Science topic

Oral and Maxillofacial Surgery - Science topic

Treatments may be performed on the craniomaxillofacial complex including the mouth, jaws, neck, face, skull.
Questions related to Oral and Maxillofacial Surgery
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We have very advanced impression materials that can copy details with the utmost precision but the accompanying die materials are still to come up to those levels both in terms of accuracy and rigidity. Fracture of dies is an imbroglio with elastomers like addition silicon and polyether. Dies with improved # resistance is the need of the hour. High time research should be directed in this direction too.
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1. CLAP- Cleft Lip And Palate
2. Any specific age in days/months/years
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 Infants born with a cleft of the palate (with or without cleft lip) are unable to breastfeed effectively and require special feeding equipment (such as squeezable bottles and teats) and many mothers need specialist feeding advice and support. While some maternity service providers and Maternal Child Health Nurses are able to provide general feeding support to new mothers, there remains significant confusion amongst both the lay and professional community about the effective feeding interventions for infants born with CL/P. As a result many families receive conflicting advice and experience significant and unnecessary emotional distress and fatigue during the first year of life if they are not able to access specialist cleft feeding support services. From the RCH cleft unit website 
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Is there any significant difference between them regarding primary stability, alveolar bone loss, and/or the success rate?
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Immediate, Delayed-Immediate, and Delayed implant placement: Which one is superior over the others? 
Is there any significant difference between them regarding primary stability, alveolar bone loss, and/or the success rate?
 ITI describes the immediate, early and traditional or conventional loading protocols. Are you talking about loading protocols or implant placement protocols relative to tooth removal?
Tooth extraction followed by implant placement (immediately or after a few months of healing) does not seem to result in any implant survival differences.  Most authors report a slightly improved been response if the implant is placed on the day of tooth extraction but this is often dependent upon the location in the dental arch.
Considering loading protocols there certainly is a difference in implant performance relative to loading protocol.  Of course there are factors that favor each protocol in different instances.  I suggest looking at the article by Gallucci et al that documents the consensus conference of ITI recommendations.  There is no straightforward simple answer.
Consensus statements and clinical recommendations for implant loading protocols. Gallucci GO, Benic GI, Eckert SE, Papaspyridakos P, Schimmel M, Schrott A, Weber HP. Int J Oral Maxillofac Implants. 2014;29 Suppl:287-90. doi: 10.11607/jomi.2013.g4. 
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1. Factor replacement  2. Consultation with a Hematologist
3. Measures to control bleeding & promote clot formation.
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First Question: Is the surgery essential ? Are there any alternatives that can be planned without needing transfusion because:
1. Every transfusion is a potential risk (in spite of transfusion science growing to such safety and complexity!)
2. Every transfusion increases the risk of the patient becoming 'resistant' to the factor thereby making it useless. (antibody formation)
3. Every transfusion is costly including the product and administration costs with monitoring.
4. If care is not taken, one may end up 'wasting' the transfusion. The effect of the factor lasts about 8 - 12 hours (for factor VIII) after which it needs to be repeated if further activity is required. So co-ordination of care is required for making sure the primary procedure is completed and clot stabilised within that period before it's effect wears off.
So apart from textbook discussions about 'transfusion / replacement of factor', 'hematologist consultation' and 'measures to control bleeding/clot formation', above issues are pertinent. But before even that, the levels of factor needs to be assessed as replacement will be based on the current level of factors and the surgical insult with bleeding risk that may occur. Also use of anti-fibrinolytic agents like Tranexamic acid are routinely advocated preferably started prior to procedure and continued post procedure for 3-4 days in a suitable dose according to weight either as IV or oral. Local application of Tranexamic acid is also an "off-lable" use where powdered tranexamic acid is placed along with a guaze piece on the bleeding site intraorally. Desmopressin has a role in Factor VIII deficient bleeding disorders.
As an additional note:
While surgical procedures require hospitalisation and monitoring, many non surgical alternatives can be done without the need for transfusion or risk of bleeding routinely in a dental chair. So a preventive plan that involves the patient-family for avoiding invasive dental procedures / surgeries may be the best route to take. This is best both in terms of clinical time. monetary benefits and safety for the hemophiliac patient as well as for the clinician.
Regards,
Akilesh. R
India
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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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 Parotid salivary fistula is a relatively common complication after parotidectomy. Salivary fistula or sialocele occurs if the resected edge of the remaining salivary gland leaks saliva and drains through the wound or collects beneath the flap (sialocele)
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If there are no contraindications, atropine i.m. for a 3 - 5 days or longer combined with the pressure dressings. In some cases it helped.
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Dear all, deficient ridges are among the most challenging situations in the dental clinic; it is considered as a critical size defect. Therefore, it is of great value to find out a successful and predictable line of treatment to such a problem.
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there r traditional tech like sagittal split osteotomy, onlay grafting.
we can also do horizontal osteotomy and place distractor.
Another option is sagitally splitting the mandible and plcaing the implants or placing the hybrid implants for dental rehabilitation.
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Presurgically, as kcot is a benign tumor , we have to manage it drastically.are there reliable diagnostic features ( clinical, radiogrophic ) particularly in dentate patients?
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The clinical and radiographic features of Keratocystic odontogenic tumors (KOT) are not pathognomonic. It is difficult to distinguish KOT from other lesions, however in most cases, the pattern of radiological destruction do not correlate with clinical examination, i.e radiologically KOT may be an extensive lesion,however clinically they might be minimum bone expansion especially when the lesion is in mandible.
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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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The lower third molar surgery is the most common surgery performed by Oral and Maxillofacial Surgery. There are various method to do bone guttering or tooth sectioning to facilitate tooth delivery. The piezoelectric surgical technique is a promising method when compared to rotary burs. Unfortunately, there was a sold evidence to support the superiority of this promising technique over the rotary instruments.Thus , We have this evidence based on papers ( a systematic review and meta analysis) to resolve the issue concerning this matter. I am asking here to allow an expert Doctors and my colleagues to discuss this very interesting topic  .
