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National Journal of Maxillofacial Surgery
 
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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 9 | Issue 2
Page Nos. 115-239

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EDITORIAL  

Evidence based or evidence biased! Highly accessed article p. 115
Indu Bhusan Kar
DOI:10.4103/njms.NJMS_77_18  
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REVIEW ARTICLE Top

Minimally invasive transgingival implant therapy: A literature review p. 117
Manoj Kumar Yadav, Umesh Pratap Verma, Harshil Parikh, Manisha Dixit
DOI:10.4103/njms.NJMS_52_17  
Transgingival (flapless) implant placement procedure is a minimally invasive surgical technique in which implant is placed without reflecting mucoperiosteal flap and hence the blood supply of bone is not hampered which is advantageous in many ways. To compare the outcomes of various implant placement techniques, an electronic database of various journals from January 1990 to March 2017 were analyzed and only human clinical trials with 6 months follow-up and at least five implants in each group were reviewed. The present literature review focuses on the comparative aspects of flapped versus flapless implants in terms of their survival, marginal bone loss, soft-tissue parameters, and patient-centered outcomes. When the proper protocol is followed by experienced surgeons, no significant difference was observed in survival rate, marginal bone loss, and keratinized mucosal width between flapless and conventional flap technique. Although transgingival approach for implant placement is reported to significantly reduce the surgical time, increased patient comfort and acceptance, i.e. the patient centered outcomes such as postoperative pain, swelling, and visual analog score, are minimized. Hence, it is concluded that transgingival (flapless) implant placement technique is well accepted by the patient with potential outcomes as compared to the conventional implant placement approach.
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ORIGINAL ARTICLES Top

Prevalence of mandibular fracture in patients visiting a tertiary dental care hospital in North India p. 123
Akhilanand Chaurasia, Gaurav Katheriya
DOI:10.4103/njms.NJMS_8_18  
Background: Injuries of the maxillofacial complex represent one of the most important health problems worldwide. At present, in developing India, due to poor traffic sense, maxillofacial trauma and fractures are most epidemiologic diseases. Mandible is the largest and strongest facial bone and it is the second most commonly fractured bone. Mandibular fractures can involve only one site or can often involve multiple anatomic sites simultaneously. Aims: The present study is aimed to know the age- and sex-related prevalence of parasymphyseal fracture, fracture of angle, condylar fracture, symphyseal fracture, and coronoid fracture of mandible in North Indian population. It also evaluates the correlation of prevalence of parasymphyseal fracture, angle of mandible, condylar fracture of mandible, symphyseal fracture of mandible, and coronoid fracture of mandible. Materials and Methods: All patients fulfilling the selection criteria and having mandible fracture were selected for the study. The data about mandibular fracture was collected by means of a structured questionnaire including age, sex, and anatomic site of fracture. Qualitative variables were compared using Chi-square test/Fisher's exact test as appropriate. Results: The study population consists of 1015 individuals aged between 7 and 68 years with the mean age of 33.49 ± 11.79 years. The most common anatomic site for mandibular fracture was parasymphyseal region (40.3%) followed by angle (28.8%), condyle (27.6%), and symphysis (12.5%) of mandible. The coronoid process of mandible (44, 4.3%) was least involved in mandibular fracture. Males (30.8%) are more predilected for condylar fracture than females (15.7%). The mandibular symphyseal fracture is more common in male (14.9%) than female (3.7%). Conclusion: Mandibular fractures occur in people of all ages and races, in a wide range of social settings. Their causes often reflect shifts in trauma patterns over time. The present assessments of mandibular fracture will be valuable to government agencies and health-care professionals involved in planning future programs of prevention and treatment.
