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This thesis aims to investigate a possible approach to increase the volume of the area in which augmentation material can be inserted under oral soft tissues with self-inflating osmotic soft tissue expanders. This then allows more augmentation material to be inserted. The properties of the augmentation material inserted, will have impact to the bone genesis. Therefore, bone morphogenetic protein 2 (BMP-2), which is known to be osteo-conductive and osteo-inductive, is studied. It is unclear whether there is bone formation when using BMP-2 in the treatment of peri-implantitis. The most effective dose BMP-2 to promote bone formation when using an osseo-conductive coralline hydroxyapatite (CHA) coated with an osseo inductive layer biomimetic calcium phosphate (BioCaP) is not clear yet. In order to describe the ideal properties of an expander for intra oral use, literature on tissue expanders used in general medicine was studied. Tissue expansion is indicated in cases where other surgical techniques aimed at gaining the soft tissue surface are inadequate. The use of tissue expanders requires extra time, extra surgical procedures, money and discomfort for the patient which limits its clinical use. The used self-inflating hydrogel Osmed ® expanders were enveloped in a silicone hull with a few small perforations, through which tissue fluids can be adsorbed by the hydrogel. Fixation of the expander, which is possible with a screw through the extension of the silicone envelope prevents dislocation. The histological findings showed no difference at comparing expanded and unexpanded tissue. The increase of the amount of soft tissue was clinically clearly visible, and no differences were found when following either the flap placement or the tunnel placement procedure. In a case report the use of two Osmed ® hydrogel soft tissue expanders enveloped in a silicone hull is described. A critical sized bone defect is too large to heal spontaneously. Bone augmentation procedures can be performed to overcome this. BMP-2 needs to have a carrier and a delivery mode to be an effective. As a carrier octa calcium phosphate (OCP) can be used. BMP-2 can be adsorbed in the outer layer of OCP: biomimetic calcium phosphate (BioCaP) with adsorbed BMP-2, or incorporated only in the outer layer of OCP: BioCaP with incorporated BMP-2, or BMP-2 can be incorporated throughout the entire layer of OCP: BioCaP with inserted BMP-2. The optimal dose BMP-2 to induce bone formation is unknown. Peri-implant bone defects can be considered as critical sized bone defects because they do not heal spontaneously. This study shows that when treating peri-implant bone defects in dogs with BioCaP containing adsorbed, incorporated or inserted BMP-2 they all generate bone. When BMP-2 has been incorporated in the entire volume of all BioCaP particles it performs the best. Hydroxyapatite is a main component of our skeleton. Marine coral is used as a natural bone graft material and has a trabecular structure comparable to bone. Through a hydrothermal process its calcium carbonate skeleton converses from coral to hydroxyapatite, thus forming coralline hydroxyapatite (CHA). CHA alone does not induce bone formation in an ectopic site. By coating CHA with BioCaP containing BMP-2 osteo-inductive properties could be added to the augmentation material. All CHA samples coated with BioCaP containing incorporated BMP-2 show bone formation in ectopic sites, whereby the sample containing 5 µg BMP-2 induces the most bone formation. It can be concluded that the tissue expanders looked promising but the research showed its limitations in volume increase, immediate expansion, costs involved and the extra surgery. BioCaP containing BMP-2 induces bone formation in animal studies in ectopic sites. The optimal BMP-2 concentrations per study are described.

This thesis aims to investigate a possible approach to increase the volume of the area in which augmentation material can be inserted under oral soft tissues with self-inflating osmotic soft tissue expanders. This then allows more augmentation material to be inserted. The properties of the augmentation material inserted, will have impact to the bone genesis. Therefore, bone morphogenetic protein 2 (BMP-2), which is known to be osteo-conductive and osteo-inductive, is studied. It is unclear whether there is bone formation when using BMP-2 in the treatment of peri-implantitis. The most effective dose BMP-2 to promote bone formation when using an osseo-conductive coralline hydroxyapatite (CHA) coated with an osseo inductive layer biomimetic calcium phosphate (BioCaP) is not clear yet. In order to describe the ideal properties of an expander for intra oral use, literature on tissue expanders used in general medicine was studied. Tissue expansion is indicated in cases where other surgical techniques aimed at gaining the soft tissue surface are inadequate. The use of tissue expanders requires extra time, extra surgical procedures, money and discomfort for the patient which limits its clinical use. The used self-inflating hydrogel Osmed ® expanders were enveloped in a silicone hull with a few small perforations, through which tissue fluids can be adsorbed by the hydrogel. Fixation of the expander, which is possible with a screw through the extension of the silicone envelope prevents dislocation. The histological findings showed no difference at comparing expanded and unexpanded tissue. The increase of the amount of soft tissue was clinically clearly visible, and no differences were found when following either the flap placement or the tunnel placement procedure. In a case report the use of two Osmed ® hydrogel soft tissue expanders enveloped in a silicone hull is described. A critical sized bone defect is too large to heal spontaneously. Bone augmentation procedures can be performed to overcome this. BMP-2 needs to have a carrier and a delivery mode to be an effective. As a carrier octa calcium phosphate (OCP) can be used. BMP-2 can be adsorbed in the outer layer of OCP: biomimetic calcium phosphate (BioCaP) with adsorbed BMP-2, or incorporated only in the outer layer of OCP: BioCaP with incorporated BMP-2, or BMP-2 can be incorporated throughout the entire layer of OCP: BioCaP with inserted BMP-2. The optimal dose BMP-2 to induce bone formation is unknown. Peri-implant bone defects can be considered as critical sized bone defects because they do not heal spontaneously. This study shows that when treating peri-implant bone defects in dogs with BioCaP containing adsorbed, incorporated or inserted BMP-2 they all generate bone. When BMP-2 has been incorporated in the entire volume of all BioCaP particles it performs the best. Hydroxyapatite is a main component of our skeleton. Marine coral is used as a natural bone graft material and has a trabecular structure comparable to bone. Through a hydrothermal process its calcium carbonate skeleton converses from coral to hydroxyapatite, thus forming coralline hydroxyapatite (CHA). CHA alone does not induce bone formation in an ectopic site. By coating CHA with BioCaP containing BMP-2 osteo-inductive properties could be added to the augmentation material. All CHA samples coated with BioCaP containing incorporated BMP-2 show bone formation in ectopic sites, whereby the sample containing 5 µg BMP-2 induces the most bone formation. It can be concluded that the tissue expanders looked promising but the research showed its limitations in volume increase, immediate expansion, costs involved and the extra surgery. BioCaP containing BMP-2 induces bone formation in animal studies in ectopic sites. The optimal BMP-2 concentrations per study are described.

