Us Pal

Direct vs. indirect sinus lift procedure: A comparison.

Background: There are different techniques for the sinus augmentation; the factors that contribute to the survival rate of sinus augmentation and dental implant placement are still the subject of discussion. So we compare the two different ways of sinus floor elevation: a) Lateral antrostomy as a one or two step procedure as direct method. b) Osteotome technique with a crestal approach as indirect method. Materials and Methods: A total of twenty partially edentulous patients in maxillary posterior region who opted for implant retained prosthesis but had a low sinus and deficient alveolar ridge within the age group of 20-55 years were taken up, 25 implants were placed in combination with bone grafting material for sinus augmentation. The final bone height was measured from Orthopantomogram. Post-operative Clinical Evaluation was based on pain, gingival inflammation status, stability, swelling and bone height. Statistical analysis was done by using Statistical Package for Social Sciences (version 15.0) (SPSS Inc., Chicago, IL, USA). Results: The gain in bone height was significantly greater in direct procedure through lateral antrostomy (mean 8.5 mm) than in indirect method through crestal approach by osteotome technique (mean 4.4 mm). Conclusions: Osteotome technique can be recommended when more than 6 mm of residual bone height is present and an increase of 3-4 mm is expected. In case of more advanced resorption direct method through lateral antrostomy has to be performed. Both sinus elevation techniques did not seem to affect the implant success rate.

Pediatric facial injuries: It's management

Background: Facial injuries in children always present a challenge in respect of their diagnosis and management. Since these children are of a growing age every care should be taken so that later the overall growth pattern of the facial skeleton in these children is not jeopardized. Purpose: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. Materials and Methods: Sixty child patients with facial trauma were selected randomly for this study. On the basis of examination and investigations a suitable management approach involving rest and observation, open or closed reduction and immobilization, trans-osseous (TO) wiring, mini bone plate fixation, splinting and replantation, elevation and fixation of zygoma, etc. were carried out. Results and Conclusion: In our study fall was the predominant cause for most of the facial injuries in children. There was a 1.09% incidence of facial injuries in children up to 16 years of age amongst the total patients. The age-wise distribution of the fracture amongst groups (I, II and III) was found to be 26.67%, 51.67% and 21.67% respectively. Male to female patient ratio was 3:1. The majority of the cases of facial injuries were seen in Group II patients (6-11 years) i.e. 51.67%. The mandibular fracture was found to be the most common fracture (0.60%) followed by dentoalveolar (0.27%), mandibular + midface (0.07) and midface (0.02%) fractures. Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

Comparative evaluation of zinc oxide eugenol versus gelatin sponge soaked in plasma rich in growth factor in the treatment of dry socket: An initial study

Purpose: The aim of this study was to report a comparison between the zinc oxide eugenol dressing and plasma rich in growth factor (PRGF) with gelatin sponge in the treatment of dry socket. Materials and Methods: This study comprised of 45 patients of dry socket in the span of one year. The patients were randomly divided into three groups on the basis of treatments: Group A (PRGF with gelatin sponge), group B (zinc oxide eugenol group), and group C (irrigation with sterile saline only). The clinical progress was noted at 1st, 2nd, 3rd, 7th, and 15th day after the treatment. Results: Patients healing was better in group A than in group B but symptomatic pain relief was faster in group B. Group C fared worst in both aspects. Conclusion: We conclude that PRGF with gelatin sponge might be a treatment of choice in the management of dry socket.

Use of Diagnostic and Surgical Stent: A Simplified Approach for Implant Placement

Dental implantology has emerged as a practical alternative to traditional prosthodontics. Since the beginning, placement of implant in the bone to achieve a prosthetic solution that fulfils biologic, aesthetic and biomechanical requirements has been a challenge. In the past, implant site and inclination were dictated by residual bone quality. The desire for predictable prosthesis led to the development of prosthetically guided implantology. This concept establishes the correct implant position during the diagnostic stage according to planned definitive restoration. In prosthetically guided implantology where ideal placement of implant is determined by the definitive restoration, use of radiographic and surgical stent in conjunction with dental CT scan can play an important role. A stent is an appliance used for radiographic evaluation during treatment planning for implant placement and during surgical procedures to locate optimal implant placement site. The stent with dental CT scan enables the dental team to identify specific sites of prospective implant surgery and hence determines the optimal position and angulation of implant relative to occlusal load. Aided by stent the surgeon can avoid undesirable implant site preparation and minimize unnecessary osteotomy, resulting in favorable design of prosthesis, reduced surgical trauma, reduced surgical time and increased patient comfort. This case report is an insight into the method of fabrication of simple and cost effective stent for implant placement and its advantages over the other techniques of stent fabrication.

Evaluation of the efficacy of a prosthodontic stent in determining the position of dental implants.