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Morphological variations of lingula and prevalence of accessory mandibular foramina in mandibles: A study p. 129
Mohammed Asdullah, Afroz Alam Ansari, Masood Hassan Khan, Nasir A Salati, Kauser J Khawja, Arti S Sachdev
DOI:10.4103/njms.NJMS_13_16  
Introduction: The lingula is used for identifying the site for injection of local anesthetics and for excision of nerve in facial neuralgia. The relationship between lingula and lingual nerves may aid in risk associated with an impacted third molar. Due to its connection to nerve and vascular structures, the study of the lingula provides important information related to oral and maxillofacial surgical procedures, such as the sagittal split ramus osteotomy and the intraoral vertico-sagittal ramus osteotomy carried out to correct dento facial deformities. Intra-operative complications such as hemorrhage, fracture, and nerve injury may occur if lingula is not correctly identified. Materials and Methods: This study was conducted in the Department of Oral Medicine and Radiology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, U. P (India) on fifty (100 sides) dry adult human mandibles to determine the different shapes of lingula. The shapes of the lingula were classified as triangular, truncated, nodular, and assimilated types. Results: The most common shape found in the study was the triangular (61.6%) while the least common shape was the assimilated (11.6%). All types of lingule were more prevalent unilaterally. The prevalence of accessory mandibular foramina (AMF) was 12% on the right side and 4% on the left side of the mandible. Conclusion: The present study provides information regarding different shapes of lingule and incidence of AMF in the populations of Lucknow and its surrounding areas (Uttar Pradesh) North India. The findings of the present study are very helpful to oro-dental surgeons, anthropologists, and forensic practice experts.
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Evaluation of efficacy of intermaxillary fixation screws versus modified arch bar for intermaxillary fixation p. 134
Tushar Manohar Rothe, Prachur Kumar, Navin Shah, Rakesh Shah, Ananth Kumar, Devika Das
DOI:10.4103/njms.NJMS_16_18  
Aim: This study aimed to evaluate the efficacy of intermaxillary fixation (IMF) screws and modified arch bar. Materials and Methods: This study is a randomized clinical trial in which all participants were divided into two groups of ten in each group and designated as Group A and Group B. In Group A, IMF was achieved by the use of four to six 2×8mm stainless steel IMF screws. In Group B, IMF was achieved by modified screw arch bar. Results: In the present study, a total of twenty patients were analyzed. The average working time for Group A and Group B was 16 min and 29 min, respectively. Oral hygiene scores through modified Turesky Gilmore plaque index were calculated at immediate postoperative period and after 15 days, 30 days, and 45 days. Maximum hygiene was maintained in IMF screw group than modified arch bar group, but maximum stability was observed in the modified arch bar group than IMF screw group. Conclusion: This study emphasizes the use of IMF screws as a quick and easy method than modified arch bar. Oral hygiene maintenance was comparatively better in patients with IMF screws than those with modified arch bar. Modified arch bar was significantly stable when compared with IMF screws; therefore, for patients who require long-term IMF, modified arch bars can be a viable option, but the perforation in the original arch bar may lead to the weakening of the arch bar, and therefore the prefabricated modified arch bar would be a better option.
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Comparative study on alveolar bone healing in postextraction socket versus healing aided with autologous platelet-rich fibrin following surgical removal of bilateral mandibular impacted third molar tooth: A radiographic evaluation p. 140
N Santhoshi Revathy, R Kannan, RS Karthik, M S Senthil Kumar, M A I Munshi, R Vijay
DOI:10.4103/njms.NJMS_17_18  
Aim: This study was to evaluate and compare the bone regeneration potential of autologous platelet-rich fibrin (PRF) placed in one of the extracted sockets after the surgical removal of bilateral impacted mandibular third molars. Patients and Methods: Twenty-five patients (10 females and 15 males; 18–35 years old) were taken for surgical removal of bilateral impacted mandibular third molar, performed in the same session. The autologous PRF was placed in one of the extracted sockets whereas the opposite side was taken as control side, and primary closure was done. Radiographic examination with orthopantomogram was done preoperatively and 1 month, 3 months, and 6 months postoperatively to assess the degree of bone regeneration at the extracted site and compare it with the control side using MATLAB software and the data are statistically analyzed using paired t-test. Results: PRF side had better healing and bone formation when compared with the control side as indicated by significant P values of (P = 0.06>5%) 1 month, (P = 0.00<1%) 3 month, and (P = 0.00<1%) 6 month postoperatively. The repeated-measures ANOVA showed a significant difference seen on 1st, 3rd, and 6th months postoperatively on PRF side (P = 0.001). Conclusion: The autologous PRF improves and fastens the bone regeneration and healing in the extracted sockets.
