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Oral Surgery - Science topic

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Thank you doctor for your advise.
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I received an e-mail from OEA publishers to submit an article for their special issue on Oral and Maxillofacial Surgery. I was naive enough to succumb to this request. I submitted my article which was rejected on grounds of length of the article (Very long article). I changed the whole article wrote it again and resubmitted it. It was rejected again since it had " repetitive paragraphs".
I want to what has been your experience with this publisher? My subsequent search has revealed that OEA is a predatory publisher.
Please comment.
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Indeed, OAE Publishing Inc. (https://oaepublish.com/ ) is mentioned in the Beall’s list of potential predatory publishers: https://beallslist.net/
However, rejecting a submission twice is not typically predatory. Are you sure about the publisher (what journal are we talking about)?
Best regards.
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It is interesting to know if there is any possible benefits to use Photobiomodulation for nerve injuries especially after oral surgery.
For example, cases of traumatic injury of the lingual nerve. Especially that this complication can sometimes persist for more than a year and affects largely the patient's quality of life.
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Hosseinpour S, Tunér J, Fekrazad R. Photobiomodulation in Oral Surgery: A Review. Photobiomodul Photomed Laser Surg 2019;37(12):814-825. https://www.researchgate.net/publication/337431725_Photobiomodulation_in_Oral_Surgery_A_Review
Dompe C, Moncrieff L, Matys J, Grzech-Leśniak K, Kocherova I, Bryja A, Bruska M, Dominiak M, Mozdziak P, Skiba THI, Shibli JA, Angelova Volponi A, Kempisty B, Dyszkiewicz-Konwińska M. Photobiomodulation-Underlying Mechanism and Clinical Applications. J Clin Med 2020;9(6):1724. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356229/pdf/jcm-09-01724.pdf
Ibarra AMC, Biasotto-Gonzalez DA, Kohatsu EYI, de Oliveira SSI, Bussadori SK, Tanganeli JPC. Photobiomodulation on trigeminal neuralgia: systematic review. Lasers Med Sci 2020 Nov 20. doi: 10.1007/s10103-020-03198-6. Epub ahead of print. https://www.researchgate.net/publication/346534901_Photobiomodulation_on_trigeminal_neuralgia_systematic_review
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One bacteria in the HACEK group is the Kingella. Kingella is a coccobacillary to short bacilli with squared ends that occur in pairs or short chain and causes infection associated with dental hygiene and oral surgery. So, aside from these occasion, what are the other factors that contributes to the manifestation of infection?
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This is interesting article ,you may get useful information
Kingella kingae: Carriage, Transmission, and Disease
Pablo Yagupsky
Clin Microbiol Rev. 2015 Jan; 28(1): 54–79.doi: 10.1128/CMR.00028-14PMCID: PMC4284298PMID: 25567222
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Do you prefer resection to avoid recurrence or you prefer more conservative approaches ( enucleation, marsupilisation...)
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My preference goes to marsupialization and decompression after biopsy which is mandatory so that we can be sure of the diagnosis.. very good results were reported and even from my personal experience.
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Always sample is contaminated with Saliva
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It is difficult to measure the exact amount of blood loss during oral surgery as most of the surgeries use normal saline irregation specially when bone intervention or osseous surgery required. But we can predict amount of blood loss based on
1- type of surgery whether osseous or soft tissue surgery, and wether saline irrigation is required or not
2- duration of the surgery of course longer duration leads To more blood loss
3- site of surgery if there are main blood vessels at that site or just capillaries leads only to oozing of small amounth of blood what ever the duration is.
these are some tip to quantify or predict almost the amount Of blood loss during oral surgery.
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Hello,
These Questionnaires are extensively used in both clinical and research settings. Berlin questionnaire has more questions and assists the patient snoring. But one disadvantage is that it only categorise patients to high or low risk. While STOP-bang questionnaire is shorter but it categorise patients to high , medium and low risk.
We are conducting a cross sectional study to find the prevalence of possible obstructive sleep apnea among dental patients based on sleep apnea questionnaire and oral findings (airway, tongue size...).
My question is: Which one of these questionnaires is recommended for such study?
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STOP-BANG Questionnaire is more reliably and easier to use
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I have CBCT pre and post maxillofacial surgery. From these images the pharinx is segmented. The aim is to simulate the pharinx's deformation caused by surgery. What can I do?
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Ok! How can I shape the palatopharyngeous muscle? Is there a mechanical model?
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Mini plate insertion may come closer or maybe even inside periodontal tissue
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Do you mean the mini-screws. If so- the answer is : Yes !
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the germs support many studies have a central role on the development of the mronj, my hypothesis and compare germ-free animals (mice or rats) with SPF with a study model that could explain much of the pathogenesis of this adverse event. ..who collaborate? (oral surgery,implant surgery, osteonecrosis of the jaw, biphosphonate)
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thank you!
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Is there a technique to be applied during excision of the denture fissuratum so that I will not need to make a vestibuloplasty later?
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You can use water laze and utelise from the bandeging effect of the laser you don't need furthermore surgery.
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What is the best laser for gingival and lip depigmentation?
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Biolase by using the turbo HP very good result
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A research assistant told me that the mandibular anterior region is a safe region for implant placement despite the presence of mandibular incisive canal because of the nerve atrophies after the extraction of teeth in this region. But what if we put a single implant between some other anterior teeth or if we take a graft from anterior bone in the presence of the teeth?
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dear Dr Ulkem Aydin .
I dont think the nerve atrophies at all we have done studies on the distribution of the nerve in the anterior area in cadavers (MSc thesis) not published )and we found that the nerve never atrophies its there but not in a huge amount as when the teeth were there .the nerves are shortnedbut shortened . if your implant is long enough it will reach it and cause numbness.
sincerely Yours
Dr.K.A.Galil.Professor of Dentistry
DDS.,D.Oral & Maxillofacial Surgery,PH.D,FAGD.,FADI.,Cert.Periodontist(Royal College of dental surgeons )
,Developer of The patented first App in Oral Histology for i Pad,i Phone ,i Pod Touch
visit the web site
 and down load a free demo ,look at the bottom of the page .
see Dr.Galil listed as  #17 on 51 first researchers
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Contact or non contact? 