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Hi dear, I think that in general, piezoelectric surgical techniques are more advantageous than conventional techniques. I think that this article also may help 
Best regards
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As we know, the reconstruction plate and artificial condyle which we use in hemimandibulectomy are rigid comparing to the natural bone, where a fracture of condylar neck prevents this more serious injury.
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the risk is high, not many have occured and reported because metal condylar head is placed much below the glenoid fossa compared to natural condyle in reconstruction of mandible.
And in TM joint cases, total TMJ recon unit is used .(total joint prosthesis)
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1.History & Clinical examination.  2.Ulcer edges.  3. Lab reports. 4. Cytological examination.
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Skin lesion, lump, or ulcer that do not resolve in 14 days located:
On the tongue, lip, or other mouth areas
Usually small
Most often pale colored, may be dark or discolored
Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth
Usually painless initially
May develop a burning sensation or pain when the tumor is advanced
Behind the wisdom tooth
Even behind the ear
Additional symptoms that may be associated with this disease:
Tongue problems (moving it)
Swallowing difficulty
Mouth sores
Pain and paraesthesia are late symptoms.
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dental field, maybe associated with Laurell.
I do not know if it comes froma paper or a textbook.
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The suture has been attributed to Dr. Lars Laurell. It is described as such in the new (2015) edition of the Lindhe Perio textbook, but there is no reference given (possibly because it was not described in an article). Consequently, the current Lindhe text can be used as reference.
The suture design was described in detail in the training material originally provided when the Guidor membranes first became commercially available.
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say in acute spurs at the level of middle turbinates .
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I think it is not the (angle) only, but also the points of contact between the septum and lateral nasal wall (at that site) have an effect.
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Is there any risk of iatrogenic C1-C2 subluxation in case of transverse facial cleft patient intubations and operations? What if there is no vertebral anomaly visible on CT.
I would grateful if you can help me. It is very difficult to get any publication about that subject.
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Flexible Fiberoptic specially awake intubation (if applicable) is the safest.
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An 11- year- old boy presented to the dental clinic with his father, complaining of poor esthetics and delaying of eruption of teeth. Examination revealed a suspicion of amelogenesis imperfecta ( clinically & radiographically). Teeth present: 11, 21, 31, 16, 26, 36, 46, all primary molars and canines and partially erupted 12,22, 42. Patient  has also angle, class III. Outline the treatment plan for such a case.
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hi
can you please upload panoramic radiography and photographies?
I think the first step is to know the exact type of amelogenesis imperfecta ,if accompanied by anterior openbite it seems that the case is of hypocalcified type.
these patients report tooth sensitivity too.If dental age of the patient is late(It takes some time for the primary molars to shed),SSC seems a good choice and if needed pulp therapies must be done.for anterior teeth,composite veneers can be used until reaching full growth when they can be replaced with crowns,if needed.for first permanent molars,permanent SSC are available if they are too hypoplastic.otherwise, more conservative approaches must be used.
Most importantly,I think it will be useful to begin the patient care with preventive approaches including fluoride therapy,sealants,diet consultation and etc.
For skeletal problems as you mentioned,consult with an orthodontist, although bonding procedures is some how difficult in these patients.
these are the plans I had, and wait for hearing more extensive treatment plans.
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Please explain your opinion and experience on this subject.
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I think that there is no complementary test or exam able to “demonstrate allergy”, since "allergy" is a clinical diagnosis. Instead, the complementary tests may suggest “”sensitization” what may help the physician to choose allergens to prove clinical relevance by means of challenge tests. See the texts attached.
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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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We are working on introducing the procedure in our hospital, your experiences will help us start successfully. Thank you all
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the result of LASER therapy in laryngeal cancer is excellent  and comparable with other modalities like radiotherpy or  chordectomy It has the advantage of avoiding external incisions rapid ambulance overall less cost .. However if it is not available in developing countries -- radiofrequence  or chordectomy through laryngo-fissure is an alternative 
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As for computational fluid dynamics analysis, can we analyze the voice predication?
If anyone knows, please recommend me some software and also on how to operate them.
Thanks!
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Dear colleague
in my humble opinion, Acoustic  module in fluent will help you.although its coding is
easy and you can solve it by codes
regards
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Usually for patient with OHA, I take a blood glucose level of 13mmmol/L as the limit. Is there any guidelines I can refer to?
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It's an interesting question ...
In hospital dental practice (while dealing with high risk patients), the main rule that is followed is, in cases of an uncontrolled medical condition, all elective procedures should be avoided. On the other note, in the same patient, any emergent condition that can be life-changing or life threatening must be performed as soon as possible while simultaneously treating the uncontrolled condition.
As an oral and maxillofacial surgeon, we have had to do extractions in patients with their blood glucose levels > 300 mg/100ml! This became necessary because the tooth was the cause of serious fascial space infection in that patient. The patient was being intensively treated for controlling his diabetes and removal of the foci of infection can also help in his glycemic control as infective states can worsen glycemic control.
The main issue of blood sugar is not during the extraction procedure, but what may happen after the procedure during the healing period as in delayed wound healing, dry socket or even osteomyelitis. Co existing conditions in a diabetic (like hypertension) may affect the outcome. The mere increased blood glucose levels are not a risk factor during the procedure. They tolerate the procedure well but in the post extraction period, some complications may be anticipated. Meticulous management of these complications can help avoid issues.
Also, in most uncontrolled diabetics, the problem tooth requiring extraction is usually periodontally compromised and mobile. A uncontrolled diabetic who is on oral hypoglycemic agents will require about 2 weeks before he is reassessed when his glycemic status will be deemed to be in control. In this two weeks, the patient may need to be on prolonged medications (antibiotics, analgesics etc;) and that can have additional complications. There is also this risk of spread of odontogenic infection to fascial space infections which can be life threatening in diabetic patients. Extractions remove the infective foci ...