For any dental implant procedure that is being carried out, the success will depend on a thorough pre-operative investigation. The quality, quantity and the volume of available bone at the planned implant site has to be assessed properly when planning a dental implant placement. When we speak of the fore-mentioned aspects pre-surgical imaging and its co-relation to clinical findings help assess the relation to the amount of bone available from underlying vital parts namely the sinus cavities, nasal floor, nerves, teeth and vessels. Different radiographic modalities have been advocated for its assessment. Intra Oral Peri-apical radiograph (two-dimensional) is one such modality that has lost its importance after the introduction of more advanced techniques like Cone Beam Tomography (three-dimensional). This article will help us understand how two-dimensional and three-dimensional imaging modalities go hand in hand while treating dental patients. It will also explain why the conventional imaging technologies are still required in this era of modern methods of imaging. Keywords: Dental implants, Implant imaging, Periapical radiograph, Dentascan, CBCT, OPG

Objectives: now a days recent intraoral scanners (IOS) are ready for digital scans of long-span edentulous patients and completely edentulous patients ; however, there is lacking of evidence. In recent years there is vigorously promoted of digitization in the dental field .there is a significant transformation in the future of dentistry by using the intra oral scanner to have digital impression. The aim of this article to evaluated the deviation between of intraoral scanning (IOS) impression and conventional impression in completely edentulous patient and to analyze the accuracy of IOS in completely edentulous maxillary arch. MATERIALS AND METHODS: Two types of impression technique were made for eight completely edentulous patients. Intra oral scanning and conventional impression technique of the maxilla was done for each patient, the two-impression techniques were compared for accuracy using GOM inspect software. Result: Total deviation between two groups were compared to hypothesized zero representing conventional impression I group and then calculated using special inspection software. The total deviation was statistically significantly different among the studied groups. Conclusion: The accuracy of IOS not reliable for completely edentulous arches

The use of stabilization repositioning splints (SRS) to treat muscular TMDs is a growing practice owing to its’ effectiveness and simplicity. The conventional construction procedure requires meticulous occlusal adjustments which consumes considerable chairside time. Changing the procedure to a full digital approach might decrease the chair side time. Aim: To evaluate the chairside time required to construct SRS with conventional impression procedure compared to intra oral scanning and printing. Materials and methods: 30 patients suffering from muscular TMDs were allocated into 2 groups. Group 1 received SRS made out of a vacuum sheet formed over a dental model and modified with cold cured resin. Group 2 received SRS made from intra oral scans and digitally constructed and 3D printed. The time needed in the impression appointment and SRS fitting appointment was calculated. Patients were followed for 8 weeks to evaluate improvement of pain scores and range of mandibular opening. Results: regarding the treatment time the impression appointment time was statistically insignificant for both groups (13.15±1.77) and (12.47±1.96) minutes for groups 1 and 2 respectively. For the fitting appointment the duration showed statistical significant decrease when comparing group 2 (4.49±1.42 min) to group 1 (36.51±6.21min). For both group there was a statistical improvement in pain score and maximum incisal opening, yet there was no statistical significant difference between group 1 and 2. Conclusion: construction SRS with intra oral scans yielded the same patient improvement when compared to conventional construction technique but with significant decrease in the required chairside time

Background: Rehabilitation of Kennedy Class I edentulous involves a variety of treatment alternatives such as overdenture, metal frame removable partial denture, RPD with precision attachment and implants. The combination of RPD and fixed dent-ture using precision attachment or semi-precision is one of the best forms of RPD. Case: A 59-year-old male came to the RSGM FKG UI clinic. He wants to have new denture to eat more comfortable and improve his appearance. Management: Anamnesis, extra-oral and intra oral examinations, and panoramic x-ray were performed. After that, bridge was removed, periapical x-ray and definitive treatment was determined using metal frame RPD in upper jaw and RPD with precision attachment in lower jaw. Conclusion: Patient feels satisfied and comfortable with his dentures both in upper and lower jaw with precision attachments.