PURPOSE To evaluate the efficacy of a dual purpose (diagnostic and surgical) acrylic resin stent with gutta percha marker used in conjunction with 3D imaging in determination of the position and inclination of dental implants. MATERIALS AND METHODS This study was performed as a case control study. A total of 41 implants, of which 20 had been placed without the use of stents and 3D imaging (control group) and 21 were placed using stents and 3D imaging (study group), were studied. A diagnostic and surgical stent with radio-opaque indicator (gutta percha) was fabricated to determine the planned prosthetic position and inclination of the implant. Computed tomography images were obtained and were analyzed using Denta Scan software. The position of the implant was analyzed in mesiodistal and buccolingual dimensions in terms of both position and angulation. SPSS v15.0 was used for statistical analysis (p < 0.05 was considered statistically significant). RESULTS The study group demonstrated an overall 98.9% efficacy of the test technique being used in the study. On qualitative assessment, the results obtained were within the defined ideal threshold level for four of five parameters (distance from buccal and lingual cortical plate, inter-implant distance, and buccolingual angulation of the implant relative to underlying alveolar bone). For mesiodistal distance from adjacent teeth, the observation was not above threshold value for only one case. For the control group, the overall efficacy was 66.9%. CONCLUSION The technique of combined use of a prosthodontic stent and 3D imaging is an efficacious and better technique in achieving an ideal position of dental implants as compared to conventional techniques using periapical and panoramic radiographs and a cast.

Neuralgia-inducing cavitational osteonecrosis in a patient seeking dental implants

NICO (Neuralgia-Inducing Cavitational Osteonecrosis) is one of the jawbone versions of ischemic osteonecrosis, a common disease affecting any bone but with special affinity for those of the hips, knees and face. By definition, NICO is associated with pain. Osteonecrosis itself may or may not be painful. It may or may not affect multiple sites. It is a problem of poor blood flow through the marrow Patients can trace the onset of their pain subsequent to one or more extractions, perhaps decades ago. Notably, if patients had infections following their extractions or even dry sockets, there was a greater likelihood of NICO development. NICOs can refer pain across the midline; that is, a lesion in the right jaw can cause pain on the left side of the face, head, neck or body. Yes, NICOs can refer pain to various areas of the body, including the neck, arms and hands, legs and feet, groin.

Evaluation of implants placed immediately or delayed into extraction sites

AIMS AND OBJECTIVES To compare the success rate of implant placed immediately in extraction socket vs implant placed delayed in extraction socket. MATERIALS AND METHODS The study comprised of 8 patients (6 male and 2 female, aged from 14 to 58 year) for evaluation of implant placement immediately (i.e. Group - A) or delayed (i.e. Group - B) into extraction site, in which at 12 sites implants were placed. RESULTS The inclusion criteria for implantation was tooth/teeth with one or two degree mobility, root stumps, tooth with failure root canal treatment and extraction sockets. HI-TEC TRX-OP (Life Care) with abutment, non-submerged, tapered at apical 5 mm, sand-blasted & acid etched surfaced implants were used. These are one stage single implants made of commercially pure titanium. The length of implants used was 10 mm and 13 mm and diameter was 3.70 mm and 4.50 mm. The vertical bone dimension was determined by palpation and radiograph (intra-oral periapical, orthopantomograph and dentascan in some patients). Gingival condition, bone condition was examined clinically and radiographically. DISCUSSION Post-operative evaluation was done under clinical parameters (i.e. Pain (VAS), Swelling, Stability (By Glickman method), Gingival status, Probing depth (By Williams Periodontal probe), Patients compliance / satisfaction, Complications (If any) and Radiological parameters was (Intra-oral periapical radiograph, orthopantomograph, Dentascan). CONCLUSION Overall conclusion drawn from this study was that both the groups are showing similar results but Group-A is slightly better than Group-B.

Placement of implants in an ossifying fibroma defect obliterated with demineralized, freeze-dried bone allograft and Plasma-rich growth factor

There has been considerable clinical interest in combining the grafts, particularly bone allografts for support for dental implants, soft-tissue support, periodontal maintenance, and ovate pontic formation. The use of demineralized, freeze-dried bone allograft (DFDBA) offers certain advantages over other graft materials and can avoid the need for a second-site surgery for autogenous donor bone. The advantages of DFDBA include handling properties, osteoinductivity, membrane tenting, and less susceptibility to migration after placement. This article will review available grafting materials and demonstrate a case of ossifying fibroma of the mandible, which was treated by curettage and hollow cavity filled with DFDBA. Six months follow-up period showed successful graft result and this grafted bone form was utilized for implant supported prosthesis.

Single miniplate osteosynthesis in angle fracture.

Aim: The present study was designed to study the feasibility of single miniplate osteosynthesis in the fracture of angle of mandible. Materials and Methods: in this study 110 patient were included and treated with single miniplate osteosynthesis at upper border along champys line of osteosynthesis. Results: All the cases were treated successfully, common complications which we have observed in this study, cosmetic disfigurement, delayed union, infection, wound dehiscence and paresthesia. Conclusion: Single miniplate fixation in unfavorable fracture is questionable and hence these fracture require some alternative method (locking plate, etc.) for fixation.

A simplified approach for the rehabilitation of an auricular defect: A case report

Background and aim: Replacement of missing ear is a challenging task in which extensive array of materials and techniques have been employed. Materials such as silicones and methacrylate acrylic resins have been widely used for auricular prosthesis. This article describes a simplified procedure for fabricating resilient heat-cured acrylic resin auricular prosthesis, retained with a custom-made acrylic bar with ball attachments. Case description and methods: A male patient was reported with right ear loss. A modified technique was preferred to fabricate ear prosthesis with resilient heat-cured acrylic resin in which heat-cured acrylic retentive bar was incorporated. Findings and outcomes: Contrary to silicones, resilient heat-cured acrylic resin was more economical and compatible with acrylic retentive bar and resulted in a more long-lasting auricular prosthesis. Conclusion: Resilient heat-cured acrylic resin was proven to be a better alternative in terms of strength and durability. Clinical relevance This article presents an economical and simplified approach for the fabrication of prosthesis for a missing ear.