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Study of stress-induced temporomandibular disorders among dental students: An institutional study p. 147
Vikram Ahuja, Vikash Ranjan, Deepak Passi, Rashi Jaiswal
DOI:10.4103/njms.NJMS_20_18  
Aim and Objectives: The aim and objectives of this study are to investigate the various types of stress-inducing factors, most prevalent etiological factor and to determine the correlation between stress and temporomandibular disorders (TMDs) in Dental students in Modinagar, Ghaziabad, Uttar Pradesh. Materials and Methods: A sample of 450 students were selected for the study divided into two groups of undergraduate (UG) and postgraduate (PG) students further subdivided into UG (1st, 2nd, 3rd, and 4th, interns) and PG (1st, 2nd, 3rd year). Study includes clinical evaluation of temporomandibular joint (TMJ) system (TMJ sounds, muscles of mastications, mouth opening, and range of mandibular motion) and questionnaire which covers demographic data (i.e., age, sex, and academic year), TMD symptoms and TMD signs along with standardized scales related to stress dental environmental stress scale and perceived stress scale (PSS). Results: Most of the students included into study are mostly of 21–25 years of age (64.3%), males (52.7%), females 47.3% with more number of UGs (91.4%) predominantly 1st year students (23.9%). Headache was found to be the most prevalent TMD symptom (26.2%) followed by clicking (24.9%), pain on clicking (5.5%), jaw lock (3.4), and difficulty in mouth opening (0.9%). Clicking was found to be the most prevalent TMD sign (24.9%) among dental students followed by deviation (16.3%), muscle tenderness (14.3%), and TMJ pain (5.7%). The most prevalent TMD was disc displacement 22.6% followed by myofascial pain dysfunction syndrome (MPDS) with disc displacement (13.5%) and MPDS (3.8%). TMD was higher in UG females students of 21–-25 years of age group, dental environment stress scale score and PSS score shows statistically significant results. Conclusion: Stress is a significant etiologic factor involved in initiation and maintenance of TMDs in Dental students.
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Management of myofascial pain dysfunction syndrome with meditation and yoga: Healing through natural therapy p. 155
Abdul Ahad Khan, Anchal Srivastava, Deepak Passi, Manisha Devi, Lokesh Chandra, Mansi Atri
DOI:10.4103/njms.NJMS_25_17  
Aims and Objectives: Aims and objectives of the study were to study the effectiveness of Raj-yoga meditation and pranayama in patients with myofascial pain dysfunction syndrome (MPDS) and compared the effects with ongoing conventional noninvasive treatment modalities. Materials and Methods: The study comprised 30 patients divided equally (10 each) into 3 group, i.e., control group (conventional, noninvasive treatment), Experimental A group (conventional, noninvasive treatment with raj-yoga meditation therapy and pranayama), and Experimental B group (Raj-yoga meditation therapy and pranayama only). Parameters such as pain, mouth opening, mandibular deviation, inflammation, swelling, clicking, occlusion, and psychologic evaluation such as anxiety, stress, and depression were assessed before the start of the study and at weekly intervals for 3 months. Results: Posttreatment pain and inflammation improved both in the control group and Experimental A group, but statistically it is highly significant in the Experimental A group. Furthermore, it is effective immediately as well as for a long period in Experimental A group. Improvement in mouth opening was statistically highly significant in control group but not in the experimental groups. Posttreatment anxiety and stress status was improved with statistically highly significant result in the Experimental A and B. The posttreatment depression status along with mandibular deviation, swelling, clicking, and occlusion has not improved significantly in any of the groups. Interpretation and Conclusion: Raj-yoga meditation and pranayama in combination with conventional, noninvasive, treatment modalities showed promising results in MPDS patients as compared to either modalities alone.
