Dental exarticulation

Tooth exarticulation or avulsion refers to the complete displacement of the tooth out of its socket. It is a complex injury, requiring immediate intervention for optimal results. Literature indicates that prolonged dry time and improper handling may be associated with increased risk of failure. Immediate replantation of the tooth allows for immediate restoration of esthetics and phonetics. This case report presents the management of an avulsed mature tooth in a young boy, with a two-year follow-up, which had been preserved in milk after around 15-20 minutes of injury and transplanted after two hours at a dental hospital. Timely modified endodontic therapy prevented subsequent inflammatory root resorption.

Four compartment method: a simplified and cost-effective method of noncultured epidermal cell suspension for the treatment of vitiligo

BACKGROUND

Despite continued progress towards an elucidation of pathogenetic pathways in vitiligo, a definitive cure remains elusive. Noncultured epidermal cell suspension (NCECS) is emerging as the treatment of choice for surgical management of both stable and segmental vitiligo. NCECS is very effective in repigmenting stable vitiligo, but the technique requires an expert and the support of a laboratory facility.

OBJECTIVES

To investigate a simplified and more cost-effective method for NCECS.

METHODS

We simplified the conventional NCECS method and made it more cost-effective and simple enough to be performed in the clinic without laboratory equipment. We named this the four compartment (FC) method. Six patients with vitiligo were treated with this FC method.

RESULTS

The FC method for NCECS is highly cost-effective and simple. Six patients with vitiligo were treated and the results showed marked to complete repigmentation in four patients and > 50% repigmentation in two patients in 3 months.

CONCLUSIONS

The FC method is a cost-effective and simple procedure to prepare epidermal cell suspensions. In this modified method we showed that there is no need for pipette, tips, centrifuge tube and most importantly a centrifuge machine or any other expensive laboratory equipment.

Shikimic acid, a base compound for the formulation of swine/avian flu drug: statistical optimization, fed-batch and scale up studies along with its application as an antibacterial agent

The sudden outbreak of swine flu has increased the global demand of shikimic acid which is an industrially interesting compound, as it is used as a key starting material for the synthesis of a neuraminidase inhibitor Tamiflu(®), for the treatment of antiviral infections such as swine flu. Statistical optimization and evaluation of medium components for the production of shikimic acid by Citrobacter freundii is addressed in the present investigation. Plackett-Burman design was applied for the screening of the most significant variables affecting shikimic acid production, where glucose, asparagine, KH2PO4, CaCO3 and agitation rate were the most significant factors. Response surface methodology was also employed to study the interaction among the most significant variables through which shikimic acid production increased to 12.76 g/L. Further, fed-batch studies resulted in the production of 22.32 g/L of shikimic acid. The scalability of the process was also confirmed by running 14 L bioreactor (7.5 L production medium) where 20.12 g/L of shikimic acid was produced. In addition the antibacterial activity of the shikimic acid produced was analysed against four Gram positive and four Gram negative bacteria and it was found to have a greater inhibition effect against the Gram negative bacteria.

Recurrent case of central giant cell granuloma with multiple soft tissue involvement

Central giant cell granuloma is a fairly common lesion in the jaws aetiology of which is still completely unknown but thought to be of a reactive process to some unknown stimuli. It usually arises either peripherally in periodontal ligament, mucoperiosteum, or centrally in the bone. The histological hallmark for both peripheral and central giant cell granuloma (CGCG) is the presence of distinctive multinucleated giant cells (MGCs) in a prominent fibrous stroma. Central giant cell granuloma is an uncommon benign proliferative lesion that almost exclusively occurs within the jaw. Eventually, it may become aggressive leading to the expansion and perforation of cortex resulting into mobility and displacement of teeth with root resorption. The present case focuses on the dilemma and perplexity in diagnosing aggressive CGCGs, due to its close proximity with respect to pathology, behavior and prognosis from giant cell tumors (GCT). Central giant cell granuloma persuaded extensive destruction to the hard and soft tissues with high rate of recurrence encourage us the need of exploring the possibilities of giant cell tumors having a definitive presence in the jaws.

Qualitative and quantitative assessment of relationship between mandibular third molar and angle fracture on North Indian population: A clinico-radiographic study

Objective:

To assess the relationship between impacted mandibular third molar presence and the risk for mandibular angle fracture with the effect of various positions of mandibular third molar and the risk of mandibular angle fracture.

Materials and Methods:

In the North Indian territory, a total of 289 patients with mandibular angle fractures were studied and evaluated for the possible relationship with impacted third molar on the basis of clinical and panoramic radiographical findings.

Results:

Results that confirmed the highest risk for mandibular angle fracture was associated with mesioangular angulations (45.42%) followed by vertical (26.34%), distoangular in sequence and least risk was found with bucco-version angulations (2.67%) according to Winter's classification. Additionally, the highest risk of mandibular angle fracture was reported with partially erupted third molar (47.75%), followed by erupted (23.53%) and unerupted third molar (19.38%).

Conclusion:

The risk for mandibular angle fracture is not only affected by status of eruption, angulations, position, number of roots present in third molar but also by the distance of mandibular third molar from inferior border of mandible and the percentage of remaining amount of bone at the mandibular angle region.

Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block

AIM

To compare the anaesthetic efficacy of different volumes (1.8 mL vs. 3.6 mL) of 4% articaine with 1 : 100 000 epinephrine injected as buccal infiltrations after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

METHODOLOGY

Two hundred and thirty-four adult patients, diagnosed with irreversible pulpitis in a mandibular tooth, participated in this multicentre, randomized double-blinded trial. Patients received IANB with 1.8 mL of 4% articaine with 1 : 100 000 epinephrine. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp chamber access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Patients who experienced 'moderate-to-severe' pain (HP VAS score ≥ 55 mm) were randomly allocated into two groups and received buccal infiltrations with either 1.8 mL or 3.6 mL of 4% articaine with 1 : 100 000 epinephrine. Root canal treatment was re-initiated after 10 min. Success was again defined as no pain or weak/mild pain during endodontic access preparation and instrumentation. Statistical analysis was performed using Mann-Whitney U and chi-square tests.

RESULTS

The initial IANB of 4% articaine gave an overall success rate of 37%. The success rate of supplementary buccal infiltration with 1.8 and 3.6 mL volumes was 62% and 64%, respectively. The difference between the success rates of the two volumes was not statistically significant.

CONCLUSIONS

Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis.

Oral myiasis involving palatal mucosa of a young female

In literal terms myiasis is the invasion of the tissues and organs of human beings by fly larvae. This phenomenon is well documented in the skin, especially among animals and people in developed and developing countries. When the tissues of oral cavity are invaded by the parasitic larvae of flies, the condition is called as oral myiasis. With the paper we are presenting a case of 19-year-old female suffering from oral myiasis of upper lip and palate. The treatment consisted of manual removal of the larvae, surgical debridement of the wound and oral therapy with doxycycline used as a locally acting drug for faster and better recovery.

Anti-dsDNA negative and anti-Ro positive lupus nephritis: a report of a rare case

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, characterized by an autoantibody response to various nuclear and cytoplasmic antigens. Renal disease in SLE occurs in 40-75% of patients, most often within five years of onset of disease, and is one of the strongest predictors of a poor outcome. A hallmark of glomerular involvement in lupus nephritis is the presence of autoantibodies against double-stranded DNA (dsDNA). Its level usually correlates with disease activity. Our patient presented with a rash resembling malar rash and features of nephrotic syndrome. On investigating, patient was found to have pancytopenia, raised erythrocyte sedimentation rate and depressed serum C3 levels with positivity of antinuclear antibodies and anti- Ro antibodies. However, most of the markers of lupus nephritis including anti dsDNA antibody were negative. Renal biopsy showed features of lupus nephritis (class-IV). Differential item functioning studies showed a full house immunoflourescence staining pattern characteristic of lupus nephritis. Association of Anti-Ro antibody alone with lupus nephritis is less known in literature. Negativity of anti-dsDNA antibody, which is usually considered to be diagnostic of lupus nephritis, poses a diagnostic dilemma short of renal biopsy. Till date only very few cases of non-drug induced lupus nephritis with negative dsDNA antibodies have been reported. In this report we wish to highlight a case of lupus nephritis which was negative for its specific anti dsDNA antibodies and with possible role of anti-Ro antibodies in the pathogenesis of lupus nephritis although the underlying mechanism is incompletely understood.

A rare case report showing direct association between hepatitis B and bulbar palsy

Bulbar Palsy is B/L impairment of function of cranial N. 9, 10, 11, 12 at lower motor neuron level either at nuclear or fascicular level in medulla or B/L lesion of lower cranial N. outside brainstem. We present case of viral hepatitis who initially presented with classical signs and symptoms of hepatitis B followed by characteristic features of bulbar palsy in form of difficulty in swallowing and slurring of speech reduced gag reflex, weak palatal movement. Other causes for bulbar palsy were excluded and indirect laryngoscopy confirmed presence of bulbar palsy. Patient had no previous neurological abnormality, there are many studies in the past for association of hepatitis B and bulbar palsy but no one confirmed about a direct association between hepatitis B and bulbar palsy. To best of knowledge this is the first case report which shows direct association between hepatitis B and bulbar palsy.

Triplication of deciduous teeth: a rare dental anomaly

Fusion of teeth is the union of two or more tooth germs, which are usually separated. Depending upon the stage of odontogenesis, it can be complete or incomplete. The present case describes fusion between the maxillary primary right central and lateral incisor with a supernumerary tooth. Clinical and radiographic examination revealed the presence of fused triple teeth. The fused teeth were extracted, sectioned and were visualized under stereomicroscope at three levels and the diagnosis of fusion of three teeth was confirmed histologically.

Purification and characterization of pectin lyase secreted by Aspergillus flavus MTCC 10938

An indigenously isolated fungal strain Aspergillus flavus MTCC 10938 was subjected to pectin lyase (PNL) production under submerged fermentation conditions. The enzyme was purified to homogeneity from the culture filtrate of the fungus involving concentration by ultrafiltration, anion exchange chromatography on DEAE cellulose and gel filtration chromatography on Sephadex G-100. The purified PNL gave a single protein band in SDS-PAGE analysis with a relative molecular mass corresponding to 50 kDa. Using citrus pectin as the substrate the K(m) and k(cat) values of the enzyme lyase were obtained as 1.7 mg/mL and 66 s(-1), respectively. The optimum pH of the purified PNL from A. flavus MTCC 10938 was 8.0 and up to 90% of its activity retained in the pH range from 3.0 to 11.0 after 24 h incubation. The optimum temperature of the purified enzyme was revealed at 55 degrees C and it was completely stable up to 40 degrees C when exposed for 30 min. The purified A. flavus MTCC 10938 PNL showed efficient retting of Crotalaria juncea fibres.