Sk Roy Chowdhury

Midline Fractures in Single Maxillary Complete Acrylic vs Flexible Dentures

BACKGROUND Patients using single maxillary denture against their natural mandibular teeth face the problem of midline fracture in their routine acrylic dentures. Various techniques have failed over the years to address the problem. In this study, flexible denture material (Lucitone) with injection moulding system has been used and evaluated for midline fracture in these patients. METHODS A total of 58 patients in the age group of 38 to 80 years, who had experienced midline fracture in their acrylic maxillary dentures were selected. They were provided with new dentures using flexible denture material. Various parameters, namely, mastication, phonetics, esthetics and comfort level were evaluated. RESULT Only two cases reported slight crack in the palatal region of the-maxillary dentures after 18 months of use. Mastication and phonetics were found to be improved with flexible dentures. CONCLUSION The flexible denture is a promising material for preventing midline fractures in a single maxillary denture. It is well tolerated by the patients as compared to the methyl meth-acrylate dentures.

Etiology and Management of Zygomaticomaxillary Complex Fractures in the Armed Forces

BACKGROUND The nature of duties in the Armed Forces predisposes its personnel to various kinds of injuries. The rise in violence coupled with an exponential increase in motorized population has contributed towards maxillofacial injuries. The aim of this study was to determine the incidence, cause and pattern of various injuries resulting in fracture of the zygomaticomaxillary complex in Armed Forces personnel and their families. METHODS A study was conducted between January 2001 - December 2002 in maxillofacial surgical wing of an Army Dental Centre with specific regard to age, sex, location and etiology of zygomaticomaxillary complex fracture. Out of 201 maxillofacial injuries received, 87 individuals were treated for zygomaticomaxillary fractures. Majority of the individuals were in their third decade of life and road traffic accident was the leading cause of the fractures. RESULTS Uneventful recovery was there in 81 individuals (93.10%). Six patients (6.89%) had post operative complications in the form of enophthalmos, hypophthalmos, paraesthesia, diplopia and facial asymmetry. These complications were subsequently treated successfully as a secondary procedure for all the patients. CONCLUSION Facial bones, especially of the middle third of the face, are composed of a network of fragile bones which give way in case of force to a lesser extent than other parts of the body. It is imperative to educate people regarding the importance of restraints and use of protective headgears/use of seat belts while travelling in motorized transport.

Maxillofacial Injuries in Counter Proxy War Posture of the Armed Forces

BACKGROUND Various maxillofacial injuries, sustained in counter insurgency operations in the counter proxy war posture (CPWP) of the Armed Forces in the Kashmir valley are being treated at various maxillofacial surgical centres. METHOD Proper triage, documentation of injuries and mode of injuries along with various clinical, radiological and other investigations were carried out before operating these individuals for primary reconstruction of skeletal tissue and facial soft tissue. RESULT A total of 324 persons with various types of maxillofacial injuries were treated within the period ranging from 01 January 2000 to 30 June 2002 successfully in this centre as a part of the advanced trauma life support (ATLS) system of Combat Medical Support. CONCLUSION Proper primary reconstruction (soft tissue and skeletal tissue) of the facial region goes a long way in reducing subsequent disfigurement and morbidity. Improving the structural design of the combat head gear for safety and comfort will go a long way in preventing majority of maxillofacial injuries or can at least reduce the severity of these injuries.

Distraction Osteogenesis in Management of Mandibular Deformities

BACKGROUND The concept of Distraction Osteogenesis is applied in Maxillofacial surgery extensively in the recent past, revolutionizing the concept of management of facial deformities specially the mandible. METHODS This article describes intra oral mandibular distractors in managing mandibular deformities in 9 cases. CONCLUSION Surgical intervention is possible in very young patients. Distraction Osteogenosis does not reduce the need for orthodontic intervention. A multifarious approach to the problem, should form the basis of treatment of mandibular deformities.