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Chemoprotective effect of nanocurcumin on 5-fluorouracil-induced-toxicity toward oral cancer treatment p. 160
Saurabh Srivastava, Shadab Mohammad, Shalini Gupta, Abbas Ali Mahdi, Rakesh Kumar Dixit, Vibha Singh, Fahad Mansoor Samadi
DOI:10.4103/njms.NJMS_27_18  
Introduction: Cancer of oral cavity is the uncontrolled expansion of damaged cell within the mouth cavity. 5-fluorouracil (5-FU) chemotherapy was focused to kill the cancer cell, but it would affect the surrounding normal cells during oral cancer treatment. This study included the evaluation of chemoprotective effects of curcumin (CU), as an herbal remedy, on 5-FU-induced-cytotoxicity toward oral cancer treatment, loaded within a nanocarrier system. CU was combined with 5-FU chemotherapy as a combinational drug-delivery system to evaluate synergistic effects. Materials and Methods: Nanoformulation of CU (nano-CU) and nanoformulation of 5-FU (nano-FU) were prepared by employing homogenization with high-energy sonication. The characterizations of prepared nanoformulations were evaluated on the basis of particle size, zeta potential, and polydispersity index (PDI) values. The chemopreventive effect of nano-CU on 5-FU induced-toxicity and synergistic efficacy were optimized through different in-vitro assays. Results: The average particle size of nano-CU and nano-FU were up to 200 nm, negatively-charged, and shown up to 4th-day control release of the drug within the acceptable concentration. IC50 value for growth inhibition was calculated as 47.89 and 26.19 μg/ml, respectively, for nano-CU and nano-FU. OCC was pretreated with nano-CU and shown the protective effect by reducing 5-FU induced-cytotoxicity by preventing normal cells through reduced viability. The DPPH-indicated fluorescence-tagged cells had quantified for antioxidant effect as it reduces intracellular reactive oxygen species level in OCC. Along with alteration in cell protein expression, Blc2, and Bax, shows enhanced apoptosis rate in OCC. Conclusion: Nano-CU provides chemoprotective nature towards 5-FU induced-toxicity, along with synergistic effects in oral cancer treatment.
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Piezoelectric harvest of osteo-odonto-lamina in modified osteo-odonto keratoprosthesis: A maxillofacial perspective p. 167
Ankit Arora, Sandeep Kumar Pandey, Ajoy Roychoudhury, Ongkila Bhutia, Radhika Tandon, Sahil Parvez Gagnani, Rahul Yadav
DOI:10.4103/njms.NJMS_32_16  
Purpose: We describe the piezo-osteotomy feasibility in rehabilitation and harvesting of osteo-odonto lamina in modified osteo-odonto keratoprosthesis (MOOKP) surgery. Surgery was evaluated regarding operative technique and success of the keratoprosthesis (KPros) in terms of perception to light (+ve) to finger counting (+ve). Materials and Methods: This retrospective cohort study included 12 patients undergone MOOKP surgery procedures. Harvesting of osteo-odonto-lamina was performed using piezosurgical osteotomy during 2007–2012. Results: The mean follow up was 34 months (range 24–48 months). Of the 12 patients six patients had vision ≥6/12, four patients had vision <6/12, but >6/60 and one patients had vision ≤6/60. KPros was retained and functional in all the eyes after a minimum follow up of 24 months. There was mucosal overgrowth over the optical cylinder occurred in two cases over 4 years follow up which was corrected with trimming. Postoperative complication at donor site was seen in three cases, two cases with exposure of root of adjacent teeth and oro antral fistula in one. Conclusions: This study suggests that piezoelectric harvest of osteo-odonto-lamina is a valuable surgical option in patients undergoing MOOKP surgery, resulting in high success rate with less complication.
