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REVIEW ARTICLES
Laser in dentistry: An innovative tool in modern dental practice
Sanjeev Kumar Verma, Sandhya Maheshwari, Raj Kumar Singh, Prabhat Kumar Chaudhari
July-December 2012, 3(2):124-132
DOI
:10.4103/0975-5950.111342
PMID
:23833485
The term LASER is an acronym for 'Light Amplification by the Stimulated Emission of Radiation'. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.
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A review of complications of odontogenic infections
Rishi Kumar Bali, Parveen Sharma, Shivani Gaba, Avneet Kaur, Priya Ghanghas
July-December 2015, 6(2):136-143
DOI
:10.4103/0975-5950.183867
PMID
:27390486
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these “space infections” has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms “odontogenic infections,” “complications,” and “risk factors.”
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67
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Radiation-induced dental caries, prevention and treatment - A systematic review
Nishtha Gupta, Manoj Pal, Sheh Rawat, Mandeep S Grewal, Himani Garg, Deepika Chauhan, Parveen Ahlawat, Sarthak Tandon, Ruparna Khurana, Anjali K Pahuja, Mayur Mayank, Bharti Devnani
July-December 2015, 6(2):160-166
DOI
:10.4103/0975-5950.183870
PMID
:27390489
Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation-related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self-applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation-induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.
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Etiological factors of temporomandibular joint disorders
Shalender Sharma, DS Gupta, US Pal, Sunit Kumar Jurel
July-December 2011, 2(2):116-119
DOI
:10.4103/0975-5950.94463
PMID
:22639496
The temporomandibular joint receives its name from the two bones that enter into its formation, namely the temporal bone and the mandible. This complex synovial system is composed of two temporomandibular joints together with their articulating ligaments and masticatory muscles. This articulation affects other synovial joints that relate specifically to masticatory function. The causes of temporomandibular disorders are complex and multifactorial. There are numerous factors that can contribute to temporomandibular disorders. In some instances a single factor may serve one or all of these roles. Iatrogenic injuries can act as both initiating as well as predisposing factors. The term craniomandibular disorder is used synonymously with the term temporomandibular disorders and is considered a major cause of nondental pain in the orofacial pain region. The successful management of temporomandibular disorders is dependent on identifying and controlling the contributing factors. The temporomandibular disorders are more common in females, the reason is not clearly known. The following article provides detailed information regarding temporomandibular joint disorders.
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Tumor markers: A diagnostic tool
Madhav Nagpal, Shreya Singh, Pranshu Singh, Pallavi Chauhan, Meesam Abbas Zaidi
January-June 2016, 7(1):17-20
DOI
:10.4103/0975-5950.196135
PMID
:28163473
The purpose of this review is to give a brief background to enable the judicious use of widely performed serum cancer markers. The markers could be product of cancerous cell or as response to cancer. They are usually proteins, which are mainly found in blood or urine. These markers may be employed to predict primary or secondary tumor risk. Sometimes, non-cancerous conditions can also cause elevation of some tumor markers to be higher than normal. Besides, not every cancer patient may have raised level of a tumor marker. For these reasons, knowledge about cancer biomarkers has increased tremendously. Awareness for cancer and related tumor markers providing great opportunities for improving the management of cancer patients by enhancing the efficiency of detection and efficacy of treatment.
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Dental care during and after radiotherapy in head and neck cancer
Seema Devi, Nimisha Singh
July-December 2014, 5(2):117-125
DOI
:10.4103/0975-5950.154812
PMID
:25937720
Head and neck cancer is a major health problem. Oral cancer is increasing in Indian subcontinent mainly due to lack of hygiene, tobacco use, chewing tobacco, smoking, and many other factors. Radiation therapy is the most common form of treatment along with surgery and chemotherapy. There are 2 types of complication that occurs during and after radiotherapy, that occur because of effects on normal tissue. Radiotherapy-induced effects occur on the oral mucosa salivary glands, bone, teeth, and musculature of face and neck. These complications needs special attention for their prevention and treatment, Preradiotherapy evaluation and disease stabilization are necessary in every patient, counseling of patients before during and after radiotherapy is important to help them become aware of several oral complications and their prevention.