Best parameter setting?
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Thank you Dr. Alhabil for the reply, i also wanted to know how do you differentiate if the melanin has been removed in non contact mode, how long does it take for the results to be evident?
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After OKC enucleation, the inferior alveolar nerve will be freely situated in the cavity. Carnoys solution application may damage it while fixing the cyst remnant. How can we avoid such complication ?
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Dear Amel... first you should squeeze the gauze (soaked by the solution) then the nerve should be covered by a wet gauze (normal saline) then you should have a good assistant to reflect the nerve and the covering gauze.. Apply the gauze soaked with the Carnoy's solution for not more than 2 minutes.. its odor is so strong and it may be toxic so try not to breath it as u can... with best regards
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The research papers on air emphysema is minimal, please explain the mechanism of development and management of air emphysema following open tracheostomy.
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the main cause for air trapping and surgical emphysema is failure to open the pre tracheal facia widely.to avoid: before you make your tracheotomy incision in the tracheal rings , dissect elevate and incise the thin layer of pre tracheal facia tightly attached to the trachea
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Just got a question concerning the total aplasia (primary + permanent) in the 4th quadrant of a 4-y-old boy. No more info available at the moment.
Don't know what to recommend.
1. Transplantation: seems from the radiograph that there is no bone as alveolar process. Would mean lateralisation of nerve. Never heared of such surgery in such a young patient. Any information???
2. Tx 2: Never done such surgery in that age. Earliest tx was a primary canine in a 6-y-old to replace a lost incisor, earliest tx of a pm to replace an aplastic pm was at about 11y.
3. Tx 3: Never done that in cases like this: Will there be the development of an alveolar process or will it stay as lower-jaw basis? I guess it should develop, at least in parts, but I don't know for sure...
4. Indication to treat: Definitely yes, I have the impression of muscular hypertrophy on the left. But when? Still some time, or tomorrow?
5. Indication 2: Any other treatment? Temporary? Definitive?
Thx.
Yango
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Hi, Hayfaa,
(sry for using first name, could imagine that Hayfaa is female, but don't know for sure, thus trying to avoid Mr. or Mrs. + I prefer first name)
thanks again for your valuable comments.
Yes, maybe there is no permanent canine, the germ looks inddeed like an incisor. Since I don't want to judge from a radiograph, especially in the aplasia cases where there sometimes also the teeth show irregular appearance, I avoided to name the tooth. Nevertheless, I had a closer look onto the radiograph, and I think the primary canine 83 is also not what I thought (and or sure) but looks like an atypical primary incisor with some developmental coronal irregularities.
But - what would be the consequence for the treatment? Maybe, it is decisive in the long run, but I think these cases are much to rare to have any information whether there are better or worse results with a permanent canine. It is in my opninion most important to have as many natural teeth as possible.
That said, I think, I will propose the transplantation of the primary incisors to the 4th quadrant... Again, thank you for forcing me to rethink...
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Uncontrolled post extraction bleeding is encountered by many dental practitioners and literature has numerous methods to control such bleeding like use of pressure pack, bone wax,suturing etc. But which local haemostatic agent is best and simple to use with limited/no post operative complications?
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Topical use of Tranexamic acid (TXA an antifibrinolytic agent) is often used by dentists who perform procedures on patients on anticoagulant treatment (Patatanian E, Fugate SE: Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction, 2006). It seems effective and safe, easy to use and well accepted by patients.
Furthermore, it has been shown to reduce bleeding in orthognatic surgery (Olsen JJ, Skov et al: Prevention of Bleeding in Orthognathic Surgery-A Systematic Review and Meta-Analysis of Randomized Controlled Trials, 2015). There is also a recent Cochrane review evaluating the topical use of surgery in general.
I am not a dentist, therefore this suggestion is not based on practical knowledge but my Work on anticoagulant treatement
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I need full text of the mechanical complication and causes!!!! 
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Dear Dr. Reyes,
I think that the recommendation that Dr. Nwhator gave is absolutely correct. You should do a Medline search which will generate a large number of "hits". Then you look at the  Titles and abstracts of these identified potential reference papers and you order the papers that are most relevant to your research question. You can order these articles from a medical library or you might be able to go into that medical library and make copies of the articles the old-fashioned way with a xerox machine.
You have to be aware that there are copyright laws to prevent distribution of articles even if you are talking to the original author of that article. If an author submits an article to a journal they give away the copyright to that article in that copyright is owned by the Journal. The abstracts are shared by the journals with Medline because it is in the interest of the publisher to gain interest in articles published in their journals. Distribution of free copies however would not be thought of as generally acceptable. There are exceptions, online full access journals  do exist. If the references that you are interested in are found in those journals you should be able to download those articles from  the Internet sites of those journals. In some instances you may have an electronic subscription to a specific journal which would allow you to download a specific article, one copy, but to ask for a blanket responsive receipt of free copies of articles on a specific topic is really not appropriate and would violate copyright law.
So  it comes down to your having to do the investigational work. You have to understand that  literature reviews are indeed secondary research and if you are interested in the results of secondary research you should be willing to make that effort. The task is to first perform the Medline search, this is called item generation, then you look at the titles and abstracts and eliminate the ones that are clearly inappropriate for the topic that you are trying to search, this is called item reduction but there are a number of steps to item reduction. Even after you read the full text article you might find in an article has no particular relevance towards your research question.  Honestly, this is the expectation in research. Anyone who has been involved in research can tell you that you have more dead ends then you have revelations. That should not stop you  from performing research but it is a recognition that you have to have.
