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National Journal of Maxillofacial Surgery
 
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   Table of Contents - Current issue
Coverpage
May-August 2021
Volume 12 | Issue 2
Page Nos. 131-293

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EDITORIAL  

Mucormycosis: “The Black Fungus” trampling post-COVID-19 patients Highly accessed article p. 131
Ambika Gupta, Virendra Singh
DOI:10.4103/njms.njms_415_21  
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REVIEW ARTICLES Top

Evidence-based analysis of the effect of smoking on osseointegrated implant outcome Highly accessed article p. 133
Abeer Ali Hadadi, Maha S Mezied
DOI:10.4103/njms.NJMS_287_20  
The outcome of the osseointegrated implant is influenced by various conditions, one of which is smoking. Literature shows conflicting results for the association between smoking and implant success. Hence, the study was conducted to assess the effects of smoking on survival and marginal bone loss of osseointegrated implants. Literature search of published articles in Medline, Scopus, Ovid, and Journal of Web till June 2020 were analyzed for the determined outcomes. Revman 5.4 software was used for the analysis of the study. Of the 437 articles screened, nine were chosen for review and analysis. Meta-analytic results showed that implant success rate was better in nonsmokers than smokers (odds ratio = 0.43, 95% confidence interval = 0.26–0.72, P < 0.0001). Smoking habit does seem to affect the implant outcome of survival and marginal bone loss negatively.
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Evidence mapping and quality analysis of published dental literature on COVID-19 – A systematic review p. 139
Morankar Rahul, Nitesh Tewari, Vijay Mathur, Shubhi Goel, Gunjar Jain
DOI:10.4103/njms.NJMS_237_20  
A large number of scientific articles have been published regarding impact of COVID-19 infection on dental practice, dental professionals, and the mode of spread of infection via dental procedures. The present systematic review was planned with an aim of evidence mapping and quality analysis of published research on the dental aspects of COVID-19 infection. The protocol was registered at https://share. osf.io/registration/46221-C87-BA8. The search was performed in Scopus, PubMed, Cochrane, and Embase databases till 15th July 2020. There was no restriction of year of publication and language. All types of published articles related to Dentistry, Dentist, Dental practice, and Oral health education on COVID-19 were included. The Joanna Briggs Institute's (JBI) Critical Appraisal Tools were used for the risk of bias analysis of included studies. A total of 393 articles were short-listed and were checked for eligibility and finally, 380 articles were included. Among the 380 research articles published (till July 15, 2020), the majority of the included articles belonged to the lowermost strata of the evidence pyramid. There were 54 original research articles with no randomized clinical trial, systematic review or, meta-analysis pertaining to the dental perspective of COVID-19 infection. The level of available evidence about dentistry and COVID-19 infection is very low with a lack of researches of highest quality. The guidelines/recommendations for dental professionals, proposed by the different scientific organizations/societies regarding COVID-19 infection are only consensus-based necessitating the need to formulate evidence-based guidelines. There is a need to identify essential research questions and strengthen the study designs in most of the aspects related to the dentistry and COVID-19 pandemic.
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Implant survival in patients with neuropsychiatric, neurocognitive, and neurodegenerative disorders: A meta-analysis p. 162
Rathindra Nath Bera, Richik Tripathi, Bappaditya Bhattacharjee, Akhilesh Kumar Singh, Shweta Kanojia, Vikram Kumar
DOI:10.4103/njms.NJMS_230_20  
Neurologic disorders impede oral hygiene measures and routine clinical follow-up, along with the various drugs used may jeopardise oral health and the peri- implant tissue health. A total of 7 studies were considered eligible for the current systematic review. The overall estimated effect was categorized as significant where P < 0.05. Funnel plot was used to assess the publication bias within the studies. Difference in means was used as principal summary measure. P value <0.05 was considered as statistically significant. 1069 implants survived in test group and 4677 implants survived in control group (odds ratio: 2.58, 95% CI: 1.93-3.43) indicating significant success in patient without any disorders or taking medications for these disorders. Subgroup analysis was done to check the implant survival rate in patients taking selective serotonin reuptake inhibitors (SSRI) compared with SSRI non-users. Subgroup analysis showed that SSRI non-users had higher implant survival rate than patients taking SSRI (odds ratio: 2.45, 95% CI: 1.82-3.31). Serotonin significantly inhibits bone mineralization and osteoblast differentiation. The presence of any form of neuropsychiatric or neuromuscular disorders precludes proper oral hygiene and may contribute towards implant failure.