Correction of midface deficiency using intra-oral distraction device

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle’s class III malocclusion. Most cases of midface deficiency are seen in patients of cleft lip/palate. The surgical procedure to correct the clefts, undertaken over a long period of time from infancy to the teens tends to take its toll on the soft tissues over the midface. The scarring that is a feature in these conditions results in hampering of normal growth of the midface causing the deformity. Conventional procedures to correct the deformity by surgical advancement have been less than satisfactory in terms of success. This is where the concept of multidimensional growth using distraction proved useful. Today distraction has proved to be a versatile tool in the correction of midface deficiencies due to its various advantages. Six patients of cleft lip/palate were taken up for advancement of the hypoplastic midface using intra-oral distractors with successful and stable results.

Secondary and Delayed Bone Grafting in Alveolar and Anterior Palatal Clefts

BACKGROUND Surgical repair with suitable bone graft / substitutes plays an important role in rehabilitation of individuals with residual anterior palatal or alveolar defects associated with an oronasal fistula. METHODS 52 cases were treated by secondary or delayed bone grafting of the alveolar defects in isolation or associated with defects of the anterior palate from July 2002 - Nov 2004. Dimension and the extent of the defects were assessed with the help of radiographs & maxillofacial CT. Cephalometric analysis, presurgical orthodontics and dentofacial orthopedics preceded surgical repair with cancellous graft from the iliac crest, followed by post surgical orthodontics and prosthetic rehabilitation. RESULT Satisfactory results were achieved in 49 cases with three cases showing failure of graft acceptance. Postoperative clinical and radiological evaluation for all the patients was done at an interval of one, three and six months. Bone density and trabeculation was comparable to the adjacent bone within six months. CONCLUSION Recreating the bony continuity of the maxillary arch followed by orthodontic correction of dental discrepancies achieves a comprehensive orthosurgical correction.

Arteriovenous Malformation in Mandible

Arteriovenous malformations (AVM) are errors of vascular morphogenesis that are present at birth and become evident due to an event like trauma, surgery, infection, etc. The management of this condition in the maxillofacial region is difficult because of the abundant vascular network. One of the most common signs of these patients, especially in the mixed dentition period, is hyper mobility of the teeth with spontaneous haemorrhage from the surrounding gingival sulcus [1]. Mandibular AVM is a potentially life-threatening pathology requiring radical treatment.

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well-designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.

Managing prosthetic complication in implant-retained overdenture.

Lt Col Navneet Dhillon *, Col S.K. Roy Chowdhury , Capt Prashant Kumar , Capt Rahul Menon c Graded Specialist (Prosthodontics), Military Dental Centre (BEG), East Kirkee, Pune 411003, India Commanding Officer & Classified Specialist (Oral & Maxillofacial Surgery), Military Dental Centre (BEG). East Kirkee, Pune-411003, India Dental Officer, Military Dental Centre (BEG), East Kirkee, Pune 411003, India

Comparative study of immediate functional loading and immediate non-functional loading of monocortical implants

BACKGROUND Attempts to shorten the overall length of treatment have focused on immediate loading, subsequent to implant placement. Prosthetic rehabilitation immediately after implant placement can be either functional or non-functional in nature. There is paucity of literature on the comparative evaluation of immediate functional and immediate non-functional loading of implants. This in-vivo study was undertaken to comparatively evaluate Immediate Functional Loading and Immediate Non-Functional Loading of monocortical implants with a follow-up period of 18 months. METHODS 50 partially edentulous cases were selected for the study. The cases were divided into two groups. In first group (Group-1), 25 implants were subjected to immediate functional loading. In second group (Group-2), 25 implants were subjected to immediate non-functional loading. The crestal bone loss, clinical stability and degree of osseointegration of these two groups were comparatively evaluated. RESULTS The crestal bone loss in both groups was within acceptable limits. The implant stability, which is a reflection of the status of bone-to-implant interface, was comparable in both the groups at different time intervals. Although, the ISQ values in Group-2 were slightly higher than those in Group-1, the results were not statistically significant. Radiodensity indicating degree of osseointegration at different time intervals in both groups was also comparable. CONCLUSION Both the IFL and INFL protocols can be undertaken satisfactorily in rehabilitation using endosseous implants; however, the main factors for success in IFL and INFL are case selection, meticulous treatment planning and the precision of technique.