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Tooth extraction under sedation, minor oral surgery, sedation, general anesthesia
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i would like not to combine the drug in case of children, but with adults studies says u can. i am not sure with children
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I am a faculty and a part time research scholar. My research is based on application of CBCT in Cleft lip and palate patients.Review of literature including guidelines given by American association of Orthodontics, American Association of Oral and maxillofacial radiology, Sedentext CT justify it's use in such subjects. I want expert's opinion on ethical issues in such clinical situations.
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Traditional 2D imaging may be adequate but 3D CBCT = anatomical truth (see my and Dr David Hatcher's article in 2002 AJODO and see article Dr Sean Carlson and I  and others did in ORtho  Town on The Truth About CBCT radiation dose) Now with medium FOV CBCT [iCAT FLX]  aqusition dose (8-15 microSV at 4.8 seconds) is  less than a traditional panoramic (18-24 microSV) . Radiation dose is ALARA, As Low As Reasonably Achievable. Only use CBCT when you need the anatomical truth of you patient. 
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1. Factor replacement  2. Consultation with a Hematologist
3. Measures to control bleeding & promote clot formation.
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Dear Alok,
Our approach is as follows :
It is important to assess the severity of hemophilia and current clotting factor levels in patient. In case of single tooth extraction hemostyptics are often sufficient if plasma levels of factor VIII or IX are above recommended levels. Otherwise consider use  Tranexamic acid or fibrin glue. 
Sincerely
Peter
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The general consensus in the field of head and neck oncology states that appropriate initial management of these tumors is surgical extirpation with adjuvant treatment. There is controversy in the field regarding the appropriateness of elective lymph node dissection.For maxillary alveolus and hard palate tumors, it has traditionally been believed that the risk of nodal metastases is not high enough to warrant elective lymph node dissection.In the majority of cases, in the absence of clinical evidence of cervical nodal metastases,neck dissection is generally not recommended, independent of the size or depth.
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For N0 Cases there is not evidence of benefits for elective neck dissection. Generally the risk of neck involvement is low. However is mandatory to perform a ct scan, MRI or ultrasonography  evaluation  for more accurate study and follow-up. It could be also considered the use of sentinel node biopsy 
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Carnoys solutions as adjuvant therapy to fix and kill a remnant epithelial cells ,daughter cyst and microcysts as chemical cauterization agent . Some surgeons used it preoperatively whereas others use it postsurgically over surgical site.
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Dear Essam A. Al-Moraissi,
The components of Carnoy’s solution are absolute alcohol 6ml, chloroform 3ml, glacial acetic acid 1ml, ferric chloride 1gm. It is a tissue fixative that penetrates bone to a depth of 1.54 mm. It should be applied post enucleation to fix and kill the remnants of epithelial cells as well as to prevent recurrence of the lesion.
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 During treatment of KCOT using either enucleation with or without ajuvant therapy or marsupialization with or without residual cystectomy, some authors advocate that excision of the overlying mucosa is necessary to eliminate epithelial and micro cysts with subsequent reducing recurrence?                                                                      
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Excision of overlying mucosa can contribute remarkably to reducing recurrence rate of KCOT however, that should not be considered a general rule. Each case should be taken on it's own merit. A lesion that is completely within the cancellous space of bone, distant from the bucal or lingual plates of bone (In the mandible for example) should not require such excision. On the other hand, a lesion that has come very close to the labial or lingual plate or has even perforated the plate would benefit from such excision. These are two extremes of the situation. You can be sure there will be the dicey cases with which you have to weigh the sides carefully or engage the use of frozen section.
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Orthotics in dentistry is to prepare a splint as per the requirements of the oral surgeon and orthodontist on the corrected cast for their aid while doing orthognathic surgery. What is the role of prosthodontist in preparing these splints (new devices, fitting, material, impressions, face bow transfers, articulators etc.)?
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 Good Morning,
Yes Dental Orthotics is an precise prosthetic adjutant prepared by TENSING the 5 and 7 th cranial nerves to rest the masticatory muscles so that you can record an perfect resting position of the mandible. This is accomplished by using EMG and ENG along with TENS gadgets. This Orthotic (Splint) is used invariably in TMD cases to resolve the symptoms as a first phase treatment which is reversible.
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As invasive as it is, this technique, with its variants, seems interesting and promising. I would much appreciate learning from your critical opinions and experience.
I attach one article and list here others, equally easily available on the net.
Periodontal Accelerated Osteogenic
Orthodontics: A Description of the
Surgical Technique
Kevin G. Murphy, DDS, MS,* M. Thomas Wilcko, DMD,†
William M. Wilcko, DMD, MS,‡ and
Donald J. Ferguson, DMD, MSD§
An Evidence-Based Analysis of Periodontally
Accelerated Orthodontic and Osteogenic
Techniques: A Synthesis of Scientific
Perspectives
M. Thomas Wilcko, William M. Wilcko, and Nabil F. Bissada
PERIODONTALLY ACCELERATED OSTEOGENIC ORTHODONTICS: A REVIEW OF THE LITERATURE
Yener ÖZAT1 Ruhi NALÇACI2
One-stage Surgical Alveolar Augmentation (PAOO)
For Rapid Orthodontic Movement. A Case Report.
1 Ashish Jain, M.D.S
2 Tarun Das, M.D.S
3 Rashi Chaturvedi, M.D.S, D.N.B
Piezocision Assisted Orthodontics: A new approach to
accelerated orthodontic tooth movement
Mittal S.K. 1, Sharma R.2, Singla A.3
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Periodontally accelerated orthodontic and osteogenic techniqueswill speed up tooth movement but will always remain additional invasive techniques. Treatment time can be much faster when you are able to avoid round tripping in using sound biomechanics and in improving time schedules.
1. Beckwith FR, Ackerman RJ, Cobb CM, Tira DE. An evaluation of factors affecting duration of orthodontic treatment. Am J Orthod Dentofac Orthop. 1999;115(4):439–47.