OBJECTIVES: To objectively determine the correlation of lower third molar angulation and posterior space discrepancy with mandibular anterior crowding digitally using intraoral scanner. METHODOLOGY: Cross sectional analytical study conducted at Rehman College of Dentistry (RCD) Peshawar from15th November 2020 till 15th December 2020. Lower third molar angulation and posterior space discrepancy were measured by IC 3.1 measure software, using digital Orthopantomograms (OPG). Digitally scanned models by (CS 3600 intraoral scanner) were analyzed using (CS 3600 3D software). Sample was divided into Control (N=30; perfect alignment), Experimental (N=30; crowding >1mm) groups, based on Little’s Irregularity Index. Both lower third molar angulation and posterior space discrepancy (Ganss Ratio) were correlated with lower anterior crowding using Pearson’s Correlation. To determine any difference between two groups independent t-test was used. RESULTS: Statistically insignificant difference and a weak correlation were found for Ganss ratio and third molar angulation in both control and experimental groups. CONCLUSION: Third molar angulation and the retro molar space has no direct effect on the lower anterior crowding.

Objectives Recently, it was shown that the Regional Oral Dryness Inventory (RODI) could determine differences in dry-mouth perception at different intra-oral locations. The main aim of this study was to determine whether the RODI might help to discriminate between various causes of oral dryness in dry-mouth patients. The second aim was to ascertain whether the RODI could become an additional diagnostic tool in dry-mouth patients. Materials and methods Data were collected retrospectively from patients who visited a specialized saliva clinic. Salivary flow rates, Xerostomia Inventory scores, and RODI scores were extracted from the medical records. Patients were stratified into subgroups according to their health status. Results Five hundred twenty-eight patients participated in this study (mean age of 59.6 ± 16.0 years; 68.4% female). Specific patient groups differed with regard to the region of the mouth they experienced as the most and least dry. The posterior palate was the area perceived as most dry by controls and Sjögren patients. In patients using limited or multiple medications, it was the anterior tongue. RODI scores also differed significantly among dry-mouth patient groups: whereas controls and patients using limited medication had the lowest RODI scores and experienced less intra-oral dryness, Sjögren patients had the highest RODI scores. Conclusion Our use of the RODI questionnaire showed that perceived intra-oral dryness differed between the various dry-mouth patients. Clinical relevance The RODI can be a valuable clinical diagnostic tool in dry-mouth diagnostics, in which it can be used to discriminate between the various causes of oral dryness in patients.

Summary Background Previous studies embracing digital technology and automated methods of scoring dental arch relationships have shown that such technology is valid and accurate. To date, however there is no published literature on artificial intelligence and machine learning to completely automate the process of dental landmark recognition. Objectives This study aimed to develop and evaluate a fully automated system and software tool for the identification of landmarks on human teeth using geometric computing, image segmenting, and machine learning technology. Methods Two hundred and thirty-nine digital models were used in the automated landmark recognition (ALR) validation phase, 161 of which were digital models from cleft palate subjects aged 5 years. These were manually annotated to facilitate qualitative validation. Additionally, landmarks were placed on 20 adult digital models manually by 3 independent observers. The same models were subjected to scoring using the ALR software and the differences (in mm) were calculated. All the teeth from the 239 models were evaluated for correct recognition by the ALR with a breakdown to find which stages of the process caused the errors. Results The results revealed that 1526 out of 1915 teeth (79.7%) were correctly identified, and the accuracy validation gave 95% confidence intervals for the geometric mean error of [0.285, 0.317] for the humans and [0.269, 0.325] for ALR—a negligible difference. Conclusions/implications It is anticipated that ALR software tool will have applications throughout clinical dentistry and anthropology, and in research will constitute an accurate and objective tool for handling large datasets without the need for time intensive employment of experts to place landmarks manually.

The penetration of foreign objects is one of the leading causes of maxillofacial infection following trauma. Failure to detect such objects at initial stages can lead to complications like abscess formation, cellulitis, or space infections. Detection is even more complicated if the patient presents to the maxillofacial center after a delay of days or weeks following trauma. Sole reliance on radiographs or CT can be inconclusive as most of these objects are radiolucent and can be difficult to detect even by the experienced radiologists. We report the case of a patient who had an unwitnessed trauma and presented to our center 7 days after the incident, with signs of buccal space infection. Failure to detect the embedded intra-oral wooden object at an earlier stage led to the propagation of infection to superficial temporal space. The management strategy and pitfalls associated with conventional imaging in detecting wooden object are discussed.

BACKGROUND The cough reflex or aspiration under monitored anaesthesia care might be associated with sedative-induced changes in swallowing and intra-oral water-retaining abilities. OBJECTIVES To investigate the effects of moderate propofol sedation on swallowing and intra-oral water-retaining ability. DESIGN Prospective observational study. SETTING Single tertiary care centre during 2017. PARTICIPANTS A total of 13 healthy adult volunteers. INTERVENTION Volunteers in the supine position were asked to retain 10 ml of orally injected water for 5 min. After 5 minutes or when the water was spontaneously swallowed, the retention time and residual intra-oral water volume were measured. Subjects then voluntarily swallowed a further 10 ml of injected water and the residual water volume was measured. This whole process was repeated under sedation with propofol at effect-site concentrations of 0.5, 1.0 and 1.5 μg ml-1. MAIN OUTCOME MEASURES The primary outcome was the estimated volume swallowed (swallowing volume); the secondary outcome was water retention time. RESULTS Median water retention time decreased from 300 to 11 s (P

Molar distalization is one of the most popular treatment now a days for Class II malocclusion and borderline cases. Whenever there is space deficiency, the techniques for picking up space that strikes to our mind initially are extraction, expansion and stripping. Molar distalization can fulfill the requirement of space without doing extraction. Various intra oral appliances were introduced for molar distalization without patient compliance.