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ORIGINAL ARTICLES Top

A comparison of different osteotomy techniques with and without pterygomaxillary disjunction in surgically assisted maxillary expansion utilizing modified hybrid rapid maxillary expansion device with posterior implants: A finite element study p. 171
Singaraju Gowri Sankar, Bathini Prashanth, Galli Rajasekhar, Mandava Prasad, Ganugapantae Vivek Reddy, J S Yamini Priyanka
DOI:10.4103/njms.NJMS_28_20  
Introduction: The study aims to evaluate the effect of osteotomies with and without Pterygomaxillary disjunction (PMD) during Surgical Assisted Rapid Maxillary Expansion on the displacement pattern and stress distribution of Dental and Skeletal structures of the Nasomaxillary (NM) complex by a modified rapid maxillary expansion (RME) Hybrid appliance. Materials and Methods: A CT scan of a 20-year-old adult with maxillary constriction and the posterior bite was utilized for the restructuring of the finite element model. Five different meshed models were created individually with varying procedures of the osteotomy. A posteriorly anchored Hybrid-Hyrax appliance was utilized for RME. Groups included Group 0 - Control group without osteotomy; Group I - Only Midpalatal osteotomy; Group II - Only Subtotal Le fort I; Group III - Both Midpalatal and Subtotal Le fort I without PMD; Group IV - Midpalatal + subtotal Le fort I with bilateral PMD. The displacement pattern and stress distribution in all three dimensions were recorded and analyzed using analysis of variance and post-hoc Tukey test. Results: Group IV with PMD exhibited the highest stress dissipation and displacement of the skeletal and dental structures followed by Group III osteotomies. The highest stress concentration was at midpalatal suture (292 MPa) for Group III osteotomies. There is no statistical difference between Group III and Group IV osteotomies for many of the parameters measured (P > 0.05). Conclusions: Posteriorly anchored Hybrid appliance without PMD is as effective as that with of PMD.
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Does an autogenous demineralized dentin (ADDM) graft has the ability to form a new bone? p. 181
Jigar M Dhuvad, Deval Mehta
DOI:10.4103/njms.NJMS_12_19  
Aim: This aimed to evaluate a new bone formation and to provide a single-stage treatment, i.e., extraction of tooth followed by autogenous dentin demineralized (ADDM) graft in the same extraction socket (ES) – for adult patients who require tooth extraction. Materials and Methods: Two hundred teeth extractions were performed to investigate the efficacy of ADDM graft in the formation of new bone. After demineralization of dentin graft parameters such as exposure of graft, any signs of infections/pus/exudates, pain, and bone density were evaluated. Results: On follow-up, exposure of graft was recorded in five sockets at 1 month and infection was recorded in four sockets. Pain was significantly high at postoperative day 1 and least with 3rd and 6th months. There was a highly significant bone formation (P < 0.01, 0.05) in the ES group at various time intervals, while there were no significant differences in the adjacent bone group. Conclusion: Using ADDM graft in providing a single-stage treatment plan, i.e., extraction of tooth followed by autogenous demineralized dentin graft in the same ES in adult patients – is an alternative for the immediate reconstruction of alveolar bone defects to facilitate the future prosthesis. It also saves the cost of other graft materials which are commercially available in market for the patient and also reduces the infective dental waste globally.