2. Sanon M, Taylor DC a, Parthan A, Coombs J, Paolantonio M, Sasane M. Effectiveness and duration of orthodontic treatment in adults and adolescents. J Med Econ. 2012 Jul 4;383–6.
3. Skidmore KJ, Brook KJ, Thomson WM, Harding WJ. Factors influencing treatment time in orthodontic patients. Am J Orthod Dentofacial Orthop. 2006 Mar;129(2):230–8.
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What is management for diagnosing in juvenile recurrent parotitis?
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sialoedoscopy doesnt play a great role in diagnosis..and it being an invasive procedure should be the last resort
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I prescribed Amoxicillin+clavulanic acid 625mg TDS, Metronidazole 400mg TDS, Tramadol 37.5mg, Aceclofenac 100mg+serratiopeptidase. 5mg BD (to be used with caution) and a multivitamin and antacid.
Planned surgical intervention but patient did not turn up.
Please advise.
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For periodontal bone loss in otherwise controlled periodontitis (i.e.no pockets or other signs of infection) the answer is no: the bone loss itself is not obviously infectious.
For periodontally compromised teeth with active periodontal disease, yes. If the periodontal infection turns acute, it usually spreads to the buccal or the submental spaces in patients I've seen, rarely sublingual, depending on pocket localization.
As a side note, I think you would have been well off empirically using only simple v-penicillin+metronidazole with NSAID + possible other pain medication such as Tramal depending on the patient's condition. However, I'm not sure about the resistance situation in your region (India tends to have higher levels than the Nordic countries) and it naturally has to be taken into account. Only very rarely (and only after sensitivity testing) do we need to prescribe Amoxycillin+clavulanic acid AND metronidazole here.
Also, surgical intervention is usually considered the first-line of treatment, antimicrobials second, so the first thing that needs doing is the I&D and treatment of the infectious focus. This is done usually under antimicrobial prophylaxis. Otherwise the patient tends to come back after the ab medication has ended. Often enough, the procedure heals the patient and antimicrobials simply support the process and prevent complications such as formation of a new abscess.
Finally, what was serratiopeptidase used for? I am unfamiliar with the drug. I only find old links showing no evidence for its use as a pain medication or as an anti-inflammatory ( for example, http://www.ncbi.nlm.nih.gov/pubmed/19168326 ).
However, seeing as the question is 1.5 years old the patient must be healed by now...
With Best Regards,
AT
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cConsider steroid derived drugs and routes for administrating these drugs.
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i think the surgeon should decide if the steroids required at the preoperative assessment phase of the patient. Personally , i reserved the prophylactic use of steroids in invasive cases of LA and most of the GA and IV sedation. one dose of 8mg dexamathasone is usually sufficient in most of cases but severe cases additional dose(s) at  six hour intervals. the concomitant use of injectable Diclofenac may minimize the need for additional steroids ie.. intraoperative 75mg diclofenac+8mg dexamathasone
off course you have to be careful with patient of gastritis, patient on aspirin or clopidpgrel, hypertensive and diabetic patients.
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Patient may be unconscious, sedated or fully conscious.
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Instrument can be resterilized. A flash sterilization cycle can get the instrument ready to you in about 20 minutes or so. We send the instrument for reprocessing immediately if the instrument is that indispensible, else if we can do away with another alternative instrument we proceed. For example, at times we have used a chisel as a screw driver alternative when our screw driver fell to the floor while fixing a fracture. But if the screw holder itself falls, we send it for processing sterilization.
Grafts are another thing.
With respect to the grafts, you have a few options:
1. Use another graft (possible when you are using allograft sources)
2. 30-min soak in 4% chlorhexidine followed by a 30-min soak in triple antibiotic solution (gentamicin, clindamycin, polymixin), followed by sterile saline wash was 100% effective according to a study.
3. Grafts can be autoclaved as well (the technique of autoclaving and using the bone is a technique used in jaw bones in some pathologies. After resection of the mandible, the pathology is removed from within the bone the bone autoclaved and then used as a non vascularized bone scaffold to hold particulate bone grafts!)
4. Postpone the procedure and complete the procedure using graft from another site at another time after getting appropriate informed consent again.
Any such occurence must be fully disclosed to the patient. The best choice will depend on the critical nature of the procedure and the wound bed/graft site, the graft volume and type among a few.
If you are using chlorhexidine, saline wash is mandatory and important as chlorhexidine induced chondrolysis has been reported. So if you are using cartilaginous structures after chlorhexidine wash, there can be chondrolysis.
The disadvantage is that the graft will lose all viable cells during the process of autoclaving or when using chlorhexidine.
Povidone iodine applied and dried has also been found to be effective with better cell viability.
Taking measures to avoid dropping the graft and instruments is THE only best solution. The surgeon must take full responsibility and ensure that all members of the team are aware and handle the grafts carefully during harvest, after harvest and during the time of fixation. At each point of transition of the graft, there must be good communication and co - ordination to avoid such incidents.
Regarding instruments,the same apply.
Breach in sterility would mean surgical site infection and loss of graft anyway ... So using just a saline wash and placing the graft or using an instrument with just after a saline wash can be disastrous.
Using a spirit wipe after washing before reprocessing for resterilization has been used by us a few times when the instrument fell into visibly soiled areas.
Regards,
Dr. Akilesh. R
Chennai
India
Update: 
Bone - low pulse irrigation with > 1 L of triple antibiotic solution is preferred. Cancellous bone is better reharvested, cortico cancellous bone may be decontaminated.
Soft tissue: Low pulse irrigation with > 1 L of 4% chlorhexidine is preferred.
Interestingly a study found that PVP-I was the most commonly used decontaminant than chlorhexidine which was found to be more effective. But saline wash is mandatory in each case especially with chlorhexidine wash as it is known to cause chondrolysis if not washed off.