Objective: In this meta-analysis and systematic review, we aimed to evaluate the effects of the TISADs to facilitates anchorage reinforcement. Methods: PubMed, Cochrane Library, Embase, ISI, Scopus, Web of Science, LILACS, BBO, OpenGrey, and Google Scholar, were used from the electronic databases until 2020 perform systematic literature. Two reviewers extracted data blindly and independently from various abstracts as well as full texts of articles they considered for data extraction. Using the Cochrane collaboration's tool, we evaluated the publications' quality. Then, we computed the mean difference of TISADs and conventional anchorage groups with a confidence interval (CI) of 95%, restricted maximum likelihood (REML), and random effect model of the mesial movement of molars and their tipping. Moreover, we employed Stata/MP 16 that has been considered the most rapid version of Stata for evaluating meta-analysis. Results: According to our electronic searches, 134 topics and abstracts with potential relevance were identified according to the research design. Finally, five publications matched the required inclusion criteria of the study. In addition, the Cochrane collaboration instrument exhibited all studies with low to moderate biases. Also, the mean difference of mesial molar movement showed less anchorage loss in the TISADs group vs. the controls, and a significant difference between these two groups (MD= -1.74 with a CI of 95%, -2.76, -0.71. P = 0.00). Conclusions: TISADs can reduce treatment time, and TISADs are more effective in enables the anchorage than other methods and higher tipping in the TISADs.

Dental radiography is usually straightforward; however, a few patients do offer a greater challenge to the dentist aiming to achieve diagnostic images. Ironically, it is frequently these tricky patients where a good quality radiograph will be of greatest use when treatment planning. This article has been written primarily to provide some tips aimed at increasing the likelihood of achieving a diagnostic image for a patient who finds the procedure difficult and includes some techniques that can be applied to all patients having a dental radiograph taken. CPD/Clinical Relevance: Achieving good quality radiographs is essential to aid in both diagnosis and treatment planning.

Teledentistry, with the use of an intra-oral camera (IOC), can overcome numerous challenges. The visual nature of oral diseases and dental treatments is ideal for practising teledentistry, especially during COVID-19. Images or videos of the oral cavity to evaluate caries, plaque, calculus, tooth wear, fluorosis, and stains can be captured by a trained and calibrated examiner with IOC. The IOC was shown to be a reliable tool to identify common oral diseases. Certain limitations like low illumination can be overcome by using IOC as they are equipped with a light-emitting diode which can offer superior visualisation and inbuilt magnification of the oral cavity. However, there is a possibility of overestimation of the disease. IOC can also be used for patient education through the “show and tell” concept in real-time like showing the areas where the disease may be a concern like plaque, calculus, and early signs of tooth decay. However, it may be challenging to diagnose diseases remotely in real-time and simultaneously seek specialist consultations and recommendations relating to the treatment protocols for numerous conditions. This manuscript reviews the challenges concerning communication, ethics, teamwork, consumables, data storage, and analysis which could be encountered with the use of IOC in this era of teledentistry and COVID-19.

Assessment of stress and micromotions using finite element analysis along both the intraoral and the extraoral distractors devices used in the mandibular distraction of post temporomandibular joint ankylosis deformed mandible patients. The process of finite element analysis was carried out to assess distraction models. The first model was an extraoral mandibular distraction model and the second model was an intraoral mandibular distraction model. To analyze the stress state, 2 vertical loads were applied on the defective and normal side respectively by a 3D finite element ball model. The intraoral system observed lower stress (4.5 MPa) in the mandibular bone compared to the extra-oral system (11.5 MPa). The results revealed that the intraoral system observed higher stress on the distractor fixing points (392.21 MPa) compared to the extra-oral fixing points (12.62 MPa). The results revealed that the extra-oral system reflected higher displacement on the bone surrounding the screws of about 3720 μm compared to the intraoral system 1414.6 μm. Internal devices give better shielding to the bone and induce fewer stresses over the mandibular, so it is more advisable to be used. The external devices permit greater distraction length because the pins and the distractor main body are subjected to fewer stresses.

Effective communication is required when referring patients for extractions and surgical procedures. There are multiple notation systems used for the identification of teeth, making communication for dental extractions challenging. The aim of this article is to provide an overview of the methods available to identify teeth and to propose a novel technique to identify erupted teeth for extraction. CPD/Clinical Relevance: Dental professionals should be aware of the importance of effective communication when identifying teeth planned for extraction and using a method that will minimize the chances of wrong tooth extraction.

Objective: To compare the difference in pain perceived by patients undergoing intra-oral local anesthesia withdifferent gauge needles. Study Design: Qausi experimental study. Place and Duration of Study: Oral and Maxillofacial surgery department of Institute of Dentistry, CombinedMilitary Hospital, Lahore Medical College, Lahore, from July 2019 to August 2019. Methodology: One hundred patients were selected by consecutive sampling from the oral surgery OPD clinic.They were divided into two groups A and B randomly. Twenty three gauge needle on a 3cc disposable syringewas used for inferior alveolar nerve block and buccal nerve block for group A and 27 gauge needle on a metaldental syringe was used for the same in group B. Patients gave a verbal pain score, from 0-10 for each injection. Results: One Hundred participants were included in study, 37 (37%) males and 63 (63%) females. Mean painscore for group A for the inferior alveolar nerve block was 4.50 ± 2.1 and group B was 3.86 ± 2. The mean painscore for the buccal nerve block in group A was 4.02 ± 1.7, while that of group B was 3.94 ± 1.8. There was nosignificant difference (p=0.167 & 0.855) in pain perceived by patients undergoing intra oral local anesthesia using needles of different gauges. Conclusion: There is no difference in pain perceived by patients undergoing intra oral local anesthesia usingneedles of different gauges.

