumour’.MethodsA systematic search and review of the literature was carried out in the online database of the United States National Library of Medicine to identify eligible titles for the study.ResultsCurrent evidence suggests that the scientific community still continues to use the term ‘odontogenic keratocyst’ more favourably than ‘keratocystic odontogenic tumour’.ConclusionThe online database search indicates that the scientific community still continues to use the term ‘odontogenic keratocyst’ more favourably than ‘keratocystic odontogenic tumour’. At this juncture, where the terminology has changed from a cyst to a tumour, a thorough review of literature on KCOT is presented.

Effects of intra-space injection of Twin mix versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery: a preliminary clinical comparative study

IntroductionA prospective randomised double-blind study was undertaken to compare the effects of intra-space injection of ‘Twin mix’ versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery.Material and methodsA randomised double-blind clinical trial was conducted on 60 patients with class II position B impaction of mandibular third molars. Sixty transalveolar extractions were performed prospectively with ten patients randomly allocated to each of the six study groups (group T: intra-space injection of Twin mix; group S: submucosal dexamethasone; group M: intramuscular dexamethasone; group V: intravenous dexamethasone; group O: per-oral dexamethasone; group C: control group, no dexamethasone). A ten-point visual analogue scale was used to assess the overall pain intensity/patient discomfort, and specific facial measurements were recorded to assess the post-operative facial swelling. Maximal mouth opening was compared pre and post-operatively to assess the trismus.ResultsMean operative visual analogue scale scores did not show statistical variation, and post-operative visual scores indicated better patient comfort in the steroid groups with statistically significant difference between group T and the control group on the first, third and the seventh post-operative day. Mean increase in distances between tragus and soft tissue menton to assess facial swelling showed strong statistically significant difference between the first and the third post-operative day between the control group and group T (p value <0.0001). Association of trismus was found less with the steroid treatment groups when compared to the control group.ConclusionSteroid groups had a better clinical outcome with improved quality of life post-operatively when compared to the nonsteroid study group. Intra-space injection of dexamethasone in pterigomandibular space as Twin mix was found to have similar clinical effects as conventional methods of administering steroids via intraoral-submucosal, intramuscular, intravenous and per-oral routes. This, however, is a small study which would now benefit from larger numbers.

Dental orthopantomogram biometrics system for human identification.

Fingerprinting is the most widely accepted method of identification of people. But in cases of disfigured, decomposed, burnt or fragmented bodies, it is of limited value. Teeth and dental restorations on the other hand are extremely resistant to destruction by fire. They retain a number of their original characteristics, which are often unique and hence offer a possibility of rather accurate and legally acceptable identification of such remains. This study was undertaken to evaluate the utility of orthopantomography for human identification and propose a coding system for orthopantomogram (OPG), which can be utilized as an identification tool in forensic sciences.

Maxillary cementoblastoma—a rarity

BackgroundThis paper highlights the unusual and rare presentation of a cementoblastoma in the maxilla. It also discusses a review on this odontogenic pathology.Case reportWe present a cementoblastoma appearing in an atypical site in a young girl. The presenting clinical features with radiologic features are reviewed. Also discussed is an approach to radiological interpretation. To the best of our knowledge, this is only the seventeenth case to be reported in literature.DiscussionCementoblastoma is a benign true neoplasm which forms a mass of cementum or cementum-like tissue on the root surface of the tooth. As a maxillofacial practitioner, it is essential to consider cementoblastoma as one of the differential diagnosis, although rare, while considering maxillary swellings. The treatment remains fairly conservative, with an excellent prognosis.

Temporomandibular Joint Arthrocentesis for Internal Derangement with Disc Displacement Without Reduction

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is a minimally invasive chair side procedure for the patients with TMJ internal derangement. This case report presents convincing results to keep arthrocentesis as an imperative procedure to relieve such patients of their acute symptoms. TMJ dynamics has also been discussed for an in-depth understanding of the pathology in cases with internal derangement.

Initial inflammatory response of skeletal muscle to commonly used suture materials: An animal model study to evaluate muscle healing after surgical repair - histopathological perspective

Objectives: To evaluate initial inflammatory response of skeletal muscle to a few commonly used suture materials for muscle repair namely nylon, polydiaxonone (PDS II), plain catgut and polygalactin 910 which in turn determines the scarring of muscle and loss of function. Material and Methods: Inflammation and healing of muscle post repair was evaluated in the lateral thigh muscle (biceps femoris) of 8 adult healthy male Rattus norvegicus. The inflammatory reaction & healing of the skeletal muscle was evaluated histologically at the end of 48 hours, 1 week and 3 weeks. Results: At 48 hours post-surgery, Nylon samples showed severe inflammation followed by Catgut and Polygalactin. At 1 week post-surgery, the catgut group demonstrated increased macrophages infiltration while Nylon demonstrated persistant lymphocytic pro-inflammatory component. PDS sutures elicited minimal inflammatory response all through. Conclusion: In the present study the most desirable suture material was determined to be PDS due to its minimal tissue response and superior handling qualities. However the fact that the presence of macrophages in healing muscle enhances the repair process would be a pointer to create an environment which contains the sustained presence of macrophages to enhance optimal healing of skeletal muscle in the presence of an ideal suture material. Key words:Muscle healing, muscle repair, inflammatory response to sutures, sutures, healing.