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Oral submucous fibrosis: Newer proposed classification with critical updates in pathogenesis and management strategies
Deepak Passi, Prateek Bhanot, Dhruv Kacker, Deepak Chahal, Mansi Atri, Yoshi Panwar
July-December 2017, 8(2):89-94
DOI
:10.4103/njms.NJMS_32_17
PMID
:29386809
Oral submucous fibrosis (OSMF) is an oral precancerous condition characterized by inflammation and progressive fibrosis of the submucosal tissues resulting in marked rigidity and trismus. OSMF still remains a dilemma to the clinicians due to elusive pathogenesis and less well-defined classification systems. Over the years, many classification systems have been documented in medical literature based on clinical, histopathological, or functional aspects. However, none of these classifications have achieved universal acceptance. Each classification has its own merits and demerits. An attempt is made to provide and update the knowledge of classification system of OSMF so that it can assist the clinicians, beneficial in researches and academics in categorizing this potentially malignant disease for early detection, prompt management, and reducing the mortality. Along with this, pathogenesis and management have also been discussed.
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ORIGINAL ARTICLES
Surgical management of ameloblastoma: Conservative or radical approach
Ramakant Dandriyal, Atul Gupta, Swati Pant, Hitesh Hans Baweja
January-June 2011, 2(1):22-27
DOI
:10.4103/0975-5950.85849
PMID
:22442605
Aim:
The ameloblastoma is a benign odontogenic tumor of epithelial origin that exhibits a locally aggressive behavior with a high level of recurrence, being believed theoretically to come from dental lamina remains, the enamel organ in development, epithelial cover of odontogenic cysts or from the cells of the basal layer of the oral mucosa. Especially larger, aggressive lesions require a more radical surgical approach resulting in large jaw defects. This paper discusses our experiences in the management of ameloblastoma tumor in 20 such patients.
Materials
and Methods:
A review of 20 cases of ameloblastoma (6 in the maxillary and 14 in the mandibular region) is presented. The lesions were between 4 and 8 cm in diameter. The methods of treatment consisted of radical surgery (i.e., segmental resection) and conservative treatments (i.e., enucleation with bone curettage). Half the cases were treated conservatively and others surgically.
Results:
Enucleation with curettage was done in 10 cases, out of which six (60%) showed recurrence, whereas one (10%) case in the surgical group showed recurrence. Relatively higher tendencies of recurrence were observed in the cases treated conservatively. The aesthetic and functional outcomes were satisfying in all patients.
Conclusion:
According to our opinion, radical surgical resection of ameloblastoma is the treatment of choice, followed by the reconstruction of the defects, allowing good functional and aesthetic outcome.
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REVIEW ARTICLES
Dental implant survival in diabetic patients; review and recommendations
Rajendra Kumar Dubey, Deepesh Kumar Gupta, Amit Kumar Singh
July-December 2013, 4(2):142-150
DOI
:10.4103/0975-5950.127642
PMID
:24665167
Rising population of diabetic individuals across the world has become a big concern to the society. The persistent hyperglycemia may affect each and every tissue and consequently results in morbidity and eventually mortality in diabetic patients. A direct negative response of diabetes has been observed on oral tissues with few contradictions however, little are known about effect of diabetes on dental implant treatment and the consequent results. Many studies concerned with osteointegration and prognosis of dental implant in diabetic patients have been conducted and published since 1994. These studies have been critically reviewed to understand the impact of diabetes on the success of dental implant and the factors to improve osseointegration and consequently survival of dental implant in diabetic patients. Theoretical literatures and studies in diabetic animals substantiate high failure rate of implants but most of clinical studies indicated statistically insignificant failure of dental implants even in moderately uncontrolled diabetic patients. Success of dental implant in well and fairly controlled diabetic patients with proper treatment planning, prophylactic remedies and adequate postsurgical maintenance appears as good as normal individuals.
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Advances in dental local anesthesia techniques and devices: An update
Payal Saxena, Saurabh K Gupta, Vilas Newaskar, Anil Chandra
January-June 2013, 4(1):19-24
DOI
:10.4103/0975-5950.117873
PMID
:24163548
Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.