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Use of plasma-enriched demineralized freeze-dried bone matrix in postsurgical jaw defects p. 174
Alok Kumar Sethi, Indu Bhusan Kar, Tanmoy Mohanty, Niranjan Mishra, Akhilesh Kumar Singh
DOI:10.4103/njms.NJMS_33_18  
Aim and Objectives: The aim is to know the augmented new bone formation in postsurgical bony defects in the maxillofacial region when filled with plasma-enriched demineralized freeze-dried bone allograft (DFDBA). Materials and Methods: The study group included 45 patients, selected randomly, and divided in three equated groups. In Group I (control) patients, the wound was closed primarily without incorporating any graft in the bony defect. In Group II, the defect was filled with DFDBA alone and in Group III with DFDBA enriched with platelet-rich plasma (PRP). The said graft material was procured from the (to be discarded) femur head, treated to get rid of its antigenicity, made suitable to be incorporated as a graft material, sterilized by gamma irradiation and then implanted into the jaw defects. Results: The results were evaluated and interpreted both clinically and radiographically by studying the changes post 1 week, 1 month, 3 months, and 6 months, respectively. Bone density was evaluated using computed tomography scan in addition to standard conventional radiographs. Evidence of trabecular formation and calcification were noted down. Measurements were recorded by taking note of Hounsfield units. Statistically, one-way ANOVA test followed by least significant difference post hoc test was done. Final results showed that the patients in the Group III had more bone density at the grafted site when compared to the Group II and I patients. These findings were significant. Conclusion: PRP-enriched DFDBA is a superior grafting material in terms of other grafting materials available. It possesses both osteoconductive and osteoinductive properties and elicits the least immunological response, thereby making it one of the best effective combinations of grafting material to be used in oral and maxillofacial reconstructive purposes.
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Evaluation of mast cells in oral premalignant and malignant lesions: A histochemical study p. 184
Shreya Singh, Vineeta Gupta, Ruchieka Vij, Rashmi Aggarwal, Bhagwat Sharma, Madhav Nagpal
DOI:10.4103/njms.NJMS_49_17  
Introduction: Oral leukoplakia, oral submucous fibrosis, and oral lichen planus are the precancerous or potentially malignant lesions and conditions whereas oral squamous cell carcinoma (OSCC) is a cancerous or malignant lesion of the oral cavity. They have characteristic clinical and histopathological features. These diseases not only originate from epithelium but also associated with chronic inflammation juxta-epithellialy. Mast cells present in the connective tissue stroma and release pro-inflammatory and mitogenic cytokines. These functions of mast cells contribute and enhance the pathogenesis translation of diseases. Aim: The study was done to histologically evaluate the number of mast cells in oral epithelial dysplasia and OSCC and compare it with normal oral mucosa (NOM). Materials and Methods: Forty-five cases each of oral dysplasia, OSCC and ten cases of NOM were studied for mast cell number using toluidine blue. Results: There was a highly significant increase of mast cells in oral epithelial dysplasia on comparison with OSCC whereas there was only a significant increase in mast cells in OSCC on comparison with NOM. Conclusion: The literature has proven that mast cells can be an indicator of increased angiogenesis and hence can help in the prediction of carcinogenesis, its progression, and also the prognosis of the malignant lesions.