Alveoloplasty has been defined as the surgical removal of a portion of the alveolar process. It has stated that some form of alveoloplasty is indicated in nearly every instance of multiple extractions and frequently even in single extraction. The aim of this study was to evaluate the prevalence of suture techniques in single tooth alveoloplasty wounds. The purpose of this study was to analyse the sutures used for single tooth alveoloplasty. A study was carried out by collecting data by reviewing patients data and analysing the data of 86000 patients between June 2019 and March 2020 at the private dental institute. A total number of 26 case sheets were reviewed from intra oral photographs and additional supports. Photographs were assessed to determine the technique of suturing for patients undergoing single tooth alveoloplasty. The study was evaluated and approved by the ethical committee of the private dental institute Data was statistically analysed using SPSS 2.0, Chi Square Test was conducted. The results were recorded. The results showed majority of the dental students provided simple interrupted sutures post single tooth alveoloplasty wounds. Statistically, the difference was not significantly associated between tooth number and type of suture in single tooth alveoloplasty wounds as the p value was 0.404, (Chi Square test, p>0.05). Within the limitation of present study, the majority of the dental students provided simple interrupted sutures post single tooth alveoloplasty wounds especially in relation to tooth number 37.

Aim of the study: This research aims to study the possibility of using the mandibular occlusal plane to determine the maxillary occlusal plane in the complete dentures, and to study the effect of patient's age on the resulting occlusal plane. Materials and Methods: Sample included 40 edentulous patients, ranging in age between 41-84 years (20 male and 20 females). Record bases had anterior occlusal wax rims at the anterior region only in maxillary and mandibular. The mandibular posterior occlusal plane was determined on the master cast at both sides, in line with the convergence of the middle third with the upper third of retromolar pad, and the posterior wax height of mandibular was constructed according to this plane. Then, this plane in patient's mouth was modified to fit the lateral border of the tongue and the commissure of the lips. The determinants of the registration of the centric relationship were fixed to the posterior inferior mandibular occlusal wax rims, and the posterior wax rims of maxillary was made according to the posterior wax rims of mandibular. The relationship of the posterior maxillary occlusal plane to Ala-Tragus line was examined using a double-level ruler specially designed for this purpose. The data obtained was statistically analyzed using Student’s independent T-test, and Pearson correlation coefficients. The level of confidence was set at 95%.Results: The results showed that there were no statistically significant differences in the mean angle values between mandibular occlusal plane and maxillary occlusal plane. There was a statistically significant effect of patient's age on maxillary occlusal plane in females (P=0.010), while there was no statistically significant effect of the patient’s age on maxillary occlusal plane in males and in the whole research sample (P=0.783, 0.064 respectively. Conclusions: The mandibular occlusal plane can be used to determine the maxillary occlusal plane in complete dentures. The use of retromolar pad, the lateral borders of the tongue and the commissure of the lips as intraoral reference points to determine the occlusal plane is a reliable landmark. The impact of patient’s age must be taken into account while determining the occlusal plane in this technique.

Context: Anaesthesia for pan-facial surgeries is challenging because the anaesthesiologist and surgeon have to share the common upper airway field. Oral and nasal routes for intubation are often not feasible. Submental intubation is alternative method to tracheostomy and other modes of intubation for management of airway during maxillofacial surgeries. Aim: To provide safe and easy airway with unobstructed intraoral surgical field without causing much morbidity. Materials and Methods: 30 ASA I and II patients who had pan-facial fracture, including Le Forte II, Le Forte III, with naso-orbital ethmoidal fracture requiring surgical correction admitted in MGM Medical College and MY Hospital Indore were selected for the study. The patients are intubated by submental route and various hemodynamic parameters were evaluated at different time interval during the surgery. In our study, we used two tube method of submental intubation in which another tube was drawn intra oral through submental incision and first tube was replaced. Result: There were no episode of desaturation and no difficulty was encountered in secondary intubation. The average duration of secondary intubation was 3-4 minute (Mean+SD = 3.45+0.95) which is less than the conventional one tube method. Conclusion: As per our experience in study and the review of literature, the submental intubation is very easy and safe method of intubation to provide the unobstructed surgical field for the Le forte II and III panfacial fracture surgeries. Keywords: Submental intubation, Panfacial trauma, Tracheostomy, Two tube method.