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Technical complications of implant-causes and management: A comprehensive review
Swati Gupta, Hemant Gupta, Amrit Tandan
January-June 2015, 6(1):3-8
DOI
:10.4103/0975-5950.168233
PMID
:26668445
Given the increasing popularity of dental implants, the number of failures due to late implant fracture is also expected to increase. Hence, the scope for prevention and management needs to be emphasized. The objective of this review article is to analyze the various causes of failure of dental implants due to implant fixture/abutment screw fractures and also to enumerate the management and the preventive options for these failures, thereby aiming to help the clinicians to properly plan the implant-supported prosthesis treatment by considering the important biomechanical aspects of this type of rehabilitation. The present review emphasizes the causes and management of technical complications and not the incidence of such complications.
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ORIGINAL ARTICLES
Direct vs. indirect sinus lift procedure: A comparison
US Pal, Nanda Kishor Sharma, RK Singh, Shadab Mahammad, Divya Mehrotra, Nimisha Singh, Devendra Mandhyan
January-June 2012, 3(1):31-37
DOI
:10.4103/0975-5950.102148
PMID
:23251055
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.
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Effect of plasma rich in growth factors on alveolar osteitis
Afshin Haraji, Eshagh Lassemi, Mohammad Hosein Kalantar Motamedi, Maryam Alavi, Saman Adibnejad
January-June 2012, 3(1):38-41
DOI
:10.4103/0975-5950.102150
PMID
:23251056
Introduction:
The high prevalence of dry socket or alveolar osteitis (AO) is of concern in surgical removal of third molars. The aim of the present study was to assess the preventive effect of plasma rich in growth factors (PRGF) on AO and also its effect on pain management and healing acceleration in third molar extraction sockets of high-risk patients.
Materials and Methods
: This split-mouth, double-blind clinical trial included 40 bilateral third molar extractions (80 sockets) with at least one identified risk factor for AO. PRGF was obtained from patient's own blood, based on manufacturer's instruction, and blindly placed in one of the two bilateral sockets (PRGF group;
n
= 20) of each patient. The contralateral socket was treated with a placebo (control group;
n
= 20). Samples were evaluated for AO and pain incidence on days 2, 3 and 4 and healing and infection on days 3 and 7. Data were analyzed in SPSS v16 using Wilcoxon test.
Results:
There was a significant difference in dry socket and pain incidence and healing rate between the two groups. Intensity of pain and occurrence of dry socket in the study group was lower than the controls. Also the healing rate was higher (
P
< 0.05) for the PRGF group. No sign of infection was seen in either group.
Conclusion:
The application of PRGF may significantly reduce the incidence of AO or its associated pain and may accelerate healing. The prophylactic use of PRGF following third molar extraction may be suggested especially in the patients at risk of AO.
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Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review
Deepankar Shukla, MR Muthusekhar
January-June 2016, 7(1):62-66
DOI
:10.4103/0975-5950.196127
PMID
:28163481
Purpose:
The aim of this systematic review was to assess the efficacy of low-level laser therapy (LLLT) in patients with temporomandibular disorders (TMDs).
Methods:
Medline search was done from 1997 to 2011 using search terms appropriate to establishing a relation between LLLT and TMD. Only randomized controlled trials were included in this study. Outcome variables related to pain, muscle tenderness, mandibular movements, and Electromyographic (EMG) activity were considered. Of the 242 articles examined, 13 were finally included in the critical analysis conducted as a part of the present systematic review.
Results:
Of the 242 titles reviewed, only 13 articles were considered eligible. 7 articles showed significant improvement in the study group, whereas 5 showed no significant improvement between the study and control groups. The primary outcome of most of the studies was pain. Other variables considered were muscle tenderness, mandibular movements; EMG activity was considered.
Conclusion:
Our results have shown that LLLT seems to be effective in reducing pain in TMD's. It may be a treatment option for patients with an interest in a noninvasive, complementary therapy.
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CASE REPORTS
Application of PRF in surgical management of periapical lesions
Smita Singh, Arunendra Singh, Sourav Singh, Rashmi Singh
January-June 2013, 4(1):94-99
DOI
:10.4103/0975-5950.117825
PMID
:24163562
Aims and Objectives:
Platelet rich fibrin is widely used in stimulation and acceleration of soft tissue and bone healing because of local and continuous delivery of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. This article will serve to introduce a second generation platelet concentrate, platelet-rich fibrin (PRF).
Materials and Methods:
Fifteen cases are presented in which conventional endodontic therapy failed to resolve the problem and periapical root-end surgery was required.
Results:
At the end of six months, all patients showed complete bone regeneration.