Guidelines of the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections: As Applied to Oral and Maxillofacial Clinical Practice

PurposeThe purpose of this paper was to undertake a systematic review of literature on methicillin-resistant Staphylococcus aureus infections in oral and maxillofacial online data-bases and discuss the Infectious Diseases Society of America (IDSA) guidelines and its applications in maxillofacial clinical practice.Materials and MethodsThe available literature in oral and maxillofacial online databases was searched. The only inclusion criterion was to review published reports, abstracts and retrospective studies with emphasis on the treatment of clinical cases with methicillin-resistant S. aureus infections. Clinical Practice Guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant S. aureus infections in adults and children was reviewed and included in the study.ResultsOut of 18 articles found with the search terms “Methicillin-resistant S. aureus” and “MRSA” in the online databases 12 articles met the inclusion criteria for this study. The relevant data was extracted and tabulated.ConclusionsConclusions were drawn and discussed based on the reviewed maxillofacial literature and the Guidelines by the IDSA.

Analgesic efficacy of acetaminophen for controlling postextraction dental pain.

Background: Considering the clinical safety of acetaminophen over other nonsteroidal anti-inflammatory drugs, this clinical trial was formulated to assess the analgesic efficacy of acetaminophen for controlling postextraction dental pain when compared to commonly prescribed ibuprofen. Aim: The aim was to assess the analgesic efficacy of paracetamol/acetaminophen in postextraction dental pain. Settings and Design: Double-blind, randomized prospective clinical trial. Materials and Methods: A total of 30 patients requiring bilateral maxillary and mandibular premolar extraction for their orthodontic treatment were included in the study to evaluate the efficacy of acetaminophen in controlling postextraction dental pain. Statistical Analysis Used: Unpaired t-test. Results and Conclusions: Clinically, both the postoperative analgesics exerted similar pain control with minor variations of recorded visual analog scale scores by the patients in both the groups. It may be concluded from the findings of this study that paracetamol at a dosage of 500 mg thrice a day (1.5 g) is sufficient to achieve reliable pain control following exodontia provided the surgical trauma caused to the investing tissues is minimal.

Comparative study to evaluate bone loss during osteotomy using standard drill, bone trephine, and alveolar expanders for implant placement

Statement of Problem: Various osteotomy modalities seem to have an impact on the primary and secondary stability of the dental implant. The available literature lacks the comparison of various available osteotomy modalities used for the dental implant placement and its effects on the initial surgical bone removal. Purpose: The purpose of this study is to compare and evaluate the osteotomy sites created using standard drill, bone trephine, and alveolar expanders for dental implant surgery. Materials and Methods: The study was done on ten goat hemimandibles. Three osteotomy sites were prepared at the inferior border of the mandible using standard drill, trephine, and alveolar expander in each hemimandibles and the sites were subjected to cone-beam computed tomography (CBCT). The CBCT images obtained were compared for the amount of cortical bone and bone marrow loss at osteotomy sites in different techniques. Results: The mean and standard deviation of loss of cortical bone with standard drills, trephines, and alveolar expanders was 3.62 ± 4.216 × 10−2, 3.6 ± 4.681 × 10−16 and 3.15 ± 7.071 × 10−2. At the middle-third region, the loss of marrow bone was 3.38 ± 7.88 × 10−2, 2.15 ± 8.498 × 10−2 and 0.03 ± 9.487 × 10−2, and at lower third region, it was 2.3 ± 4.714 × 10−2, 0.02 ± 6.325 × 10−2, and 0.0, respectively. Conclusion: CBCT images showed minimum bone loss with the use of alveolar expander which may be due to the lateral bone condensation rather the removal of the marrow. Trephine showed less marrow removal in comparison to the standard drill used for dental implant surgery.

Proposed mechanism of action for twin mix anaesthesia when used as intra-space pterygomandibular injection for inferior alveolar nerve block with emphasis on effects of perineural injection of dexamethasone

There has been recent research on the use of dexamethasone as an adjunct to local anaesthetics to enhance the block characteristics and improve post-operative pain outcomes. Numerous studies have shown that perineural dexamethasone improves post-operative analgesia, along with other clinical benefits. Intra-space pterygomandibular twin mix anaesthesia is a novel technique for inferior alveolar nerve block used for mandibular anaesthesia. Twin mix anaesthesia has its advantages in shortening the latency and prolonging the duration of the soft tissue anaesthesia, along with improving the quality of life in the post-operative period after mandibular oral surgical procedures. The concern regarding the use of perineural dexamethasone has been discussed.