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Diagnostic significance of serum and salivary lipid levels in oral precancer and oral cancer p. 188
Vandana Singh, Ranjitkumar Patil, Subash Singh, Anurag Tripathi, Vikram Khanna, Wahid Ali
DOI:10.4103/njms.NJMS_268_20  
Introduction: Lipids are one of the major constituents of the cell. Variations in the serum lipids have been considered a cofactor of carcinogenesis, as lipids play a crucial role in cell integrity. Saliva is an ultrafiltrate of plasma and correlates with the serum, which may be used as an alternate method of serum lipid level estimation. The study was conducted to find any correlation between serum and salivary lipid levels and to evaluate the changes in serum and salivary lipid levels in oral precancer and cancer patients. Aims and Objectives: This study aimed to evaluate the changes in serum and salivary lipid levels in oral precancer and cancer patients and to correlate salivary lipid levels with serum lipid levels. Materials and Methods: The study was an in vivo study conducted on randomly selected 129 patients with oral cancer and oral precancer. The selected subjects were divided into four groups as Group 1 – healthy control, Group 2 – oral submucous fibrosis, Group 3 – leukoplakia, and Group 4 – oral cancer. Serum and salivary lipid levels were estimated biochemically and statistically analyzed for any correlation with oral precancer and cancer. Results: Lipid level estimation showed no statistically significant difference on comparison of intergroup serum and saliva total cholesterol level and high-density lipoproteins among all four groups, whereas intergroup comparison of serum and saliva triglycerides (TG) levels among the four groups showed a statistically significant difference in saliva TG level. The correlation of serum and salivary lipid levels showed a significant positive correlation. Conclusion: In the present study association between serum/salivary lipid levels and oral precancer and oral cancer could not be established. A positive association was there in serum and salivary lipids hence salivary lipid levels may be used as a noninvasive technique for serum lipid level estimation.
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Role of cartilage correcting sutures in single-stage secondary rhinoplasty for unilateral cleft lip nose deformity p. 193
Sunil Sharma, Kshiteej Dhull, Archana Jai Singh Yadav
DOI:10.4103/njms.NJMS_282_20  
Introduction: The purpose of this study is to highlight the role of cartilage correcting suture in single-stage surgical correction for secondary unilateral cleft lip nose deformity with three-dimensional observations of preoperative and postoperative nasal forms. Material and Methods: Between July 2017 and June 2019, 18 consecutive patients of unilateral cleft lip nose deformity aged between 16 and 28 years underwent surgical correction. The corrective procedure of nose involved columellar lengthening, medial and lateral nasal osteotomies along with augmentation of premaxilla by bone graft at premaxilla, and alar base wedge resections. Focus was laid to correct nasal cartilaginous framework using tip sutures along with repositioning of lower lateral cartilages, fixation of the alar cartilage complex to the septum, and the upper lateral cartilages. We investigated the following surgical interventions and nasal tip suture techniques, which were transdomal suture, interdomal suture, lateral crural mattress suture, columella septal suture, and intercrural suture. Results: We achieved adequate esthetic and functional results in all the patients without any morbidity. Conclusion: This concept of simultaneous approach toward complete single-stage correction of secondary cleft lip nasal deformity incorporating various cartilage suture using 5-0 nylon in developing nation like ours, where the patient presents late with complex conditions showed promising esthetic and functional outcome.
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Collagen matrix membrane as a biological dressing in defects of the oral mucosa p. 199
Fahad Ahmad, Jeevan Lata
DOI:10.4103/njms.NJMS_128_20  
Objectives: The objectives of this study were to evaluate the usefulness of the extracellular collagen matrix membrane as a biological wound dressing material for defects of the oral mucosa. Materials and Methods: One hundred two patients were included in the study. A bovine-based extracellular matrix collagen membrane was used. The study was confined to those defects of oral mucosa which were large enough to close primarily. Results: The results were evaluated under various parameters such as hemostasis, pain relief, granulation, epithelialization, and contracture of the wound. Secondary infection and allergenicity to the membrane were also considered, and finally, the usefulness of the collagen membrane was tested by the use of the Chi-square test and P < 0.001 was found. Conclusion: We concluded that the extracellular collagen membrane could be used as a biological dressing in oral defects. Although it does not replace, it is proved as a good substitute of autologous graft.