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Reconstruction in head-and-neck cancers – analysis of the learning curve p. 191
Ranganath Ratnagiri, Shubhranshu Jena, P Parvathi, R Srikanth, G S N Raju
DOI:10.4103/njms.NJMS_66_17  
Background: Oral cancers are some of the most common cancers in India. Most patients present with locally advanced disease requiring extensive resection resulting in large defects. Reconstruction of these defects plays a major role in restoring form and function to these patients, as well as enabling the delivery of adjuvant therapy on time. Aim of the Study: The aim of this study was to analyze the learning curve involved in microvascular surgery. Materials and Methods: A retrospective analysis of the case records of all patients of oral cancers, who underwent resection and reconstruction between January 2008 and December 2012 at our institute, was done. Demographic, clinical, and pathological data were collected and analyzed. Statistical analysis was done using the SPSS software. Results: The operative time and the postoperative ventilation (7.8 h and 3.7 days, respectively) were significantly higher than those for pedicled flaps (3.6 h and 1.4 days, respectively). Both these variables reached statistical significance with P < 0.05 and < 0.04. The hospital stay was also statistically significantly longer for patients who underwent free-flap reconstruction (17.9 days vs. 7.9 days; P < 0.05). The number of reexplorations were higher in the free-flap group (31), when compared to the pedicled flap group (9). However, partial flap loss was higher in the pedicled flap subset when compared to the free-flap group. The complications significantly dropped after the performance of 30–40 free flaps. Conclusion: There is a steep learning curve in microvascular surgery, but the cosmetic and functional outcomes outweigh the complications.
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Evaluation of the relative efficacy of autologous platelet-rich fibrin membrane in combination with β-tricalcium phosphate (Septodont- resorbable tissue replacement)™ alloplast versus β-TCP alloplast alone in the treatment of grade II furcation defects p. 196
Neetu Rani, Shalini Kaushal, Surendra Singh, Nandlal , MA Khan, Anjani Kumar Pathak
DOI:10.4103/njms.NJMS_68_17  
Introduction: Platelet-rich fibrin (PRF) is considered as the second-generation platelet concentrate, contains combined properties of fibrin, platelets, leukocytes, growth factors, and cytokines that make it as healing biomaterial with incredible potential for hard tissue and soft tissue regeneration. The present study was aimed to evaluate the effectiveness of PRF with β-tricalcium phosphate (β-TCP) graft (R. T. R) and compare it with β-TCP allograft alone in the treatment of mandibular Grade II furcation defects. Material and Methods: A total of 20 mandibular Grade II furcation defects sites were assigned in the study and treated with either β-TCP alone (Group I) or β-TCP with PRF membrane (Group II). The clinical parameters analyzed were probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), horizontal defect depth (HDD), and vertical defect depth (VDD), recorded baseline and at 6 months reentry. Results: At 6 months, both groups showed statistically significant results for all parameters from their baseline value, although intergroup changes were statistically insignificant. In Group I, gain in CAL was 2.80 ± 1.40 and in Group II it was 3.00 ± 1.44. Bone fill in Group I was VDD (3.50 ± 2.12) and HDD (3.70 ± 0.67), whereas Group II showed VDD (3.70 ± 1.57) and HDD (4.0 ± 0.88), respectively. PPD reduction was higher in Group I (3.50 ± 2.27) than Group II (2.80 ± 1.93). At reentry GR was established, Group I showed higher GR (0.70 ± 0.67) and Group II (0.40 ± 0.52). Conclusions: Significant improvement was found in both groups, but the combination of PRF with β-TCP allograft led to more favorable improvement in the management of Grade II furcation defect except PPD.
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Comparison between intra-articular platelet-rich plasma injection versus hydrocortisone with local anesthetic injections in temporomandibular disorders: A double-blind study p. 205
Savina Gupta, Amit Kumar Sharma, Jeetendra Purohit, Rahi Goyal, Yogendra Malviya, Sugandha Jain
DOI:10.4103/njms.NJMS_69_16  
Introduction: Temperomandibular joint (TMJ) is subjected to many disorders commonly called Temperomandibular disorders (TMDs); such as TMJ hypermobility, ankylosis, internal derangement, degenerative joint disease. Internal derangement is characterized by abnormal relationship of articular disc to the condyle and disc to fossa. In past many non-invasive conservative treatment modalities were tried out for its treatment which are joint unloading, use of anti-inflammatory agents, physiotherapy etc. Now a days corticosteroids and platelet rich plasma (PRP) has been proposed as an alternative therapeutic agent. We aimed to assess whether intra articular injection of PRP in TMJ minimises the symptoms of internal derangements as compared to injection of hydrocortisone with local anaesthetic. Materials and Methods: Twenty patients for a total of 32 joints with reducible anterior disc location were divided in two groups. One group received PRP injection and the other received hydrocortisone with local anaesthetic for arthroscopy in their affected joints. Both patients and operator were blinded to the contents of injections. The patients were assessed for pain, maximum inter-incisal mouth opening and TMJ sound. Results: In the group of PRP injection, pain was markedly reduced than the group of hydrocortisone with local anesthetic; mouth opening was increased similarly in both groups and TMJ sound was experienced lesser in patients who received PRP. Conclusion: Injections of PRP were more effective in reducing the symptoms, as compared to hydrocortisone with local anaesthetics.