Low Pulse Pressure vs Washing vs Soaking
Soaking or washing is not adequate. Low pulse irrigation is preferred for thorough decontamination. The 5 second rule or the 15 second rule may not be applicable. OR floors though are cleaned they are not part of the sterile field and even the area just around the Operating table is walked repeatedly by the surgical team. Moreover, the bacteria may not necessarily fly away, they may just be bombarded into some of the crevices / folds of the harvested graft.
Culture of the graft
Routine culturing of the dropped graft before decontamination is helpful. If an infection develops we know the sensitivity and appropriate antibiotics to use.
An interesting publication in this regard is attached which formed the source of my update:
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normally we use ibuprofen and paracetamol combination or ketorol or aceclofenac. but there is difference in responce in different patients. 
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PAIN RELIEF FOR POSTOPERATIVE PATIENTS
The most effective single dose oral analgesics for acute postoperative pain in adults have been identified by Oxford researchers in a Cochrane review of 45,000 participants across 350 studies.
Over 70% of participants with moderate or severe acute pain who took a single-dose achieved good pain relief with 120mg etoricoxib (Arcoxia) or the combination of 500mg paracetamol plus 200mg ibuprofen.
With other drugs, such as 1,000mg aspirin and 600mg paracetamol taken on their own, only 35% benefitted.
The worst was codeine, with only 14% getting significant pain relief. The period over which pain was relieved also varied, from about two hours to about 20 hours.
So everyone is different and you will find what works for you. It may be different to that which works for your friends.
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I see an indian lady 30 year with painful ulcer and Oral submucous fibrosis
I do a Low level laser for the ulcer and the patient complains of limitation in oral movement, what's your recommendation?
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Dear Sunil
Let me be clear on what we are talking about.
In the case that started the discussion a patient is suffering from OSMF and wants relief. The therapist chooses the best available option for giving her relief. This may include Lycopene.  If it is the free oxygen radicals that caused the fibrosis I don't think anti-oxidants are going to reverse the fibrosis. So, I am sure its effect is due to some other activity. Lycopene has many other effects too; may be it has fibrinolytic activity.  Anyway, any increased risk of malignancy may be offset by the relief that the patient gets from the OSMF.
But, if the aim of treatment is prevention of malignancy, then you have to consider the risk of the drug, be it Lycopene or Betacarotene or any such drug, in particularly pharmaceutical form.
Here, I am sure that any drug that can increase the risk of cancer Lung, especially squamous cell cancer, has good risk of increasing oral squamous cell carcinoma too and I would not under take any trial.
AntiOxidant trial has been done in oral Leukoplakias etc. Some trials have been done in Trivandrum, where I used to work, on the basis of Stich and Rosins finding on Micronuclei reduction. The finding there and generally has been that some leukoplakias disappear, others appear and overall benefit to the patient is doubtful because most of the leukoplakia patients come because they worry that they may get cancer., and are not worried per se about the white patch. It is meaningless to give them antioxidants. Other extensive leukoplakias that are symptomatic by themselves can be and we usually treat them by surgical excision.
Relying on intermediate endpoints like MN, Leukoplakia regression as surrogate markers of cancer reduction can lead to opposite results. From antioxidant induced MN reduction the conclusion was that MNated cells are potentially malignant and their reduction indicates that cancer is being eradicated. But, one factor that they failed to think was that MN cells are dying cells and reduction in their frequency also could have been indication that such cells destined to die were being saved by the drugs and allowed to bloom into cancer.
I would be grateful if you can send me one or two publications (send the website) which categorically showed reduction in oral/other cancer in a population given an antioxidant; I dont mean reduction in intermediate markers.
Narayanan
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In the treatment of gingival recession around lower incisors by applying free connective tissue graft along the area of recession, how it is possible to pull the alveolar mucosal flap from the vestibule and inner mucosa of lower lip with the purpose of covering the connective tissue graft over the gingival recession?
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Beautiful suggestions! From my experience, your dilemma seems to have arisen from insufficient keratinized gingiva. In such instances, I have found a two- stage procedure useful. Stage 1 will be to increase the zone of keratinized gingiva achievable with a free gingival graft. Allow a few weeks to heal then proceed to stage two. Harvest your CTG and suture to the prepared recipient site.Complete the process with an immediate coronally-advanced flap. Alternatively, place the CTG using the tunnelling technique. Cheers!
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Secondary alveolar bone grafting in cleft lip and palate patients is usually done following expansion using fixed orthodontic appliances such as quadhelix or a hyrax type appliance. Does the surgeon need to remove the appliance to do the graft?
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With the appliance in situ its technically difficult to close the palatal fistula. Otherwise a passive appliance is generally not a major hindrance. 
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four implants have osseointegrated well., but are too close to place impression posts
any suggestions to make good impressions 
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Thank you all
   For helping me to give a good prosthesis
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If yes, then what is specific advantages you feel over, conventional inferior alveolar nerve block.
Are you aware of any studies in this subject.
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Yes I have but I did not get the 99% success rate as reported in the original Gow-Gates experiment. I recommend reading the Gow-Gates technique; a pilot study for extraction procedures with clinical evaluation and review.
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1. The patient is under antibiotic therapy
2. HOT is considered
3. Systemic condition is poor (respiratory and CVS diseases)
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It is thought that osteomyelitis is decreasing in prevalence due to broad-spectrum antibiotic treatment; however, it still remains a challenging clinical entity in developing countries. I think stabilization with non-invasive means is a good way.
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Class II molar, overjet 15mm, openbite of 3mm, deficient chin, vertical growth pattern.
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1. mandible first approach 
2. multisegment Le Fort for width control
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I referred one of my patients to an oral surgeon to do lateral wall sinus lift on both sides of the maxilla. On one side everything went smoothly. On the other sides, two sites of perforation of sinus membrane occurred . Attempts to raise up the sinus membrane were done but the surgeon was not able to elevate the sinus membrane. The surgeon covered the window with non resorbabale membrane and asked the patient to some back again after 4 months.