So in emergency situations requiring hospitalization, we shift the patient to insulin drip or injections and perform the procedure while titrating the dose of insulin and later slowly shifting back to OHA in the post operated period after discharge.
I'd suggest removal of the tooth which is periodontally compromised and hopeless at the earliest even if there is a mild derangement of blood glucose levels after assessing the risk benefit ratio for that particular patient. Also there is an important aspect of treatment of diabetes. If the patient is reasonable and compliant but has fallen into slight derangement of blood glucose levels, it might be prudent to even extract and then refer to a physician if it's mobile periodontally involved teeth. Additional precautions like using antiseptic mouth wash and antibiotic prophylaxis may be considered. Post extraction oral hygiene can help avoid complications.
The strict control of diabetes is required only for minor surgical procedures. On arbitrary terms we can expect more complications in any procedure that may last beyond 30 minutes. If the tooth is abscessed and mobile, immediate removal and referral to physician may be prudent provided the blood glucose levels is not too high (no particular set of guidelines exist).
To summarise the above confusing answer:
1. If the patient can wait for 2 weeks before extraction ? If the answer is yes, refer immediately for blood glucose control and follow up in 2 weeks.
2. If the patient's condition may worsen or if there is risk of involvement of masticatory spaces or floor of mouth etc; immediate management is required preferably in a hospital setting as day care procedure with additional simultaneous medical management either on OPD basis or as in-patient..
3. If the patient's condition is already bad (as in fascial spaces already involved), hospital admission becomes mandatory with IV antibiotics and physician care.
4. If the tooth can be easily extracted, one can do so in the hospital setting with physicain stand-by. (if there is anticipation of complications).
In diabetic states, the potential risks / complications are related to the poor healing capacity, neutrophil which are qualitatively poor (counts are normal usually). A case by case decision may be required before decisions and it's important to remember that 'guidelines' exist for 'guiding' and may need to be adapted per patient per condition.
Regards,
Dr. Akilesh R
Consultant Oral and Maxillofacial Surgeon
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Immunohistochemistry has been widely used in malignant lesions,  to recognize antigens and, consequently, to identify and classify specific cells within a cell population whose morphology is heterogenous or apparently homogenous.Can this technique be applied to differentiate KCOT form ameloblastoma? if so what is specificity and sensitivity of the tests?
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Dear Karpal,
The attached publication about comparisons  ameloblastoma and Keratocystic odontogenic tumor.
I Hope this will be helpful,
JM
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I was wondering if I could get some information and references (upto date) regarding bone transport distraction after partial maxillectomy of posterior palatal region ?
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Hi Haroon.... have a look at this
hope it could help.
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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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It is avisable to remove the appliance as it would exert pressure which in turn may have negative impact on the graft. Passive appliances can used until the graft is taken
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Intracapsular mandibular condylar fracture displaced more than 5 mm and more than 30 angulation.Is it always necessary to open TMJ capsule? Please give your idea. The patient may visit early, or it may be delayed case.Thank you.
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2% lignocaine means 20 mg in 1 ml ?
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20mg/ml therefore 36mg in 1.8ml carpule
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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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Thanks Denis,
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Dear researchers from Field of oral and maxillofacial surgery,please do suggest thesis topic on impaction of third molars.
Any help will be highly appreciated.
Thanks
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Hi Tahir.
Do you have any possibility of chang the topic. Impaction of third molars is nothing new. So many thesis, analysis and publications....
The idea of the thesis is to prove sth new or to present relevant information to the colleagues.
Why don't you think of sth contemporary.
alv. ridge preservation after extraction.....or comparison of two methods of apicesctomy...or sth with medically compromised patients- anemia and alveolitis.
Hope to give food for thoughts :)
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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 partial impacted or fully impacted third molar significantly increase the incidence of mandibular angle fractures and decrease the incidence of condylar fractures. Due to the potentially challenges to the surgeons also more serious complications associated with condylar fracture, should the clinicians carefully consider the decision of mandibular third molar extraction?
How about the opinion that said, "the early removal of 3M is suggested to prevent the risks inherent in maintaining these impacted teeth as well as to limit future surgical risk and difficulties"?
How can we calculate the benefits and risks?
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I enthusiastically support the prior two comments. Data strongly suggest that the odds of creating problems that did not exist initially go up when asymptomatic third molars are routinely extracted. Dental insurance data for patients treated in the State of Washington support this finding.
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Literature revealed that this is a rare tumor of jaw. Prognosis are not very well described. Looking forward for any clinician/surgeon/researcher to share their experience in managing this tumor in an adult patient. 
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Dear Tengku Aszraf Tengku Shaeran:
I think the answer to your question will be found in this article.
Regards
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A 74 year old gentleman with severe anterior deepbite and generalised attrition, with severely attrited mandibular anterior teeth insisting on full mouth rehabilitation. Bite (vertical dimension) to be raised minimum by 5mm-6mm. Please give your opinions / suggestions/ experiences of such cases with possible prognostic outcomes. Thanks & regards
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In Nijmegen at our university, we treat these patients routinely with direct composites. 5-6 mm increase of VDO is not a problem. The technique we use is the DSO technique as described in our paper in Operative Dentistry 2016. Because these patients have a high risk for fracturing restorations, ceramics could be contrindicated.
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In this case  two ducts come out of the anterior border of Parotid gland, unite with each other to form a single duct. This  duct resumbles  english letter Y, So we named it as Y shaped parotid duct. A sound Anatomical knowledge of this duct is important to decrease post operative complications after parotid surgeries, as leakage of secretion from parotid duct may lead to delayed wound healing.
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Is it the same variation called a 'double parotid duct' with a dual origin in the parotid gland and fuse with each other at the anterior border of the masseter muscle to form the Stensen’s duct ?
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1.Root planning/Curettage/Flap surgey
2.Root conditioning/Local irrigation?