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Comparison of stability with two-time use of platelet-rich growth factor versus one-time use of platelet-rich growth factor in immediate placement of dental implant in infected socket p. 209
Uma Shankar Pal, Dipti Daga, RK Singh, Lakshya Kumar, Mayank Singh
DOI:10.4103/njms.NJMS_1_18  
Purpose: The aim is to evaluate the outcome and compare the stability with two-time use of platelet-rich growth factor (PRGF) versus one-time use of PRGF in immediate placement of dental implant in infected socket. Materials and Methods: This study comprised placement of immediate implant in infected sockets in 100 patients with two-time use of PRGF (Group B) versus one-time use of PRGF (Group A). Proper administration of antibiotics, careful debridement of the socket, and meticulous suturing were done in every case. In Group A, it was placed at the time of immediate implant placement. In Group B, it was placed twice: at the time of placement of implant and 1 month after placement of implant. Clinical assessment of pain and swelling was done. Stability was assessed by radiofrequency analyzer immediately after placement and at follow-up of 2 months and 3 months. Results: The stability of implants with two-time placement of PRGF was more than that with one-time placement of dental implant. All except 14 implants osseointegrated in this study. There was significant decrease of pain and swelling in both the groups from day 1 to week 1 and was nil by 12 weeks. Conclusion: It can be concluded that placement of immediate implant in infected socket with two-time use of PRGF is an effective and better alternative for rehabilitation. However, more studies with longer follow-up and large number of patients are needed to confirm the results of this study.
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The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study p. 215
Preeti Singh, Priyanka Nath, Sukhvinder Bindra, Sadam Srinivasa Rao, K V Ramana Reddy
DOI:10.4103/njms.NJMS_13_17  
Aim: The aim of this study was to describe the characteristics of the mandibular third molar at highest risk for acute pericoronitis using clinical and radiographic analysis. Materials and Methods: A total of 120 patients ranging in age from 18 to 55 years suffering from pericoronitis were examined. Subjective and objective observations were recorded that included the age, gender, angulation of partially impacted mandibular third molar, the frequency of pericoronitis in a year, the presence of impinging maxillary third molar, the extent of soft tissue coverage over the impacted mandibular third molar, the clinical signs evaluated in the patient, the class and position of the impacted mandibular third molar, and the presence of distal radiolucency with respect to the impacted mandibular third molar. Results: The results obtained in the study indicate that pericoronitis is associated more in the age group of 26–35 years and is more commonly reported in the female gender. Distoangular partially impacted mandibular third molars impacted at Class II and position B seem to be at the highest risk of developing pericoronitis. Conclusion: The results obtained in the study indicate that pericoronitis is associated more in the age group of 26-35 years and is more commonly reported in the female gender.Distoangular partially impacted mandibular third molars impacted at class II and position B seem to be at the highest risk of developing pericoronitis.