What can be done with such a patient? Can a sinus lift be attempted again?
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Check cone beam CT before doing again. Possible compartment-dividing septa might cause the membrane perforation and also make elevation difficult. If the surgeon is not well experienced, he or she should use the round bur with the speed of 4000 rpm. The rotation speed at 4000 rpm could make you feel the outer cortex as well inner cortex.  Moreover the level of inferior osteotomy also determines the difficulties of elevation. Orientation is also important during the sinus lift as well...
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Is it true that the orthodontic treatment is useless with osteopetrosis patients? Are there any approved trial results?
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The osteoclast dysfunction define the pathogenesis of this disease. In addition, the whole bone metabolism is affected in the osteopetrosis patient, once the crosstalk between osteblast and osteoclasts is also deficient. The major concern is in fact the osteomyelitis. The orthodontist and the physician should discuss the patient’s risks and benefits of orthodontic treatment according to the severity of the osteopetrosis.
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Today I recieved an 11 years old patient in the practice for evaluation and possible frenectomy pre-orthodontic treatment. To my knowledge there is controverse in terms of which is de ideal age for performing this proceidure in young patients: Some say its necessary to wait till full eruption of the teeth before considering surgery and others state its ok to do the surgery right away. In your expirience and knowledge, is there an age limit for frenectomy in young patients?
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But nobody asked wether the patient had diastema!!
Some over-educated parents would get worried seeing the high frenum attachment, or else their friend or relative would make them aware of such a condition and they might come for consultation.
Evaluate:
1. Whether there is any diastema associated with frenum? that is if the band is too thick and crossing across the papilla and penetrating the nosopalatine area. If yes, then even the eruption of laterals or canines wont close the diastema automatically. Frenectomy is definitely indicated, either during or just a month short of completion of ortho treatment.
2. If no diastema, check if the frenum is causing any functional problem. Means, if the frenum is too prominent, child might be getting pain or discomfort while brushing in upper anteriors and he would avoid that area. So you'll see deposits in upper centrals and laterals, but other teeth are well maintained. Then again frenectomy is must.
3. If the frenum is too short that while smiling or laughing the attachment on lip is causing lip to deform, then again it is surely indicated.
4. Rest of case, ask patient to visit every 6 months, as and when the frenum is of concern, surgery can be planned.
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The FGP technique is not always the panacea. We are practicing different approaches for the last 20 + years and I can assure you that:
1. You will need a very distinct indication.
2. One registration approach does not fit all indications.
3. You need a very detailled understanding of occlusion.
4. Translation into prosthodontic work does not work with all materials and techniques.
5. You need an excellent lab technician.
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Diabetes and Dental Implants.
Is there evidence in the literature that correlates the success or failure of dental implants with readings for Glycosylated Hemoglobin(HbA1c)? In other words , is there evidence that states that at the time of dental implant surgery the HbA1c should not exceed certain figures .
Moreover is their any study that correlates the success or failure during the healing phase with the HbA1c reading at time of second stage surgery?
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The best resource I was able to find is : Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review, J Periodontol. 2009 Nov;80(11):1719-30
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Oral tissues' cicatrization is a really interesting topic, I'm trying to study a way to classify that cicatrization, without invasive procedures. But I'd like to know if there's any publication about or any literature that talks about this topic.
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Why do we care?
Classification systems are way to communicate to our colleagues. So the most important thing we can do when we're communicating is make sure that we communicate in an unambiguous way. A classification system is only valuable if it lacks ambiguity. So if you have a classification system is accepted by 3% of people in your field it is… Worthless! If you have a classification system is accepted by 97% of the people in your field it is valuable but it's only valuable if the information is clearly understood by all of those 97%.
I had the dental implant Journal, I see classifications all the time and am shocked at how many of these classification systems are poorly understood or air are ambiguous in nature. Think about it, if you create a classification system in which the treatment for class I is the same as the treatment for class II and for class III, why should anyone care what the classification system is? It might be nice to put your name on the classification system so that your wisdom lives on into infinity but the reality is that if the intervention does not differ there is no particular reason for knowing the differentials in the classification. Think of cancer staging. Today most malignant tumors are staged and the stage defines the recommended treatment. When we only staged just to create a stage the staging in those days was of little clinical value but now that staging also includes other factors beyond just tumor size, presence or absence of local nodes and presence or absence of metastases there is a biologic rationale for the treatment is provided. It makes a difference.
So the question as to whether or not there is a classification system is a basic knowledge question. The real question is whether or not there needs to be a classification system.
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We find such cases in our clinic. We may confused at that time what we should do. Many options like surgical clinical crown lengthening, extraction followed by implant placement, extraction followed by fixed partial denture or removable partial denture. For long term prognosis, it is very difficult to select the treatment option.
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I think a lot will depend on the patient's compliance and his or her willingness to retain their natural dentition...as far as i am concerned i would definitely try 2 save the natural tooth instead of blindly going 4 implant....surgical crown lengthening, root canal treatment, post and core should be done but ultimately it all depends on the patient's will and whether they would be ready to come for so many appointments for saving a tooth..if the answer is no...definitely implant therapy..provided the periodontium is healthy and we have sufficient sound bone to receive an implant...
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I'm writing a review and I just want to test the opinion of the network.
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Yes platelet rich fibrin and platelet rich plasma have been extensively used in periodontal regeneration and excellent results have been achieved.The newer of the two, that is PRF has tremendous potential as it harbours lot of growth factors and are used even by oral surgeons in dental defects.Hence it makes a lot of sense to use them in regeneration procedures n dentistry.
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I would like to do RCT on rabbit's molars. If they are continuously growing, then I have to look for another animal.
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Oops, I haven't attached the file- I am new to Researchgate- but can send it privately if you want.