Conclusion:
Production of a dense, cross-linked, physically robust PRF made of intact platelets and fibrin by high-speed centrifugation in the absence of exogenous thrombin, yields an ideal scaffold for use in tissue repair.
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REVIEW ARTICLES
Blood gas analysis for bedside diagnosis
Virendra Singh, Shruti Khatana, Pranav Gupta
July-December 2013, 4(2):136-141
DOI
:10.4103/0975-5950.127641
PMID
:24665166
Arterial blood gas is an important routine investigation to monitor the acid-base balance of patients, effectiveness of gas exchange, and the state of their voluntary respiratory control. Majority of the oral and maxillofacial surgeons find it difficult to interpret and clinically correlate the arterial blood gas report in their everyday practice. This has led to underutilization of this simple tool. The present article aims to simplify arterial blood gas analysis for a rapid and easy bedside interpretation. In context of oral and maxillofacial surgery, arterial blood gas analysis plays a vital role in the monitoring of postoperative patients, patients receiving oxygen therapy, those on intensive support, or with maxillofacial trauma with significant blood loss, sepsis, and comorbid conditions like diabetes, kidney disorders, Cardiovascular system (CVS) conditions, and so on. The value of this analysis is limited by the understanding of the basic physiology and ability of the surgeon to interpret the report. Using a systematic and logical approach by using these steps would make the interpretation simple and easy to use for oral and maxillofacial surgeons.
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ORIGINAL ARTICLES
Prevalence and pattern of mandibular fracture in Central India
Dhananjay Barde, Anupama Mudhol, Ramnik Madan
July-December 2014, 5(2):153-156
DOI
:10.4103/0975-5950.154818
PMID
:25937725
Introduction:
The etiology and pattern of mandibular fracture vary considerably among different study populations. Despite many reports about the incidence, diagnosis and treatment of mandibular fracture there is limited knowledge about the specific type or pattern of mandibular fractures in South Asian countries. This study attempts to delineate predictable patterns of fracture based on patient demographics and mechanism of injury in central part of India.
Materials and Methods:
The medical records of patients with mandibular fractures treated over a 3 years period were identified and analyzed based on age, sex, mechanism of trauma, seasonal variation, drug/alcohol abuse, number and anatomic location.
Results:
We reviewed 464 patients having mandibular fractures with age ranging from 7 to 89 years. Male (343, 79%) to female (91, 21%) ratio was 3.7:1, significantly higher for males. The highest incidence (37.5%) of mandibular fractures was in the age group of 21-30 years. The main cause was road traffic accidents (RTAs, 68.8%) followed by falls (16.8%), assaults (11%) and other reasons (3.8%). Parasymphyseal fractures were the most frequent 331 (41.1%), followed by condyle (135) and angle (124) fractures in occurrence. Mandibular angle fractures were found mostly to be associated with assault victims.
Conclusion:
The mechanism of injury correlates significantly with the anatomic location of fracture and knowledge of these associations should guide the surgeons for appropriate and timely management. Because RTAs are most frequent, good traffic sense needs to be imbibed and developed by the government as well as the public.
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Expression of p53 protein and ki-67 antigen in oral premalignant lesions and oral squamous cell carcinomas: An immunohistochemical study
S Humayun, V Ram Prasad
January-June 2011, 2(1):38-46
DOI
:10.4103/0975-5950.85852
PMID
:22442608
Aim:
To study expression of p53 protein and ki-67 antigen in normal, non-dysplastic, dysplastic, premalignant and malignant lesions of the oral mucosa.
Materials and Methods:
The standard immunohistochemical method along with MIB-1 and DO-7; DAKO antibodies was used to study the expression of p53 and ki-67 in paraffin-embedded tissue specimens.
Results:
All samples studied showed positive staining for p53 and ki-67. Only one case each from leukoplakia and oral squamous cell carcinoma (OSCC) groups showed negative staining for ki-67. The staining was confined to basal layer in most of the cases except OSCC in which it was seen in all layers. The intensity of staining was moderate to intense. The percentage of p53-positive cells in normal mucosa was 15-25% which was increased to 95% in malignant mucosa. Statistical analysis revealed that the expression of p53 and ki-67 increases as normal oral mucosa becomes dysplastic and undergoes malignant transformation.