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Common postoperative complications after general anesthesia in oral and maxillofacial surgery p. 206
Parveen Akhter Lone, Nisar Ahmed Wani, Qurrat ul Ain, Abha Heer, Ranjna Devi, Shivani Mahajan
DOI:10.4103/njms.NJMS_66_20  
Aim and Objectives: Anesthesia is Greek word meaning loss of sensation, and involves painful invasive procedure to be performed with little distress and no pain to the patient. Postoperative anesthetic complications are very common and duration of surgery is frequently cited as major risk factor for postoperative complications. The recognition and treatment of these complications are important when providing good quality care. The purpose of this study was to evaluate mild, moderate, and severe postoperative complications in patients undergoing maxillofacial surgery under general anesthesia and also determine the safety of general anesthesia in healthy and patients with comorbidities. Subjects and Methods: This prospective study was conducted in the oral and maxillofacial surgery department. Two hundred and twenty patients who were operated under general anesthesia were taken in study. All relevant past medical and dental records were noted and were supported by preformulated questionnaire and was filled preoperatively and after surgery to 12 weeks. Results: Mild-to-moderate and severe complications were noted. Females showed more complications than males. Most common complications were sore throat, dysphagia, nausea, vomiting, pain, swelling in normal patients, and in patients with comorbidities delayed wound healing, hypertension, and infection were also seen. Conclusion: The use of General Anesthesia is considered safe but it has few risks associated with it and past medical conditions should be evaluated preoperatively.
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Effects of intraoperative placement of tetracycline, tetracycline + gelatin sponge, and placebo on postoperative pain after mandibular molar extraction: A comparative prospective study p. 211
Vinay Patil, PN Ramaraj, Mandeep Sharma, Rohit Singh, Abhijith George, Bhaskar Roy
DOI:10.4103/njms.NJMS_47_20  
Background: Painless postoperative period is a major requisite following routine dental extractions. Reduction in the postextraction complication is beneficial to both clinician and patients. Hence, emphasis should be given to the techniques and agents that help reduce the complications for better postoperative recovery. Materials and Methods: Three groups of 30 patients each requiring mandibular molar extractions were randomly selected with intrasocket placement of tetracycline, tetracycline plus gelatin sponge, and placebo control after extraction. A small piece of collagen membrane was used on the superior surface of the socket after the placement of the medicament in Group A and Group B. The postoperative pain scores were evaluated at 24 h, 48 h, and 7 days postoperatively. Results: Ninety patients requiring mandibular molar teeth extraction were enrolled as the study participants. Forty-two patients (55.26%) were male and 34 (44.73%) were female. Tetracycline alone and tetracycline + gelatin sponge group shows no statistical significant difference in reducing postoperative pain after 7 days, but the pain score values were less in Tetracycline + gelatin sponge group. The comparison between tetracycline alone and control group showed no significant difference observed between the groups at 24 h but showed statistically significant difference between the groups after 48 h and 7 days, whereas comparison between tetracycline + gelatin sponge and control group showed statistically significant difference between the groups after 24 h, 48 h, and 7 days (P = 0.009, 0.001, and 0.017, respectively). Conclusion: Tetracycline and gelatin sponge intrasocket placement provides a good substitute to the prolong use of analgesics and as a good adjuvant in reducing pain in the first few days after routine dental extraction.
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Impact of COVID-19 on oral and maxillofacial surgery practice in India: A national survey p. 219
Kuldeep Vishwakarma, Deepakkumar Hamirbhai Khakhla, Aafiya Ambereen, Saurabh Kumar Rawat, Prabhaker Mishra, Bharat Shukla
DOI:10.4103/njms.NJMS_263_20  
Study Design: The Coronavirus disease-19 (COVID-19) pandemic has disrupted oral and maxillofacial (OMF) surgeons' practice globally. We implemented a cross-sectional, questionnaire-based survey among the OMF surgeons of India. Objective: The objectives of the study were (1) gathering data among the maxillofacial surgeons in terms of their occupational exposure and access to adequate personal protective equipment (PPE) and (2) to estimate how the COVID-19 pandemic has affected the practice of OMF surgeons in India. Materials and Methods: Complete responses of 178 OMF surgeons were included in the study. Descriptive and analytic statistics were computed. The level of statistical significance was set at P < 0.05. Binary logistic regression models were created to assess the predictors of the impact of the COVID-19. Results: Out of the 178 respondents of the study, most (37.1%) were following their hospital's guidelines. Most had access to adequate PPE (89.9%), whereas 93.8% had COVID-19 testing available. One hundred and thirty-three (74.7%) surgeons were involved in teleconsultation. Ninety-two (51.7%) and 166 (93.3%) were involved in elective surgery and emergency surgeries, respectively. Median outpatient department cases and number of surgeries done per week reduced by 73.9% and 66.7% (P < 0.001), respectively. Most surgeons (86%) experienced that cost of treatment had increased during the COVID. Over 75% were afraid to get infected with COVID, whereas 44.9% were anxious to lose the income. More than 56% of the OMF surgeons reported a fall in income and 94% reported decreased productivity in academic research. Most surgeons (93.8%) believed that COVID had a positive impact on human behavior in terms of hand hygiene. Conclusion: The impact of COVID-19 among OMF surgeons has adversely affected clinical practice, personal lives, and academic productivity and has catalyzed an exponential increase of telemedicine. Future surveys should capture the long-term impact of COVID-19.