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I have highest failure rate of securing local anesthesia [ both mandibular & maxillary ) first molars.
What could be reasons for it?
If you too are experiencing the same, what do you do to anesthetize them?
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First of all, I would like to apologize for my late reply to the question by Dennis Nutter. I have been away from home for 4 weeks (Indonesia and Malaysia…on MAS aircrafts!), with little or no connection to the web.
Now, I give you more details on intraosseous anesthesia for children, as the initial problem was : "Enamel Hypomineralization in molars : I have highest failure rate of securing local anesthesia [ both mandibular & maxillary ) first molars", wasn't it?
We describe, in Europe, 2 types of intraosseous (intra diploic, inside the diploe) anesthesia :
-transcortical : consists in injecting the anesthetic directly into the cancelous bone after crossing the cortical plate with a drill or with a rotating and perforating needle (8mm long, and 0.3 or 0.4 mm diameter) (Quicksleeper system), at right angle to the cortical plate surface.
-osteocentral : the perforation point is similar to an intraseptal anesthesia, but you insert the needle vertically much further into the interdental space, with a loger needle ( 12 or 16 mm long, and 0.3 or 0.4 mm diameter.
On permanent teeth,
-between the ages 6-9 : for anterior teeth and first molar : transcortical anesthesia without rotational system for peforing the cortical bone. Generally, at that ages, bone is rather easy to perforate by a simple pression on the needle (8 mm, diameter 0.3 or 0.4 mm)
-between the ages 10-16 :
+for anterior teeth : transcortical anesthesia with rotation
+for first maxillary molar : transcortical or osteocentral anesthesia with rotation
+for second maxillary molar : osteocentral anesthesia with rotation
+for first mandibular molar : transcortical or osteocentral anesthesia with rotation
+for second mandibular molar : osteocentral anesthesia with rotation
You will use less than 0.9 mL of an anesthetic formulation with epinephrine. I consider hypo mineralized teeth as chronically inflamed teeth, and this implies to use an anesthetic formulation with 1:100 000 or, better, 1:80 000 epinephrine. The onset will be immediate (as soon as the injection is over, you can begin to treat ); there will be no or minimal soft tissue anesthesia. If you want to install a clamp for thre rubber dam, no supplemental anesthesia is required.
Moreover, in the maxilla, you can anesthetize 2 teeth distally and 3 or 4 teeth mesially to your injection point, depending on the amount injected. You can make the anesthesia either on the labial or the palatal aspect of the tooth.
In the mandible, you will anesthetize one tooth distally and 2, 3, or 4 teeth mesially, because the vasularisation of the mandible is unidirectional, postero-anteriorly oriented. So, when anesthetizing a mandibular molar, always try to inject in the distal interdental space (transcortical anesthesia) or in the inter radicular space of the molar tooth (osteocentral anesthesia). The injection is made on the buccal aspect of the tooth.
I understand Dennis point of view, but I prefer anesthetizing systematically, because, as demonstrated by Sixou and al. these intraosseous anesthesias are very well tolerated by children (no "big shot").
I also would like to point out that, for numbing the attached gingiva prior to performing the intraosseous injection, I never use any kind of topical compound : I think that proper use of the needle (correct positioning of the bevel "flat" on the mucosa), and pen-grip handling of the syringe (Wand, SlleperOne, QuickSleeper) and computer controlled injection, are three basic factors allowing a totally pain-free anesthesia : see for more about that our pedagogic article about pain-free palatal anesthesia...in French...
I hope this will help.
If you need further details, please let me know : if you provide me with your email details, I can send you a lot of articles (with good iconography demonstrating the art of doing).
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I have a patient who has osteogenesis imperfecta. I do not know the type of OI. There a few case report in the literature about dental implant treatment for these kind of patients. Does anyone an experience on this area?
45 years old - male - single implant - left mandible first molar position
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Exclude the case if it is on Bisphosphonate, otherwise dental implants can be placed safely and osseointegartion can be acheived....
Best,
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Can any one support me with some articles about types, clinical application, and side effect of anti-fungal and anti-viral medication in oral and maxillofacial surgery.
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And the second file.
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Wisdom tooth extraction complication nerve paresthesia.
Alternative treatment method for paresthesia
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Ee used in patients with paresthesia, laser acupuncture, there is a published article in Herbert publications, maybe this can help you.
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Physiologic melanin pigmentation is a common finding in oral cavity. Most commonly the gingiva and buccal mucosa are involved, however it has also been reported occasionally on tongue. For aesthetic reasons, depigmentation of gingiva using scalpel or diode laser is commonly performed. The procedure is simple without any potential complications. However, tongue has different histologic structure, as it is highly vascularized and contains taste buds. Can it be treated similar to the procedure of gingival depigmentation ? Will there be any effect on taste sensation post-operatively?
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In out limited experience (10 pts), we have not observed any post-surgical complications in tongue de-pigmentation using Nd:YAG laser so far. Taste alteration are not usual following superficial tongue surgeries, and bleeding is not a concern.
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Treating patients suffering from recurrent herpes simples or even Aphthus ulcer there is a marked relief postoperatively with no recurrence. Maybe there is some sort of biostimulation to the immunity.
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Thank you
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Which approach do you suggest to a student that has an idea and would like to research its potential, when one does not yet have the knowledge and skills to do by oneself most of the work? Thank you.
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Well designed research is becoming a rarity. The most important thing is the study design and about asking the 'right research question' . If you ask the right question and design a good study - only then are the results reliable and useful. A good resource to start with is to read about the protocols / application of grants process of NIH or any other funding agency. Not that you have to apply for it but they have templates for study protocols.
Also it would be good to go through the clinical trials registries to understand relevant ongoing / completed / incomplete studies in areas of your interest. You can then get in touch with them to understand the limitations. The basic tenet in research is knowing what has already been done and what needs to be done in the field! No use doing the same research giving the same answers ... unless you really think what you are doing adds to the information already available.