Purpose Determination of intra-oral surface areas might contribute to our understanding of the physiology of the oral cavity and oral diseases. In previous studies, the intra-oral surface area was determined using a laborious and technically challenging method. Our aim was to develop an easy and non-invasive method to determine the intra-oral surface areas. Methods In this study, we used cone-beam computed tomography (CBCT) and digital analysis in 20 human cadavers to determine various intra-oral surface areas, based on digital segmentation. Next, we explored whether there was a relationship between various intra-oral surface areas and anthropometric measurements of the head using Pearson correlation coefficient. Results Using CBCT and digital analysis, it was possible to determine various intra-oral surface areas. On average, the total intra-oral surface area was 173 ± 19 cm2. Moderate, statistical significant correlations were observed between (1) the length of the head and the palatal surface area, as well as (2) the depth of the head and the surface area of the tongue. These correlations suggest the feasibility of estimating intra-oral surface areas without relying on CBCT imaging. Conclusions This study presents a technique for measuring the intra-oral surface areas by CBCT imaging in combination with digital analysis. The results of this study suggest that anthropometric measurements of the head might be used to estimate the surface areas of the palate and tongue.

The aim of the study is to access the types of arch tracing achieved using tracer in a prosthetic system (BPS). Assessing the relation plays an important role in the fabrication of complete denture. Gothic arch tracing is one of the methods used to achieve relation in complete denture patients. The types of the arrow forms include the classical pointed form, classical flat form, weak form, asymmetrical form, miniature form, vertical line extending beyond the arrow point. The variations in achieving arrow tracing for a complete denture patient depends on mandibular movements. Data collection was done from DIAS (dental hospital management system) which is an electronic record management system and details such as , types of arrow point achieved and type of tracer used was obtained and tabulated. Further the data were by statistical tests (chi-square analysis) using SPSS software (write the version). The typical arrow point tracing was common in both sexes. Females show more variation in tracing arrow types of tracing were more commonly seen in females. The chi-square analysis reveals an insight value of p> 0.005. The typical arrow point tracing form is seen in both males and females. Other forms like atypical, double arrow are commonly seen in females and only miniature forms are seen in males.

This study was performed to assess the effectiveness and comfort of two intraoral imaging techniques using respective digital radiograph receptor devices/holder in obtaining digital intraoral images. Methods: A total of 60 patients undergoing anterior intraoral periapical radiographs were single-blindly recruited. The imaging procedure was performed by two calibrated researchers where the novel holder group (Bisector©) was prospectively compared to the paralleling technique group, RINN® by performing thirty radiographic examinations, respectively. All patients were randomly segregated into different groups using block randomization method. The effectiveness of both holders was quantified based on the repeat rate percentage and quality of the images. The comfort study was enumerated using the Horizontal Visual Analogue Scale 100mm (HVAS). The Wilcoxon test (alpha = 0.05) was applied to compare the comfort score of different types of imaging receptor device reported by the patients. Results: The repeat rate percentage for Bisector© and RINN® holder devices were 8.9% and 18.6%, respectively (p

Approximately 90% of halitosis cases originate within the oral cavity (intra-oral halitosis). With a focus on intra-oral halitosis, this narrative review article provides a current summary of the epidemiology, diagnosis and management of halitosis and discusses practical considerations for healthcare professionals (HCPs), including dentists, dental hygienists, general practitioners, community pharmacists, nurses and medical specialists. MEDLINE and PubMed were searched up to 31 December 2019. Additional information was sourced from reference lists of relevant published literature. Full-text articles which reported on the epidemiology, diagnosis and management of halitosis were considered for inclusion. Halitosis affects substantial numbers of individuals globally and is an underestimated problem in dental practice. Current estimates of the prevalence of halitosis, in addition to diagnostic methods and management considerations for halitosis, are discussed. Although not a life-threatening condition, halitosis has a significant impact on patients' quality of life and can result in psychological consequences including social, professional and affective limitations. Using a simple step-wise approach for diagnosis and treatment, dentists and dental hygienists are ideally placed to respond to an initial consultation for halitosis.

Background: In recent years, the number of procedures for buccal fat pad removal has increased. In cases of thinning of the face, bite injuries or bruxism, partial removal of the corpuscle is performed, always taking into account facial harmonization. Objective: The aim of the present study was to demonstrate the post-operative procedure of the removal of the BFP by pain parameters, mouth opening and presence of edema. This longitudinal cohort study was registered in clinical trials and all participants had access to the informed consent form. Methods: Forty BFP removal surgeries were performed with the technique of intraoral access. After the bichectomy procedure, the individuals were followed for 4, 7, 10, 15, 30, and 90 days. Visual pain scale, mouth opening measurements and clinical visual assessment were performed at all times. Results: We observed that the presence of edema and limited mouth opening for about 15 days were the changes most commonly found in surgeries performed. The results showed a significant decrease in painful symptoms after 15 days, regarding mouth opening, the results showed a return to normal levels after 30 days (p Conclusion: We conclude that the BFP removal, when performed following a precise indication, properly and with the recommendations of post-operative care, followed correctly, promotes limitation in mouth opening and painful symptoms by 15 days. The procedure is becoming a new area for the dental surgeon, who can perform the procedure safely, reliably and with aesthetic and therapeutic results.

Purpose: This prospective study aimed to compare the intraoral placement of the pre-bent reconstruction plate with that inserted via the extraoral approach, to evaluate their impact on the three-dimensional (3D) position of the proximal segment Patients and methods: Patients were divided into two equal groups. In group 1, the mandible was reconstructed with a pre-bent reconstruction plate via an intraoral approach. In group 2, an extraoral approach was used. The primary outcome variables were the need for intraoperative plate readjustment, the time needed for plate insertion, total operation time, difficulties encountered during surgery, and the postoperative stability of the proximal segment. Distances between corresponding anatomical landmarks on the mandibular angle and condyle as well as the intercondylar angle (ICA) and B`XC angle, were measured. The difference between the pre- and postoperative measurements was used to evaluate the reconstruction accuracy. Results: Thirty patients were enrolled in this study. In group 1, four plates required minor readjustment. In group 2, only two cases required re-adaptation. The intraoral insertion of the pre-bent plates revealed a decrease in the linear measurements, resulting in mandibular compression. On contrary, the extraoral approach showed increase in the measurements, resulting in widening of the mandible. However, this width difference was statistically insignificant. Concerning the ICA and B`XC angle, no significant difference could be ascertained between the two groups. Conclusion: Intraoral approach is more conservative procedure, thereby achieving the best esthetic outcomes and resulting in a more accurate 3D mandibular reconstruction.