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Serum beta-2 microglobulin analysis in patients with oral squamous cell carcinoma p. 227
Joyce Sequeira, Shreya Sengupta, Bhupendra Mhatre
DOI:10.4103/njms.NJMS_242_20  
Aim: This study aims to compare the level of serum beta-2 microglobulin (β2-M) in normal healthy individuals and patient with squamous cell carcinoma (SCC). Methodology: This study has been conducted in patients attending the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Deralakatte, Mangalore. Sample comprises of 25 cases of clinically and histologically diagnosed oral cancer and 25 normal healthy individuals as control group. The serum was analyzed for β2-M by enzyme-linked immunosorbent assay. Results: It was observed that there was a significant increase in serum β2-M levels in oral SCC patients as compared to controls. Circulating levels in serum β2-M were also elevated significantly among different clinical stages with progressive rise from stage I to stage IV of the disease. Conclusion: The evaluation of these markers would be useful in assessing malignant change, increasing accuracy of clinical diagnosis and also in assessing the spread and invasiveness of the cancer of the oral cavity.
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Manuka honey: A promising wound dressing material for the chronic nonhealing discharging wounds: A retrospective study p. 233
Nupur Kapoor, Rahul Yadav
DOI:10.4103/njms.NJMS_154_20  
Objectives: To assess the efficacy and feasibility of topical manuka honey application in chronic nonhealing discharging extraoral wounds. Materials and Methods: The study includes 15 patients (9 males and 6 females, mean age: 38.06, range: 20–50 years), presenting with the complaint of chronic nonhealing discharging extraoral wounds from January 2018 to January 2020. After wound irrigation with normal saline, manuka honey in conjunction with the antibiotic treatment was directly applied onto the surface of the wound and was then covered by an absorbent layer to contain the honey. Dressings were changed every alternate day for a week till there was complete cessation of pus discharge. Henceforth, the interval between dressings was increased to 1 week subsequently and was continued for 4 weeks. Assessment was done on the basis of discharge and depth of the wound before the procedure and weekly for 4 weeks. Results: The average depth of wound as seen at 15 sites after a week was 5.72 mm, and decrease in the average depth of wound seen at the end of the 4th week was 0.88 mm with complete wound epithelization. This was found to be statistically significant (P = 0.0001). No cases were reported with allergy, pain, infection, inflammation, and swelling on 1st, 2nd, 3rd, and 4th week. Conclusion: Hence, the use of manuka honey as a wound dressing material in our study has proved to promote the growth of tissues for wound repair, suppress inflammation, and bring about rapid autolytic debridement.