Also, reading the literature is important with a critical review of those articles. Some limitations of the study are always mentioned in the article but there will be few areas which are grey or not mentioned. These are either omitted or have been lost due to the restriction of "words limit" in most publications. A simple email to the author or a letter to editor raising the question would enable you to understand better as to what other challenges the researchers faced to avoid a hiccup in your own research.
And last but not the least, a good guide in your Department or Instiution can give you valuable insights on how you can proceed but they definitely will not have the time to teach you step by step .... but after all researcher is named as a re'searcher' because they are expected to search ... so ...
All that you should expect from a guide is that they 'show you the way/path'.
They should "talk the walk" and let you "walk the talk".
On a side note, are we all not students all through our profesional lives ? The moment we stop learning we have stopped growing in our field :)
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Adenoids may lead to mouth breathing and increase the risk for dental caries. is it sufficiently important to consider their presence while examining pre school children for dental caries in a community based survey?
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With more breathing oral, less saliva.
With less saliva, more caries and gingivitis.
Only see other animals, that never Brushing Teeth, but has perfect teeth :)
The saliva, tongue and lips are the power :)
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Which technique do you employ to reduce needle phobia in children? Please let me know what are your self developed methods?
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My motto: Be honest, be fast - and then extremely slow.
Some own observations and how I do local anaesthesia personally.
Under the limitations Klaus mentioned (child is "accessible")
To avoid phobia: Prevent bad experiences. Reduce the experience of pain as far as possible / avoid unnecessary pain.
Tell before what you do - and never try to lie. That would be a betrayal of confidence which you will never be able to repair.
A. Punctuation of tissues
From my experience the pain from puncturing the tissues with the needle is by far the smaller problem.
1. I try to puncture the tissues very fast. I use sometimes a surface anaesthetic, sometimes some pressure before. Depends how I judge the patient or whether he asks for that.
2. For (nearly) every new puncture of tissues I use a fresh needle. At least if you had contact to bone - never try to use this needle again. And even if you just had contact to soft tissues the needles lose a bit of their sharpness. Needles damage tissues and cause pain if they are not sharp...
3. There are needles with special bevels to reduce pain during puncturing.
4. I try to reduce the number of tissue punctures as far as possible. The modern anaesthetic solutions are really good, they can quite well spread within the tissues. You definitely don't need a depot every half a centimeter. And you can protrude the needle within the tissues..
B. Injection
What is bad for most patients is the feeling of burning during the injection of the anaesthic solution. It is quite a volume which has to be injected: Thus the tissues are damaged, cells must part from each other.
The less pressure, the less pain:
1. Find a place with lots of subepithelial tissues: injecting into the fixed gingiva requires high pressure, it is a torture. On the palatal aspect I use the region with lots of small salivary glands - I prefer blocking the nerve at the palatal foramen and the incisal foramen instead of doing an terminal anesthesia.
2. Needles: I don't use these very thin needles, the pressure in the tissues increases with diameter reduction! Also in children, also palatally, I use g25 (orange) - and never what most colleagues use in children: G30(grey).
3. There are needles with reduced thickness of the wall, thus allowing a bigger inner diameter with the same outer diameter. http://www.septodont.ca/products/septoject-xl?from=668&cat=4
(same link as above)
4. I take my time and inject very carefully (veeeeery slowly): just a little drop of the solution and then stop waiting for the effect of the anaesthesic. With the needle in place... That takes some seconds. Then another drop, which is announced as perhaps still a bit noticeable.
We have "The Wand" in our department - I never use it. Yes, the pencil design may be an advantage, but what a waste of material, and what amount of anaesthetic solutions trapped in the tubes...
As long as my patients tell that they have never got such a well done injection, with this little pain, I don't see the need for this device. And no, I don't have golden hands. The "light thumb" (like this expression from Klaus) - it is not a matter of the hands, it is a matter of the head, and the heart. It is just the will to consider some banalities, fed by some knowledge, own experiences, and some thinking. I am sure that every dentist could inject at very low pain levels... It is the will to invest some time for the injection - instead of injecting fast and then nervously waiting for the effect.
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I use a bone inductive material for regeneration of bone in chronic periodontitis and need to asses it.
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Actually, I am in complete agreement with Dr Agrawal in that bone formation and resorption are a continuous and coupled process. Nevertheless, salivary levels of sRANKL and OPG, more importantly assessing their ratios at different times might provide an insight into the healing. We now have really sensitive ELISA tests that can measure the levels of these substances in saliva upto a few picograms. Matrix Metalloproteinases especially MMP8 and 10 could also be looked into as potential candidates for determining the phase of tooth movement.
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Horizontal ridge resorption
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Dear Alberto, it is a fact that, at the state of knowledge, the absence of an universally accepted measurement method, able to assess the degree of defect correction and the three-dimensional stability over time of the augmented bone, still prevent clinicians to draw significant conclusions about the long-term clinical success of the different augmentation procedures.
Of course, neither open flap caliper measurements nor CT scan can be considered feasible routine methods of monitoring bone stability over time, because of their unreasonable economical and biological costs.
I fully agree with Dr Kashi that “bone sounding” is the technique with the best cost-benefit ratio, but - as rightly pointed out Dr Nakamai about the angulation of the caliper- the reproducibility of position may be an issue, for any chosen instrument for measuring . This problem - for bone sounding - may be partly overcome by using a template customized on the basis of final restoration and pierced at some buccal and lingual/palatal points at each implant site. In this way the holes guide the endo files during bone sounding in a reproducible position and angle, allowing the long-term evaluation of the horizontal stability of the augmented bone.
In this regard, if you think it might worthwhile, please view the article
Horizontal and vertical ridge augmentation in localized alveolar deficient sites: a retrospective case series. Implant dentistry. 06/2012; 21(3):175-85