3. RCT
4. Crown
5. Extraction of hopeless tooth
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Hello there Alok, hope you are well. This question has a lot of divisions and we could see a long debate. lets hope the followers give their valuable comments and share their knowledge.
In my personal experience and as far as my knowledge is concerned regarding the subject, endo-perio or perio-endo whichever the case, we must perform endodontic therapy of a tooth. Curretage or root surface debridement is for sure recommended in case there is severe periodontal condition. Local irrigation would be a part of our overall treatment planning and maybe done. As far as crown fabrication is concerned, that would depend on the size of the access we make for endodontic therapy. and well extraction would be of course the BEST option for a tooth which is hopeless. 
I am attaching a link for you to have a look. Its an old article in dental update but quite sound and simple. Please share if you have something new,
Best wishes !
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There are various surgical methods for management of KOTs. Each with its own set of advantages and disadvantages . However, there is no method with zero recurrence rate.
What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?
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Extraction of involved teeth , enucleation of cyst with peripheral osteotomy , chemical cauterization with Carnoy's solution and excision of overlying mucosa as proposed by Stoelinga . This is the best treatment method to achieve best possible results and a close long term follow up too . 
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I am working with exosomes purified from whole saliva samples. I would like to know the best RNA kit to isolate both mRNA and miRNA from exosomes for microarray profiling.
I appreciate any response.
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MiRvana kit is what we use to isolate miRNA from exosomes. It will also isolate mRNA. We had originally just used trizol isolation, but found we lose most of the miRNA.   
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I am looking for the mouse/rat model of septic peritonitis. Can someone suggest working method or give publication link. Thanks
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Animal Models of Anemia of Inflammation
Seth Rivera, M.D., Ph.D.1 and Tomas Ganz, Ph.D., M.D.1,2
Abstract
Anemia of inflammation (AI) is a complex multi-organ response to inflammatory disorders. Because AI can result from many infectious and non-infectious inflammatory diseases, multiple mechanisms may contribute to its pathogenesis including iron restriction, direct erythropoietic suppression, shortened red cell survival or frank hemolysis. Animal models have been helpful in the study of the mechanisms of AI and its potential treatments but each model reflects distinct aspects of this heterogeneous syndrome. It is therefore important to study a variety of models of AI. This review focuses on the use of infectious and noninfectious mouse models of inflammation that have been shown to manifest anemia. We review many of the models reported in the literature or developed in our laboratory, and discuss their respective merits and drawbacks.
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Could infection which leads to final plates removal decision regard as hardware failure?
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Hardware failure is either fracture of a plate or loosening of screws leading to non-union or malunion. Infection does not necessarily lead to loosening of screws, but loosening of screws frequently leads to infection. As for plates removal after uncomplicated healing, it is not necessary provided it is titanium and patient is asymptomatic.
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what is the update information regarding Craniomaxillofacial training using simulations?
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Could fall down be the most common etiology of mandibular fractures especially in countries with rapid architectural urbanization? are there published articles or researches which support or have this result?
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It is true in a country like India where due to rapid urbanisation & using of high velocity vehicles ,without proper road safety majors RTA is the commonest cause of Maxillofacial injury followed by fall.This is my experience in atertiary care centre like AIIMS Bhubaneswar.
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Spilint; Drugs- MR; TENS; Guards; lifestyle
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"The treatment of bruxism varies depending on its cause:
Stress — If your bruxism is stress-related, your dentist or physician may recommend professional counseling, psychotherapy, biofeedback exercises or other strategies to help you relax. Your dentist may prescribe a medicine such as diazepam (Valium). This will be for short- term use, usually one week or so. It should be taken at night before you go to bed to help reduce grinding at night. You also may receive a prescription muscle relaxant to temporarily ease the spasm in your jaw. You may also be fitted for a custom-made bite plate. If this does not help, your dentist may refer you to an oral surgeon or to a dentist who has advanced training in head and neck pain.
Dental problems — If your bruxism is related to tooth problems, your dentist probably will correct tooth alignment. In severe cases, your dentist may need to use onlays or crowns to entirely reshape the biting surfaces of your teeth. The dentist also may make a mouth guard or bite splint that fits your mouth and teeth. This will help prevent further damage to the teeth. In some cases, it may help your teeth and muscles to realign.
Medicines — If you develop bruxism as a side effect of antidepressant medicines, you have a couple of options. Your doctor may switch you to a different drug or give you another medicine to counteract your bruxism."
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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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Dear Dr Parveen,
I agree with Dr Tatakis. It is very important to consider in term of the risk/benefit. In our Institution, the CBCT has been used with tools in care of syndromic orofacial cleft patient, with goal to establish the plan of orthodontic treatment, which is started after of seven years old.
In terms of research, we are conducting a study that uses TCCB to characterize the maxillar and mandible structure of a specific group syndromic cleft palate (mandibulofacial dysostosis). The knowledge of the abnormalities these structures could contribute with syndromic delineation and with more adequate craniofacial treatment. This project was evaluated by Ethical Committee that considered the benefit of project this nature.    
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Usually for patients with OHA.
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Very nice answer
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Anatomical considerations which could influence risk of Voluma injections for malar augmentation.
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There is a rather large difference between psychological trauma and medical/somatic traumatic injury. We should observe this difference and use the correct terms. Sorry, I know nothing about medical injuries.
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Just Imagine... A Short Tribute to Nelson Mandela, the guest editorial by C Peter Owen (Int J Prosthodont 2010;23(6):491) is an unique one and something that's rare in the pages of a specialty journal. This impassioned piece is written on the eve of the 92nd birthday of Nelson Mandela and is adeptly connected to prosthodontics and how the industry driven hype can mire our ultimate goal as caring professionals. Check my blog post for details.