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CASE REPORTS Top

Single-stage reconstruction of large defect of oral commissure and lips by submental artery island flap p. 222
Arsheed Hussain Hakeem, Imtiyaz Hussain Hakeem, Fozia Jeelani Wani
DOI:10.4103/njms.NJMS_61_16  
Large defect of the lip and buccal mucosa created due to wide resection of the cancer is difficult to reconstruct and always a challenge. Such defects are complex as there is loss of outer skin, muscle, soft tissue, and inner mucosal lining. We report the use of submental artery island flap (SAIF) in the reconstruction of a large defect of oral commissure and buccal mucosa in a 70-year-old female with the diagnosis of verrucous carcinoma. The final outcome was optimal in terms of cosmetic and functional results. We obtained good lip seal without any problem in speech and swallowing. SAIF is an excellent alternative option for reconstruction of large complex defects of lips and oral commissure. It has a reliable vascular supply and provides a thin and pliable tissue for reconstruction in such critical area of face.
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Prosthodontic rehabilitation of a sub-total maxillectomy defect with a definitive hollow obturator prosthesis using the modified lost-wax concept: A novel technique p. 225
Nitasha Gandhi, Harit Talwar, Sumir Gandhi, Vijay Alageshan, George Abraham, Surbhi Mehdiratta
DOI:10.4103/njms.NJMS_26_18  
Squamous cell carcinoma (SCC) of the oral cavity is relatively common in the Indian subcontinent with surgical resection and adjuvant radiotherapy/chemotherapy being the treatment modality of choice. Prosthetic rehabilitation with an obturator following resection is more economical and yields satisfactory results. Better patient acceptance and comfort necessitates hollowing the prosthesis to a great extent. This novel method modifies the existing lost-wax technique in fabricating a definitive hollow maxillary obturator. An elderly man had reported to the Department of Prosthodontics with the chief complaint of a “big hole” in the mouth which affected his quality of life. He had undergone subtotal maxillectomy, following a histopathologic diagnosis of SCC, with adjuvant radiotherapy. Examination revealed an Aramany Class II defect with the healthy oral mucosa. A lightweight definitive obturator was designed and fabricated using a simple technique which utilizes easily available modeling wax. This article describes a relatively simple, single-step fabrication of a closed hollow-bulb obturator prosthesis with a uniform thickness of heat-cured resin encapsulating the hollow prosthesis.
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Solitary myocysticercosis of masseter muscle: A rare presentation p. 229
Shankar Singh, Akhilesh Kumar Singh, Naresh Kumar Sharma, Arun Pandey
DOI:10.4103/njms.NJMS_18_18  
Cysticercosis in human is caused by larva of cyclophyllid cestode named Taenia solium. Worm infestation is quite common in developing countries due to poor sanitation, habit of open defection. This condition primarily involves central nervous system. We present a rare case of myocysticercosis involving the masseter muscle.
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A case of dental hamartoma associated with unerupted primary canine in maxillary region p. 232
Ashish Katiyar, Kirtija Gupta, Swati Solanki, Sukriti Gupta
DOI:10.4103/njms.NJMS_22_18  
Odontomas are usually one of the most common odontogenic tumors of the jaw and are perhaps more accurately defined as a hamartoma than a true neoplasm. It is asymptomatic, nonaggressive, slow growing, and benign nature. They are considered to be the malformations of the dental tissue and can sometimes interfere with the eruption of the associated tooth leading to its impaction or delayed eruption. Complex odontomas in primary teeth are rare and unusually diagnosed before the second decade of life. This article aims to present the case of a child with complex odontoma and its effective treatment planning. The results indicate that early diagnosis and proper treatment planning can ensure a better prognosis and can prevent later craniofacial complications and other developmental problems.
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Anchorage possibilities in case of a unilateral maxillary defect using the concept of Strategic Implant® p. 235
Stefan Ihde, Lukasz Palka
DOI:10.4103/njms.NJMS_36_18  
The aim of this article was to present the treatment method applied to a patient who suffered from a multiple fracture of the right maxilla, as a result of an accident that happened to him at an early age. The main consequence of this injury was an inhibited growth of the maxillary bone segment due to the lack of functional stimulus. The treatment consisted of four phases: the removal of all the teeth in the upper right maxilla, the immediate restoration with bicortical implants, the immediate prosthetic rehabilitation, and closing the oroantral communication.
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