Excessive gag reflex could be problematic for adequate dental care. Although various factors may increase the susceptibility to gagging, its contributing factors have not been fully determined. This study aimed to determine whether gag reflex was associated with tactile sensitivity and psychological characteristics. Fifteen volunteers of healthy males and females each were recruited for this study. After completing a questionnaire describing the self-perceived gag reflex activity, a disposable saliva ejector was inserted along the palate into the mouth until gagging was evoked. The ratio of the insertion depth to the palatal length was used as an index for the gagging threshold. The two-point discrimination (TPD) and Semmes-Weinstein monofilament (SWM) tests were performed to assess the tactile sensitivity of the palatal regions (hard palate, anterior and posterior soft palate). The Symptom Checklist-90-Revised was used to investigate the relationship between the gagging threshold and the psychological status. Our findings showed that the gagging threshold had a significant positive correlation with the TPD and SWM thresholds on the hard palate. The psychological profiles of psychoticism and hostility score were also significantly correlated with the gagging threshold. However, there were no significant differences in the tactile and gagging thresholds, as well as the psychological profiles, between males and females. Our results suggested that the tactile sensitivity of the anterior palate is a determining factor for the gagging threshold and implied that the initial response of the oral entry site to stimulation may lead to the development of gag reflex.

Teratoma is a most common extra gonadal germ cell tumour of perinatal or neonatal period, but teratomas of nasopharynx and intra oral are rare in neonates. Naso pharyngeal teratoma is a serious condition leading to the respiratory distress in newborn. In present case one day old female newborn female born to a 22 year healthy female by normal vaginal delivery with uneventful antenatal period with intra oral and nasopharyngeal growth protruding from the oral cavity leading to severe respiratory distress. Baby was managed immediately and MRI of head and neck suggested nasopharyngeal mass lesion with left intratemporal and left intra cranial extension suggesting solid cystic, calcified fat components of teratoma. Baby was resuscitated and growth was excised successfully and cleft palate was repaired and patient was discharged on normal bladder and bowel habits. Histopathological examination specimen suggested intraoral and nasopharyngeal benign teratoma. We present the intraoperative and specimen finding and treatment followed in this case. Surgical excision is the treatment of choice for mature teratoma as the excision is complete the recurrence rate decreases.

Objectives To investigate the potential utility of intra-oral ultrasound (IOUS) in guiding deep margin clearance and measuring depth of invasion (DOI) of oral tongue carcinomas (OTC). Materials and Methods Retrospective chart review of consecutive patients with T1-T3 OTC who underwent intraoperative ultrasound-guided resection and a comparator group that had undergone resection without the use of IOUS both by a single surgeon. Data was extracted from operative, pathology and radiology reports. Deep margins and DOI were reviewed by a dedicated head and neck pathologist. Correlation between histologic and ultrasound DOI was assessed using Pearson correlation. Results A total of 23 patients were included in the study cohort with a comparator group of 21 patients in the control group. None of the patients in the study cohort had a positive (cut-through) deep margin and the mean deep margin clearance was 8.5 ± 4.9 and 6.7 ± 3.8 for the IOUS and non-IOUS groups respectively (p-value 0.18) showing a non-significant improvement in the IOUS group. As a secondary outcome, there was a strong correlation between histologic and ultrasound DOI (0.9449). Conclusion Ultrasound appears to be a potentially effective tool in guiding OTC resections. In this small series, IOUS facilitated deep margin clearance and resulted in a non-statistically significant increase in deep margin clearance. Intraoral ultrasound can accurately measure lesional DOI.

A basal cell ameloblastoma is an uncommon benign neoplasm and has a similar histological appearance to basal cell carcinoma of the skin. This clinical case report will discuss an ameloblastoma originating in the maxilla and of the baseloid variant. The objective of report is to highlight the possibility of misdiagnosis from this challenging case. A 34-year-old male was referred to the maxillofacial department with recurrent nasal regurgitation following dental extraction from the left maxilla 1 year previous. Clinically there was an oro-antral fistula visible and initial CT showed cystic lesion in the left maxilla likely to represent an odontogenic cyst. The patient underwent extraction and enucleation, where the diagnosis of the amelobalstoma was established with need of resection. Partial maxillectomy and primary closure with buccal fadpad was performed in the second stage and histological results showed a 6mm completely excised basal cell carcinoma within the oral mucosa and no bony invasion. Due to this extremely unusual results, secondary histological review was requested, and conclusion was a fully excised basal cell ameloblastoma. Following the procedure and subsequent reviews, the patient has no evidence of oro-antral fistula or recurrence of this rare type of neoplasm. A basal cell ameloblastoma variant is a rare lesion and due to its’ similar histological appearance to a basal cell carcinoma, can lead to a misdiagnosis. The aim of the report is to show the unusual presentation and findings along the way to correct diagnosis in this case.