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I certainly agree with your obsevation and subsequent appreciation.Personal regards.--nkm
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Frederick James Trevor Burke and Martin G.D. Kelleher in an article (J Esthet Restor Dent 2009; 21:143-6) elaborate on a very relevant test, 'the Daughter test', applicable in complex elective esthetic treatment planning. This test asks the question, “Knowing what I know about what is involved with this proposed dentistry, would I carry out this treatment
on my own daughter’s teeth?”. Or simply, 'will you carry out this treatment on your near and dear'. A negative answer necessitates a total revamp of the current plan to something less destructive and more sensible. A 'kith n kin test' will sure aid us in keeping our ethical sense intact!
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Swelling appears and disappears on and off for past 3-4 months. Swelling usually develops in the morning and subsides in 4-8 hrs on the same day. His TC,DC and ESR : WNL
What can it be?
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It also could be a manifestation of a granulomatosis (crohn, miescher, sarcoïdosis ...)
Sorry, but what means TC, DC, ESR and WNL ? I'm not fluent in english.
Dear All: Are you into trauma ? Do you have a paper you would like to publish ?
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Check out www.traumamon.com and submit to "Trauma Monthly". Indexed in Scopus. 100 % free online. You may apply as a reviewer or join our editorial board as well. Address requests to info@traumamon.com.
Dear All: Are you into trauma ? Do you have a paper you would like to publish ?
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Check out www.traumamon.com and submit to "Trauma Monthly". Indexed in Scopus. 100 % free online. You may apply as a reviewer or join our editorial board as well. Address requests to info@traumamon.com.
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I've got a 2.5 year old male patient, presented with lt parotid swelling, CT scan revealed 1.3 cm intragladular stone. The swelling is 6 times recurrent. Any suggestions for optimal treatment?
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A 1.3 cm claculus is unusual and there is bound to be quite substantial inflammatory fibrosis if there has been 6 episodes of sialadenitis. It may be possible to retrieve this by sialoendoscopy (if the technique is easily available to you - it certainly isn't universal) or basket retrieval at sialography (again if the technique and expertise is available). Calculi this size surrounded by inflammed and fibrosed tissue are often not easily retrievable by these methods and the situation can sometimes be made worse. If these fail a direct approach to the duct by raising a standard parotidectomy skin flap and identifying the buccal branch of the facial nerve which lies running in parrallel with the duct allows direct visualisation of the duct and removal of the calculus by a linear access incision in duct which can be repaired microscopically. My experience has been that this is comparitively quick definitive solution and as long as the duct is well repaired salivay fistula has not been a problem. The older approach of cannulating the duct, everting it out to the cheek and approaching the calculus by a transfacial incision carries a much higher risk of parotid fistula, is less aesthetic and risks the buccal brach of the facial nerve being traumatised.
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I'd like to know the experience of the researchers about the use, efficacy, safety and side effects of this therapy for large CGCG.
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Thanks for contributions. This article published by Pogrel is really very good and will help us, so thank you Dr Bharkava. When I was in my post-graduate I followed one case reported in this attached paper and the results using calcitonin spray was very good in a growing child and really costed much time like said Dr Varol. Now I´m treating an adult woman with a large CGCG intra-osseous.
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As per my understanding, trials should be conducted specifically on single and precise indication For example; can we do trial on bone defects at multiple locations in body ?
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Would the study be powered to look at each individual indication or just the whole population studied? Having an "unclean" population (ie many conditions ) makes the study results less clear.
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Second stage surgery was done after six months for loading.
Implant was immediately placed after extraction.
There was no cortical fracture nor dehiscence when implant was loaded.
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Remodeling of the buccal cortical plate resulting in a netloss of bone and exposure of the implant threads should be expected, it has been shown to include 50-60% of all implants placed in animal models. It appears that one needs an at least 2 mm bone envelope to avoid resorption. Placement of biomaterials ("grafts"), membranes, connective tissue grafts will not change the biology. However with the application of BMP-2 we have shown that resorption can be avoided.
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Or are you using a combination of the two procedures?
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Each is the same principle, with no technical differences. SMAS resection vs imbrication/plication have not been shown to be any different in long term followup comparisons. Risk may be higher in resection, but studies are not large enough to show the difference.
Hello, I need Articles about sutures in oral cavity and adhesion of microorganisms, can you help?
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I need articles like this.
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Maxillofacial surgery
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I have been using Infuse Bone Graft (rhBMP2) and dembone for the last two years in periodontal surgeries though I still prefer an allograft with infuse as the results are fantastic. Incase if you try then please do let me know your results also.
Regards
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1.DNA changes-a great deal of research is being done to learn what dna alterations bring obout the cancerous changes in the cells of oral cavity & oropharynx.
2.New chemotherapy techniques
3.New radiotherapy techniques
4.Gene therapy
5.Vaccines for HPV viruses
6.Advances in fluorescence in imaging techniques to detect oralcancer.
7.A new research has investigated the potency of indian wild plants against microbials found in the mouth of oral cancer patients viz asparagus,desert date,false daisy,curry tree,caster oil plant,fenugreek
8.NANOTECHNOLOGY
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Yes all very interesting but at an even more basic level, clinical suspicion is still (I believe) of utmost importance. This dosen't necessarily mean doctors and dentists becoming more aware and ramping up the referrals, I mean even more basically: General population education. Whilst this is getting a bit better in this country, I think we still have a long way to go.
Abhitosh I do appreciate all your comments on the research drive and I think point 7 is especially interesting considering India has one of the highest incidences of Oral Cancer in the world. What no one seems to have got a handle on though is why, given all the advances in earlier detection and management modalities, is the 5 year survival still not drastically improved....
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While maxillofacial prosthesis is not a substitute for plastic surgery, in certain cases it may be an alternative. Some of the advantages are: less or no additional surgery,decreased hospital stay,less invasive than plastic surgery,more aesthetically pleasing than plastic surgery
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Good point! Burned patients do not provide enough soft tissue (quality and amount) to cover prosthetic devices. Skin expansions from adjacent sites may be considered for late recover of the affected area; however prosthetic devices can also be used to keep spaces ready for posterior correction avoiding tissue collapse or graft deiscence.