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Comparison of efficacy of lignocaine, ropivacaine, and bupivacaine in pain control during extraction of mandibular posterior teeth p. 238
Jazib Nazeer, Soni Kumari, Nazia Haidry, Pranay Kulkarni, Aastha , Ashesh Gautam, Preeti Gupta
DOI:10.4103/njms.NJMS_14_20  
Background: The management of pain during extraction of mandibular third molars is an important requisite to achieve patient comfort and to obtain desired result in an effective manner. There are various anesthetics that can be used to achieve regional or local anesthetic effect in this regard. Aim: The aim of this study was to compare the efficacy of 2% lignocaine with 1:80,000 adrenaline, 0.75% ropivacaine and bupivacaine in pain control during extraction of mandibular posterior teeth. Materials and Methods: This prospective, cross-sectional study included 300 study participants indicated for mandibular third molar surgical extractions. The study subjects were categorized into three broad groups - (a) Group I (n = 100): Third molar extractions performed using 2% Lignocaine with 1: 80,000 epinephrine; (b) Group II (n = 100): This group included subjects who underwent extractions of mandibular third molars using 0.75% ropivacaine and (c) Group III (n = 100): This group included patients who underwent extractions of mandibular third molars with bupivacaine. Inclusion criteria were: (a) partially impacted mandibular third molars which were symptomatic; (b) written informed consent. Exclusion criteria were – (a) any systemic diseases and/or undergoing any medication for same; (b) subjects not willing for extraction after clinical and radiographic examination and opinion and (c) subjects undergoing orthodontic therapy. Subject response for pain was recorded using – (a) visual analog scale (VAS) and (b) Verbal Rating scale (VRS). Postoperative pain was assessed using requirement of analgesics after extraction. SPSS version 21.0 was employed as statistical software. Statistical tool used was the Analysis of Variance test which was used for determining statistical significance which was set at a P value of lesser than 0.05 (significant). Results: On analysis of visual analog scale (VAS), it was observed that in Group I (2% Lignocaine with 1:80,000), no pain during the extraction procedure was demonstrated in 30 study participants while minimal or less pain was present in 70 patients, while in Group II (0.75% ropivacaine), 90 patients presented with no pain while ten patients had presented with minimal amount of pain during tooth extraction. While on the other hand, Group III patients whose mandibular third molars were extracted using local anesthesia by injecting bupivacaine, lack of any pain was observed in 69 patients while minimal pain was noted in 31 individuals. While making statistical comparison between three groups, a significant P = 0.03 was observed. Also, postoperative pain was noted in 60% of cases who underwent extraction using 2% lignocaine (Group I), 10% patients who had third molar extractions under Bupivacaine anesthesia presented with pain whereas none of the patients (0%), demonstrated the presence of pain following third molar extraction. Conclusion: 0.75% Ropivacaine is the most effective local anesthetic agent that can be used for extracting mandibular third molars due to its effective pain control both during and following the procedure when compared to 2% lignocaine and bupivacaine.
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Knowledge and awareness of dental implants as a treatment choice in the adult population in North India: A hospital-based study p. 244
Abhinav Jha, Vinit Aher, Preeti Lath, Monica Khangembam, Nishant , Pooja Pani, Ujwal Singh
DOI:10.4103/njms.NJMS_38_20  
Background: Implantology is an emerging field of science, although there are not many subjects who opt for this treatment modality. Replacement of missing or lost teeth with dental prostheses supported by oral implants has been accepted and received positive evaluations from patients who have undergone implant treatment. Today, implant-supported restorations can be considered the treatment of choice from the perspective of occlusal support, preservation of adjacent teeth, and avoidance of a removable partial denture. Currently, dental implants are widely accepted as a prosthetic treatment of completely or partially edentulous patients. This led to widespread acceptance and popularity of dental implants within the dental professional community. Aim: The aim of this study was to evaluate knowledge, attitude, and awareness of dental implants in residents of Uttarakhand. Materials and Methods: A total population of 500 subjects were randomly selected and evaluated based on filled questionnaire responses. Results: A low level of knowledge was observed on analyzing the filled responses among the studied population. Conclusion: General public should be made aware on dental implants as treatment modality along with the focus on increasing the cost feasibility.
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Comparison of the efficiency of arm force versus arm force plus wrist movement in closed method extractions an observational study p. 250
Prashanth Sundaram, Saravanan Kandasamy, Reena Rachel John, K C Keerthana Sri
DOI:10.4103/njms.NJMS_212_20  
Backgound: Atraumatic dental extraction preserves not only the bone, but also maintains the gingival architecture, hence allows immediate or late dental implant placement. The incidence of fracture of roots and buccal cortical plates increases when wrong force is used. Currently, there is insufficient literature evidence with regard to the appropriate method for application of arm and wrist force at the time of dental extraction. Aim: Therefore, the aim of the present study was to compare the efficiency of arm force only versus arm force plus wrist movement during closed extractions. Materials and Methods: The patients who underwent extractions of right upper molars (n = 50) in the Oral and Maxillofacial Surgery Department were selected for the study after obtaining Informed Consent. The patients with grossly decayed broken teeth and mobile teeth were excluded. The procedure was carried out by interns and was observed by three maxillofacial surgeons of more than 5 years of experience independently. Results: It was observed that 30% of the trainees used arm only force during dental extraction and were unaware about it. The time taken for tooth removal in the group which used arm and wrist force was significantly lesser (P < 0.001). It was also observed that the breakage of tooth and alveolar bone fracture was more common with the group who used only arm force. Conclusion: From the results of the present study, it can be concluded that during exodontia procedures, the principle of using arm and wrist facilitates safe and easy removal of tooth with less time.