Conclusion:
These results emphasize the potential use of p53 protein and ki-67 antigen as markers of malignant transformation and carcinogenesis in oral premalignant lesions, conditions and OSCC, respectively; and in future they may serve as prognostic tools in the early detection of malignant transformation in oral premalignant lesions and conditions.
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REVIEW ARTICLES
Temporomandibular joint dislocation
Naresh Kumar Sharma, Akhilesh Kumar Singh, Arun Pandey, Vishal Verma, Shreya Singh
January-June 2015, 6(1):16-20
DOI
:10.4103/0975-5950.168212
PMID
:26668447
Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation.
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Botulinum toxin the poison that heals: A brief review
Shubha Ranjan Dutta, Deepak Passi, Mahinder Singh, Purnima Singh, Sarang Sharma, Abhimanyu Sharma
January-June 2016, 7(1):10-16
DOI
:10.4103/0975-5950.196133
PMID
:28163472
Botulinum neurotoxins, causative agents of botulism in humans, are produced by
Clostridium botulinum
, an anaerobic spore-former Gram-positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. This paper aims at discussing botulinum neurotoxin, its structure, mechanism of action, pharmacology, its serotypes and the reasons for wide use of type A, the various indications and contraindications of the use of botulinum neurotoxin and finally the precautions taken when botulinum neurotoxin is used as a treatment approach. We have searched relevant articles on this subject in various medical databases including Google Scholar, PubMed Central, ScienceDirect, Wiley Online Library, Scopus, and Copernicus. The search resulted in more than 2669 articles, out of which a total of 187 were reviewed. However, the review has been further constricted into only 54 articles as has been presented in this manuscript keeping in mind the page limitation and the limitation to the number of references. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin (BT) is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle-associated proteins responsible for acetylcholine release into the neuromuscular junction. A fascinating aspect of BT research in recent years has been the development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for the treatment of human diseases. The present review focuses on both warfare potential as well as medical uses of botulinum neurotoxin.
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CASE REPORTS
Obturator prosthesis for hemimaxillectomy patients
Mayank Singh, Akshay Bhushan, Narendra Kumar, Sharad Chand
January-June 2013, 4(1):117-120
DOI
:10.4103/0975-5950.117814
PMID
:24163568
Rehabilitation of hemimaxillectomy patients can be challenging. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. The obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In cases of large maxillary defects, movement of the obturator prosthesis is inevitable and requires a form of indirect retention to limit the rotation of the prosthesis. The goal of prosthodontics is rehabilitation of missing oral and extraoral structures along with restoration of the normal functions of mastication, speech, swallowing, appearance, and so on. Malignancies are common in the oral region, which are treated through surgical intervention. Surgical intervention creates communication between the oral cavity, nasal cavity, and maxillary sinus. In such cases, it is very difficult for the patient to perform various normal functions like mastication, swallowing, speaking, and so on. Prosthodontic rehabilitation with obturator prosthesis restores the missing structures and acts as a barrier between the communication among the various cavities.
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ORIGINAL ARTICLES
Pectoralis major myocutaneous flap in head and neck reconstruction: An experience in 100 consecutive cases
Mayank Tripathi, Sanjeev Parshad, Rajender Kumar Karwasra, Virender Singh
January-June 2015, 6(1):37-41
DOI
:10.4103/0975-5950.168225
PMID
:26668451
Background:
The pectoralis major myocutaneous (PMMC) flap has been used as a versatile and reliable flap since its first description by Ariyan in 1979. In India head and neck cancer patients usually present in the advanced stage making PMMC flap a viable option for reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. The aim of this study is to identify the outcomes associated with PMMC flap reconstruction.
Patients and Methods:
After ethical approval we retrospectively analyzed 100 PMMC flap at a tertiary care hospital from 2006 to 2013. A total of 137 PMMC flap reconstructions were performed out of which follow-up data of 100 cases were available in our record.