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Basic oral armamenterium
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As Shazad mentioned, one is bevelled on 1 side (Chisel) and the other is bevelled on both sides (osteotome).
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Sodium hypochlorite has proved to be very effective because it is mainly the sterilization of canals also washing with hydrogen peroxide followed by sodium hypochlorite is proven to be effective.
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Shape of fill
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If cavity is big and patient will do prosthetic for it no need to shape
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From my expeience in lower wisdom tooth removal surgeries there is no clear cut criteria to define the difficulty of removal depending on radiographs. may be the presence of distal radiolocency is the only promising feature seen on radiograph that encourages and shift even very difficult impaction accounted by available criteria from difficult to simple.
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Radiographs are a two-dimensional representation of a three dimensional object (the patient's anatomy) and can be quite deceptive.i do agree both a clinical and radiographic assesment are important. Surgical disimpaction can be a very humbling experience.
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Conventionally it is the thesis/dissertation. More effective steps have to be suggested. Otherwise research contributions will not become relevant. Researchers may make comments
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Short communications/studies are the only solution to this. Apart from the mandatory projects multiple (minimum 3) relevant short studies can be conducted that can be later used for publication, poster, presentation etc.
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American academy of dental research (AADR) has come with a few suggestions on the treatment modalities of TMDs. It's concise and practical which can be considered in intriguing cases of TMDs. Check my blog post for details.
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AADR's recommendations were based on a Biopsychosocial paradigm of TMD.  It maintains that TMD is self limiting.  As a clinician that exclusively treats TMD for over 20 years, I disagree with those recommendations. Evidence Based Dentistry is the overlap of 'evidence' including case series, clinician's judgement AND patient preferences.  The attached paper should be of value in informing clinicians that want to help TMD patients get relief from their often debilitating symptoms.  More information may also be found on our website MidwestHeadaches.com
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Anatomic landmarks that should be respected in the craniofacial skeleton, navigation, transfer of pre-op insertion of implants to the surgical field.
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Thank you Aberto,
This is a very interesting answer. I also agree in that implant angulation taking care not to entry in the orbital cavity and assuring a good stability in the malar bone should be the main goal. Pre-op virtual planning would be a good choice if some anatomical landmarks are fixed for translation into the surgical field.
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Class II molar, overjet 15mm, openbite of 3mm, deficient chin, vertical growth pattern.
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Overjet is considerably high in your case. A sajittal split advancement alone will cause a significant relapse.If the maxilla is protruded ( depend on the SNA) maxilla may be setback at Le Fort 1 level ( difficult procedure) to reduce the relapse This way the overjet can be distributed in themandible and maxilla.If SNA is within normal limits, a mandibular distraction pre operative will help to reduce the overjet. Open bite can be addressed with a posterior impaction of the maxilla.
Assymmetry has to be addtessed with BSSO/VSS combination.
If micrigenia is a problem an advancing genioplasy will be necessary (or an Implant). These are only for guidance in the surgical planning.Final plan will depend on the cephalometric findings and profile analysis.
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The extra or intracapsular parotid dissection.
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Here you can see conservative parotid gland surgery
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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,
In the 17th National Anatomy Congress, in the dental anatomy section, a case was reported by maxillofacial surgeons. In that case single implant was implanted for incisive tooth and patient was complaining of hypoesthesia after implant. I think this indicates nerve injury due to intervention. If there was nerve atrophy hypoesthesia would have ended but patient was complaining of hypoesthesia for 1 year. I hope this will help you.
Best wishes
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A 19 years old male patient feels muscle function loss on the right side accompanied by parasthesia to the right of the mandibula, which occurs for approximately 20 seconds. It relapses many times a day. In addition there is alveolar bone loss without tooth mobility and bleeding.
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M.R.I to rule out S.O.L  of brain
vitality of teeth -in case acute osteomyelitis pressurizing on I.A.nerve.
also psychological counselling...
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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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Prolotherapy is the use of material that promote fibroplastic activity.
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Hypermobility of the joint may be indication for prolotherapy
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Atraumatic extraction was done of right first maxillary molar with buccal infiltration and greater palatine nerve block (lignocaine 2%with adrenaline 1:80,000). The patient complains of blurred vision and pain in the lacrimal gland area of their right side. Pupil reflexes are normal, as is the healing of the socket.
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First of all, was the patient referred to the ophthalmologist to check what was the reason for blurred vision. When the patient complains on blurred vision and pain ? immediately or latter. In my opinion the reason for meantioned abnormalities was local anesthesia into second branch of trigeminal nerve spreaded into first - ophthalmic branch , causing pain in lacrimal gland area due to lacrimal nerve - V1
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1. Why are Malignant Odontogenic Tumors uncommon in the pediatric age group?
2. If you have reported any case/ come across with any literature, please provide the reference.
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We have recently reported 2 cases of paedriatic CEOT case in JISPPD journal in the upcoming Apr issue.
And true malignant odontogenic tumors are very rare entities.
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I need the appearance in X rays and CT in jaw bones or other bones, also I need references.
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Maybe you can use dental ct.
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If intra-bony lesions of considerable size, the buccal plate of bone could be easily penetrated with needle to get sample. I think that the accuracy of fine needle same as incisional biopsy but less traumatic and with fewer post operative complications than incisional biopsy.
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Fine needle aspiration biopsy is easy and convenient method for diagnosis of intrabony lesions but direct microscobic evaluation ( by partial or complete removal of the lesion) of the lesion lining may be more accurate for provisional diagnosis
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I think that the meniscus doesn't follow !
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No in fact it goes in the oposite direction
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If yes, is it coincidental or a correlation? Gardner's syndrome is known to be associated with intestinal polyposis, supernumerary tooth, impacted tooth, odontomas, osteomas.
Since, the syndrome is associated with supernumerary tooth/impacted tooth, can the odontogenic keratocyst occur in these cases?
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The clue probably would be the PTCH gene. Supernumerary teeth may involve the Wnt, Notch, SHH etc while these genes could be influenced by PTCH mutation - exon7 see - Int J Mol Med. 2006 May;17(5):755-9.