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A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars p. 255
Shubhada Harishchandra Nalawade, Kumar Nilesh, C D Mounesh Kumar, Prashant A Punde, Pankaj B Patil
DOI:10.4103/njms.NJMS_7_20  
Introduction: Dexmedetomidine is a selective alpha-2 adrenoceptor agonist. It is conventionally used as a sedative in the intensive care unit. However, recently, the application of dexmedetomidine as an adjuvant to a local anesthetic agent has been studied. The present study intends to evaluate the effectiveness of dexmedetomidine as an adjuvant to 2% plain lignocaine for surgical removal of impacted mandibular third molar and to compare the efficacy of dexmedetomidine with 2% plain lignocaine with 2% lignocaine and 1:200000 adrenaline. Materials and Methods: A total of 80 patients who required surgical removal of impacted mandibular third molar extraction were included in the study. Patients were randomly divided into two groups using a computer-generated table. Patients in the study group received 2% plain lignocaine with 1 mcg/ml dexmedetomidine. Patients in the control group received 2% lignocaine with 1:200000 adrenaline. The parameters evaluated were onset and duration of action, pulse rate, blood pressure, oxygen saturation, and blood loss. Results: Onset of action was faster and the duration of action was longer when dexmedetomidine was used with lignocaine as a local anesthetic agent. The vital parameters in both the groups were stable. Bleeding at the surgical site was less in the dexmedetomidine group. Conclusion: The study concluded that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine when injected for nerve blocks.
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CASE REPORTS Top

Late-onset inverse Bell's phenomenon after upper eyelid trauma p. 262
Dimitrios A Liakopoulos, Georgios Bontzos, Efstathios T Detorakis
DOI:10.4103/njms.NJMS_283_20  
Bell's phenomenon evaluation is an important part of preoperative patient assessment for eyelid surgeries. Inverse Bell's phenomenon is a rare manifestation, usually observed in the early postoperative period following ptosis restoration surgeries, in pathological conditions, and in a small proportion of normal population. In the current case report, a 6-year-old girl presented with late-onset posttraumatic inverse Bell's phenomenon, 6 months after facial trauma with posttraumatic lagophthalmos. Rehabilitative blepharoplasty for the correction of lagophthalmos led to the restoration of inverse Bell's phenomenon 3 months postoperatively. Potential causative mechanisms are discussed for this late-onset manifestation of inverse Bell's response.
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One-piece implants: Careful approach for complex rehabilitation p. 266
Farhan Durrani, Rakhshinda Nahid, Samidha Pandey, Preeti Singh, Aishwarya Pandey
DOI:10.4103/njms.NJMS_191_20  
It is understood that one-piece implant design is a stronger concept as there is no connection between implant and abutment. The absence of a microgap can lead to minimal peri-implant bone loss. Furthermore, there is a reduction of mechanical complications such as screw loosening and abutment fractures. These implants can be immediately placed and can be put through instant function because of their high cortical stabilization. This immediate function protocol has advantages over two-stage surgical placement. Other benefits are fewer surgical appointments, reduced treatment time, and minimal trauma. It is suggested that one-piece implant can be an alternative to conventional implants for edentulous arches where there is a resorbed bone in width and height. Initially, one-piece implants were used as transitional or provisional implants. However, because of biological osseointegration, their removal often became difficult. Several manufacturers obtained approval for its use in defined situations. Proper treatment planning avoided comorbidity associated with augmentation procedures and acceptable esthetic result was achieved.