Introduction There are a spectrum of treatment options available for reconstruction of oral mucosal defects including secondary healing, skin grafts, local flaps and microvascular free flaps. We present the use of an alternative intra-oral reconstruction with Integra® Dermal Regeneration Template. Case Report An 85-year-old patient with a severe gag reflex and history of oral cancer presented with biopsy proven severe dysplasia of the right palate extending to the hamular notch. She was treated with wide local excision, extraction of teeth, buccal fat pad advancement for closure of an oral-antral communication and placement of Integra® Dermal Regeneration Template. Discharge was possible the same day as the patient was able to eat and had minimal pain. Discussion Integra® Dermal Regeneration Template is a bilayer wound matrix consisting of silicone in the outer layer with bovine collagen and glycosaminoglycan from shark cartilage in the inner layer. Oral cancer predominantly affects the older population, and this method can reduce surgical time, remove donor site pain, reduce post-operative pain and avoid use of a cover plate where a strong gag reflex was present. The area heals quickly and aids quick restoration of oral function. Conclusion Integra® Dermal Regeneration Template has been used for head and neck defects with good outcomes. It is being increasingly used intra-orally with good outcomes, suggesting a further application of the material with advantages over traditional techniques in specific patient groups.

Aim To evaluate the quality of intra-oral radiographs taken within two hospitals in South Wales, United Kingdom, and assess the impact of radiographer training, with the aim of reducing the percentage of undiagnostic radiographs to 10% or less in accordance with national performance targets. Method Details of intra-oral periapical and occlusal radiographs taken in the two hospitals between the 1st July 2015 and the 30th June 2016 were retrieved. 100 radiographs were randomly selected and assessed. Change was then implemented in the delivery of radiographer training workshops, which involved two hours of both didactic teaching and hands-on skills training. There were 10 workshops and 52 attendees. A second audit cycle was completed, with a further 100 radiographs randomly selected from the 1st December 2018 and 30th April 2019. Results There was a 33.2% reduction of undiagnostic radiographs, bringing the total down to 6.3%, meeting the standards of the audit. Feedback from the workshops were also extremely positive; 50% of radiographers grading the quality of the workshops at 10/10. Conclusions The workshops were successful in improving the quality of intra-oral radiographs, therefore improving the quality of this service. This blueprint can be shared amongst other hospitals, to sustainably improve the overall quality of dental radiography in the hospital setting. Recent updated guidance in 2020 introduced a new two-point scale radiograph grading system: ‘Acceptable’ and, ‘not acceptable’. Radiographs graded as, ‘not acceptable’, should account for no more than 5% of radiographs. Future audit cycles will follow this new grading system and standard.

Neurofibromatosis (NF) is an autosomal-dominant disorder, characterized by neurocutaneous tumors arising within multiple organs, which the diagnosis is made based on clinical criteria proposed by National Institute of Health Consensus Development Conference. Neurofibromatosis type I (NF-1), also termed as von Recklinghausen’s disease, is the most common type accounting 90% of the cases. We report a clinical case of NF-1 with oral manifestations in a 60-year-old female patient. Keywords: Glioma, Lisch nodules, Neurofibromatosis, Neurocutaneous tumors.

Intra-oral removable devices are readily available and increasingly advocated for the correction of body posture and alleviation of associated musculoskeletal symptoms. The precise clinical application and mechanism of action is poorly understood and their use remains controversial. We present the case of a 47- year-old female where prolonged use of such a splint resulted in significant and adverse occlusal alteration

BACKGROUND: Gillies temporal approach and intra oral supraperiosteal approach are the most commonly used approaches for reduction of isolated zygomatic arch fractures. PURPOSE: To set forth a less invasive technique for reduction and stabilization of isolated zygomatic arch fractures. MATERIALS AND METHODS: A 24-G stainless steel wire is passed through a 16-G cannula needle and is shaped to form a semi-circle. The precontoured needle was then inserted into the inferior part of the depressed zygomatic arch and the tip passed out through the superior part. The wires are then twisted and pulled laterally to reduce the fracture and are tied over an external splint to stabilize the arch. CONCLUSION: The technique discussed in this article is simple, less time consuming, cost effective and less traumatic than the conventionally performed techniques for reduction and stabilization of isolated zygomatic arch fractures.

The purpose of this study was to evaluate the effect of different occlusal concepts which are bilateral balanced occlusion, canine guided occlusion on masticatory efficiency, in implant supported mandibular over denture wearers.Material and methods: ten completely edentulous patients were selected for this study, aged 50 to 60 years old. All patients free from any systematic dieses. The patients were divided into three groups according to the treatment protocol; {GI} All patients wore denture with intra oral adjustment, {GII} five patients wore denture with bilateral balanced occlusion and {GIII} five patients wore denture with canine guided occlusion. All patients were submitted to masticatory efficiency test, after one month by using different textures of foods. The recordings data were analyzed using ANOVA. This was followed by Tukey’s post hoc test using LSD test. P< 0.05 was considered statistically significant. Results: with soft food, there was non-significant difference between the three groups, while with hard food; the greatest mean was recorded in occlusion after oral adjustment, whereas the lowest mean was recorded in bilateral balanced occlusion. Conclusion both bilateral balanced occlusion and canine guidance occlusion can be used successfully in implant supported overdentures without affecting masticatory function.