This is just a hypothesis and probability
All the best
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The surgical approach to cystic lesions of the jaws is either marsupialization or enucleation. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall and its proximity to vital structures.
The technique of marsupialization, or Partsch’s technique, consists of removing a window from the lesion and suturing the surrounding mucoperiosteum to the margins of the cyst wall. The ensuing cavity is filled with gauze, which is removed after seven to ten days. If necessary, the gauze is changed during this period. This procedure aims to reduce the size of the cyst: opening the cyst eliminates its osmotic pressure and bone apposition gradually occurs at the site previously occupied by the epithelial covering of the cyst. These procedures can be used as a single treatment for a cyst or as preliminary treatment for subsequent enucleation. This procedure aims to reduce the size of the cyst: opening the cyst eliminates its osmotic pressure and bone apposition gradually occurs at the site previously occupied by the epithelial covering of the cyst. These procedures can be used as a single treatment for a cyst or as preliminary treatment for subsequent enucleation.
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The properly so called cysts of the jaws are endosseous lesions, mainly containing fluid material, that appear radiologically as well-defined lucent areas within the bone, tipically with a sclerotic rim, although severe inflammation may result in a less evident sclerotic border. A true cyst is delimited by a fibro-connective wall, coated inside by a multistratified epithelium. Most of the cysts in the jaws arise from odontogenic sources, although also non odontogenic - nasopalatine duct cyst, globule-maxillary cyst, median palatal or mandibular cyst, being however, the last three controversial as independent nosological entities - or pseudocystic lesions - Stafne cyst, aneurismal bone cyst, hemorrhagic bone cyst - can be observed.
Being very variegated the context of the simil-cystic radiolucencies of the jaws, the finding of a seemingly cystic lesion in the maxillary/mandibular bone requires thorough evaluation by clinical history, careful physical examination (the state of the mucous membranes in the affected area, the presence of necrotic teeth in relation to the lesion, any deformation of the jaw, the presence of egg-shell crackling of the cortical bone on palpation), and radiographic assessment (OPT, TC) before considering surgical treatment options to follow.
As well known, in order to formulate a preliminary diagnosis, which is compatible with the clinical and radiological findings, it is necessary to consider:
- patient age
- location (maxilla; anterior / posterior mandible)
- shape, dimension and appearance (unilocular? corticated outline? expanding in the antero-posterior or in the bucco-lingual dimension? )
- in relation with an unerupted tooth? in relation with necrotic tooth/teeth?
- cortical plate disruption? root resorption? tooth displacement?
Nevertheless in some cases the preliminary differential diagnosis may challenge the clinician.
For example, a follicular (dentigerous) cyst presents tipically as a well-demarcated radiolucent lesion in relation with the cervical area of an unerupted tooth (commonly the third molar). Nevertheless, also keratocystic odontogenic tumor may present in the same location (posterior mandible), as unilocular radiolucency, in continuity with the follicular tissue of an impacted tooth. Moreover, the possibility of ameloblastic transformation of a dentigerous cyst has been reported.
In accordance with the considerations made above, it is clear that, whenever possible, the surgical enucleation probably remains the treatment of choice, as supported by a more comprehensive scientific evidence.
Marsupialization is however to be preferred in some cases:
- in deciduous or mixed dentition, when are involved the gems of permanent teeth
- in the presence of a follicular cyst, when the aim is the recovery of the involved tooth
- in the very elderly or debilitated patients, in which ademolitive intervention is not indicated
- when, for the considerable size of the cystic lesion, there is a real risk of mandibular fracture
- to achieve decompression and reduction in size of the cyst, as a step preliminary to a subsequent cystectomy
Although evidence base still favors definitive surgery whenever possible, there is some recent reports that even large keratocystic odontogenic tumors respond to marsupialization (Pogrel, Jordan J Oral Maxillofac surg 2004; 62.651-655), actually with complete resolution, with the “neoplastic” epithelium being replaced through metaplasia by epithelium wholly similar to that of the oral mucosa.
These findings of course open new perspectives towards less invasive and more conservative approaches, especially – as already pointed out by Dr Barbato, Dr Nesse and Dr Gaballah, in selected cases of very large lesions with presunctive diagnosis of dentigerous cysts or keratocystic odontogenic tumor in order to avoid major surgery (very large and bilateral cases). I’m learning with interest that also ameloblastoma can benefit from a decompression, in order to reduce its volume before surgical removal, as reported by Dr Lizio in his very interesting publication. So, at the state of knowledge, I think that the conservative management of odontogenic lesions appears very promising as definitive treatment or as a therapy preceding and supporting a subsequent surgical enucleation.
Thanks for asking this interesting question!
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lignocaine with epinephrine in exodontia?
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Most studies involving adrenaline's effect on blood glucose have been done in regions where the usual concentration is about 1:80000.
The following article discusses the effect of adrenaline on human physiological responses:-
1/ Sivanmalai S, Annamalai S, Kumar S, Prince CN, Chandrakala, Thangaswamy V. Pharmacodynamic responses of exogenous epinephrine during mandibular third molar surgery. J Pharm Bioall Sci [serial online] 2012 [cited 2013 Sep 27];4:390-3. Available from: http://www.jpbsonline.org/text.asp?2012/4/6/390/100296
I think you can get in touch with the authors of that article to get more information.
There are atleast two more studies where 1:2,00,000 adrenaline is commony used. I do not have access to the studies, and you can go through the articles for more info as they must have some table / info on the topic you are searching on.
1/ Salins PC, Kuriakose M, Sharma SM, Tauro DP. Hypoglycemia as a possible factor in the induction of vasovagal syncope. Oral Surg Oral Med Oral Pathol. 1992 Nov;74(5):544-9.
2/ Cunningham AJ, Donnelly M, Bourke A, Murphy JF. Cardiovascular and metabolic effects of cervical epinephrine infiltration. Obstet Gynecol 1985;66:93-8.