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Low-grade fibromyxoid sarcoma: A rare case report p. 271
Vinayak Gourish Naik, Kirthi Kumar Rai, HR Shivakumar
DOI:10.4103/njms.NJMS_54_15  
Low-grade fibromyxoid sarcoma (LGFMS) is a rare type of sarcoma that is characterized by benign-appearing histologic features but a paradoxically aggressive clinical course. Recognition of this lesion is important because of its indolent but metastasizing nature. These tumors generally occur in young to middle-aged adults, sometimes in children, but rarely in the high-aged adults. LGFMS typically affects the deep soft tissues of the trunk or lower extremities: however, it is rarely seen on the maxillofacial region. Here, we describe a case of LGFMS on the left lower one-third region of the face of a 35-year-old male patient with a 6-month history. On gross examination, the resected specimen consisted of an open ovoid mass of 2 cm × 2 cm × 1 cm. Light microscopy revealed well-circumscribed myxoid tumor with hypocellular areas in nodules merging to collagenized areas. Immunohistochemical examination revealed diffuse positivity to vimentin, whereas tests for desmin, S-100 protein were negative, thus confirming the diagnosis. After the initial healing of the surgical wound, the patient was advised 30 cycles of radiotherapy. Recurrence and metastasis have not been observed for 1 year of surgical excision now. Due to the notably indolent nature of LGFMS, long-term follow-up is necessary to evaluate its clinical course
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Management of a case of osteoma of coronoid: A rare case report p. 276
D Saikrishna, Asutosh Das, Chhaya Jha
DOI:10.4103/njms.NJMS_68_19  
Coronoid process osteoma is an extremely unusual and slow growing tumor which causes functional limitations of the temporomandibular joint. Till december 2014 only 7 cases have been reported worldwide. This case report is about a 40 year old male patient with osteoma of left coronoid process. Treatment plan constitutes of surgical resection of the mass and post operative physiotherapy.
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Treatment of partial ankyloglossia using Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF): A case report with 6-month follow-up p. 280
Astha Jaikaria, Suhani K Pahuja, Seema Thakur, Pooja Negi
DOI:10.4103/njms.NJMS_69_19  
Ankyloglossia or “tongue-tie,” observed in neonates, children, or adults, is characterized by an abnormally short, thick, fibrosed lingual frenulum which may cause restriction in function of tongue including limitation in tongue movement. The use of Hazelbaker Assessment Tool for Lingual Frenulum Function allows elaborate and extensive scoring of the anomaly. This article reports the surgical management of an 11-year-old patient having ankyloglossia associated with restricted movement of tongue and difficulty in speech. Six months postoperatively, the patient showed uneventful healing and was satisfied with the procedure.
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Rare case of giant myoepithelioma in minor salivary glands of palate in a 9-year-old child p. 284
Swapna Patankar, Reshmi Sharma, Amod Patankar, Venkatesh Kulkarni
DOI:10.4103/njms.NJMS_16_19  
Myoepitheliomas (MEs) are extremely rare benign neoplasms composed of ectodermally derived contractile smooth muscle cells (myoepithelial cells). Various tissues such as the salivary glands, breast, larynx, and sweat glands show the presence of these myoepithelial cells. They occur, principally, in the parotid gland and infrequently in minor salivary glands. The term “Myoepitheliomas” was first coined by Sheldon in 1943. It is an uncommon salivary gland tumor which accounts for < 1% of all major and minor salivary gland tumors. Batasakis considers the ME to be “one-sided” variant at the opposite end of the spectrum from the pleomorphic adenoma. There are distinct histological and immunohistochemical characteristics of the tumor which aid in the diagnosis. ME of the palate is uncommon, and only a limited number of cases have been reported in the English literature. It shows a benign clinical course with recurrence in up to 20% of cases without metastasis. The present article sheds light on the presence of ME of minor salivary glands in the palate of 9-year-old child.
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Guide flange Prosthesis for management of hemimandibulectomy p. 289
Siddharth Bandodkar, Deeksha Arya, Saumyendra Vikram Singh, Pooran Chand
DOI:10.4103/njms.NJMS_36_19  
Guide flange is given to patients who have undergone surgical hemi/segmental/subtotal mandibulectomy due to various reasons (leading cause being squamous cell carcinoma), with resultant mandibular deviation. If procedures such as secondary osseous grafting are planned, the clinician has to wait for healing of the graft, lesion, or radiotherapeutic effects to abate. Only after the healing of the graft, a definitive prosthesis can be planned. During this time lag, prosthesis must be given to the patient to correct mandibular deviation on account of unilateral muscle pull. Furthermore, in certain cases, a definitive prosthesis has to be put on hold due to failure of bone grafting or when the patient is not willing for a second surgery. This report describes the fabrication of such a mandibular guide flange prosthesis.
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