Results:
A total of 100 patients were reviewed of these 86% were of oral cavity and oropharyngeal lesions, 8% were of hypopharyngeal, 3% were of laryngeal malignancies and 3 cases were of salivary gland tumor. Most tumors (83%) were advanced (T3 or T4 lesion). 95 PMMC flap reconstruction were done as a primary procedure, and 5 were salvage procedure. PMMC flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients. Overall flap related complications were 40% with a major complication in 10% and minor complications in 30%. No total flap loss occurred in any patient, major flap occurred in 6% and minor flap loss in 12%. In minor flap loss patients, necrotic changes were mostly limited to skin. Orocutaneous and pharyngocutaneous fistula developed in 12 patients. 10% patients required re-surgery after developing various flap related complications Pleural empyema developed in 3 patients. Other minor complications such as neck skin dehiscence and intra-oral flap dehiscence developed in 26 patients.
Conclusion:
PMMC flap is a versatile flap with an excellent reach to face oral cavity and neck region. With limited expertise and resources, it is still a workhorse flap in head and neck reconstruction.
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1,117
REVIEW ARTICLE
Medicinal plants and bone healing
Vibha Singh
January-June 2017, 8(1):4-11
DOI
:10.4103/0975-5950.208972
PMID
:28761270
Fracture is defined as complete or incomplete separation in the continuity of bone Fracture healing is a complex physiological process that involves the coordinated participation of hematopoietic and immune cells within bone marrow. It conjunction with vascular and skeletal cell precursors it also includes mesenchymal stem cells which are recruited from the circulation and the surrounding tissues. It is estimated that 80% of the population in developing countries still rely on the traditional herbal medicines. Healing is practiced by people from all levels of society, who live and work in intimate relation with their environment. They range from bone setting, treatment of snake bite and mental disorders. Knowledge of Medicinal plants and their identification should be gain with the help of cowherds, hermits, hunters, forest dwellers and those who gather plants of forest for food. Sushruta Samita Sutrasthanam 36 V.10. Herbs can effective in reducing swelling pain and soreness of the fracture and al so speedy recovery of function. In last few decades there has been growing In alternative forms of therapy globally. Herbal medicines are currently in demand and their popularity is increasing.
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13,966
1,280
REVIEW ARTICLES
Cone beam computed tomography in oral implants
Jyoti Gupta, Syed Parveez Ali
January-June 2013, 4(1):2-6
DOI
:10.4103/0975-5950.117811
PMID
:24163545
Cone beam computed tomography (CBCT) scanners for the oral and maxillofacial region were pioneered in the late 1990s independently by Arai
et al.
in Japan and Mozzo
et al
. CBCT has a lower dose of radiation, minimal metal artifacts, reduced costs, easier accessibility, and easier handling than multislice computed tomography (MSCT); however, the latter is still considered a better choice for the analysis of bone density using a Hounsfield unit (HU) scale. Oral implants require localized area of oral and maxillofacial area for radiation exposure; so, CBCT is an ideal choice. CBCT scans help in the planning of oral implants; they enable measurement of the distance between the alveolar crest and mandibular canal to avoid impingement of inferior alveolar nerve, avoid perforation of the mandibular posterior lingual undercut, and assess the density and quality of bone, and help in planning of the oral implant in the maxilla with special attention to the nasopalatine canal and maxillary sinus. Hence, CBCT reduces the overall exposure to radiation.
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1,688
ORIGINAL ARTICLES
Primary and secondary closure technique following removal of impacted mandibular third molars: A comparative study
Manoj Chaudhary, Manpreet Singh, Sanjay Singh, SP Singh, Gagandeep Kaur
January-June 2012, 3(1):10-14
DOI
:10.4103/0975-5950.102141
PMID
:23251051
Aim:
The purpose of this study was to evaluate and compare the post operative healing, using primary versus second closure techniques after impacted mandibular third molar removal.
Materials and Methods:
The study consisted of twelve patients, Seven males and five females under 30 years of age were divided into two groups as Group A and Group B in the randomized fashion. In the Group A, closure was done by primary intention and in the Group B, by secondary closure. A comparison between both groups was done with a follow-up period of 6 h to 6 days with regards to postoperative pain and swelling.
Results:
The statistical analysis (analysis of variance for repeated measures,
P
< 0.05) showed that pain was greater in Group A, although it decreased over time similarly in the two groups. Pain and swelling was less severe with secondary healing than with primary healing.
Conclusion:
The outcome of this study suggested that secondary closure technique is better than primary closure technique for removal of impacted mandibular third molar with regards to postoperative pain and swelling.
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1,383
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© National Journal of Maxillofacial Surgery | Published by Wolters Kluwer -
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Online since 5
th
September, 2010