(This study used 0.5% adrenaline with 1:2,00,000 adrenaline).
Regards,
Dr. Akilesh. R
Oral and Maxillofacial Surgeon
Chennai
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Radiological features of TMJ ankylosis reveals the prominent coronoid process and antegonial notch, but don't know the mechanism, could anyone help?
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It is a fallacy that the action of mouth opening creates downward forces which cause deepening of antegonial notch and elongation of coronoid process in ankylosis cases.
These patients may not be able to open mouth, but nothing stops them from "clenching" their teeth together. This isometric contraction (in an attempt to chew) creates forces in the elevator muscles e.g. temporalis and masseter which in turn develop according to "Force-length relationship". Force-length relationship, also called the length-tension curve, relates the strength of an isometric contraction to the length of the muscle at which the contraction occurs. Muscles operate with greatest active force when close to an ideal length (often their resting length). In order to generate maximum forces of contraction, masseter and temporalis develop to attain an ideal length, causing the mandible to grow in proportion (Functional matrix theory). In ankylotic patients,since the mandible is prevented from responding normally to these forces (because of lack of function and growth center destruction), the attempt of the muscles to attain an ideal length causes the bone to remodel at their point of attachment. Thus we see that the gonion increases in length as does the coronoid process. The downward bending of the mandible at the antegonion is probably caused by depressors trying to open mouth, but their contribution to deepening of the notch is minimal.
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After radical neck dissection, I saw a few patients developing saliva collection under the flap, So, how could the case be managed?
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The only reliable way would be reconstruct the floor of the mouth in some manner so as to separate the oral cavity and the neck. The 'salivary leak' that is taking place under the flap is one of the most problematic areas of NEck Dissection done in continuity with the oral cavity (tumor). The problem in this case being the potential risk fo 'contamination' of the neck with the oral fluids and bacteria with potentially fatal complications like even Carotid Blowout or other vascular erosions or flap failure / necrosis. But reconstruction of floor of the mouth is one of the most difficult aspects of post ablative reconstructive surgeries due to lack of local tissues available. Free Flap reconstruction might be the most viable option at the moment, in my opinion.
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Osteoradionecrosis was once considered a dreaded complication following Radiotherapy for Head and Neck Malignancies, is rarely seen now a days, thanks to the new techniques of radiotherapy and the prophylaxis taken before therapy. Is this complication still be considered among the complications of Radiotherapy?
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Absolutely yes. There is some evidence that the complication may occur more often in patients who have received concurrent chemotherapy with radiotherapy. Appropriate dental management is prerequisite to prevention. Additionally, the role of actinomyces and fungal pathogens has been observe, but the role of the organisms is poorly understood. The evidence basis for hyperbaric oxygen is weak. The role of Vitamin E and rheological agents such as pentoxyfyline (Trental) is proposed and may be helpful, though there is only low level evidence supporting this approach. Surgical resection and vascularized bone and/or soft tissue reconstruction is often required in severe cases (i.e pathologic fracture).
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I need help from you doctors , please
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Alessandri Bonetti, G., Bendandi, M., Laino, L.,
Checchi, V. & Checchi, L. (2007) The orthodontic
extraction: the riskless extraction of
the impacted lower third molar close to the
mandibular canal. Journal of Oral Maxillofacial
Surgery 65, 2580–2586.
¹*Department of Periodontology, School of Dentistry,
University of Bologna, Via S.Vitale 59 Bologna, Italy.
²*Department of Periodontology and Oral Medicine, Shool of Dentistry,
University of Belgrade, Dr Subotica 4, Belgrade, Serbia and Montenegro
(ORTHODONTIC EXTRACTION:THE EXTRACTION OF THE THIRD
MOLARS IN CLOSE PROXIMITY TO THE MANDIBULAR CANAL BY AN ORTHODONTIC-SURGICAL APPROACH)
Thank you Dr Akilesh R
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Hi Mr. Islam,
it depends on the quality and the topics of the articles. Frankly, if you want to publish more local results, you should try to get some local journals. Though, if you want to have some impact factor and/or pubmed indexing, this might be difficult with this. If you want, you can send me the respective abstracts and we can discuss where to submit it the best...
Regards,
Peer
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Early versus Delayed reconstruction, where experts for micro-vuscular surgery are not available.
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The patient and the pathology should be the determinant, there is no single "best way" of doing anything so the question has to be refined. In benign disease free non vascularised bone supported by semirigid fixation provides a flexible solution.
If the disease process is malignant then optimum treatment will require postoperative radiation in the vast majority in which case there is little argument against microvascular reconstruction - which also influences survival. Depending on patient co-morbidities and preference DCIA gives the best height match for mandibular resections and high maxillectomies (both with internal oblique - the skin is precarious unless you use a groin flap as well), fibula with skin for edentulous mandibles and lower maxillectomies, composite radial forarm for atrophic mandible or low maxilla where an obturator is declined. Scapula is a good pluripotential flap if your team doesn't mind non synchronous operating. If the environment is such that this expertise is not available and the patient cannot be transferred such as in the developing world reconstruction plate and pectoralis major will fill a defect but the plate will fail long term.
I'm not sure I can envisage a scenario where distraction is available but something as straightforward as free flaps are not...
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Just information pertaining to the most recent research topics in or around TMJ.
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Sir, are you kidding us?
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Distraction Osteogenesis for TMJ Ankylosis with facial asymmetry followed by ankylosis release or vice versa.
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I would argue that in case of TMJ Ankylosis pt with obstructive sleep apnea. .. First treat the mandibular retrognathiam by distraction. After attaining satisfactory results, then ankylosis release can be done. The reason is we need a stable bone for distraction . If after ankylosis release we do distraction, where is the stable Bony ramus....  We have done quite a few cases like this and have very good results. 
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Deterioration of maxilarry mid-facial growth, injury to vomero pre- maxillary suture
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