Congenital granular cell epulis: a rare paediatric tumour of newborn

Congenital granular cell epulis is a congenital growth rarely found on the gingiva of neonates. These remarkably large tumours present in an infant's mouth may impede with feeding, respiration or adequate mouth closure. Recognition of this entity and prompt treatment are essential for preventing any difficulties for the neonate. This is a case report of a 35-day-old female neonate who presented with a single exophytic lesion in the maxillary alveolar ridge. The differential diagnosis, management regimens and complications of this condition are reviewed. The lesion was excised under intravenous sedation and subjected to histopathological analysis. Based on the microscopic findings, the diagnosis of congenital granular cell epulis was confirmed. Clinicians including paediatricians, sonographers, dentists and surgical pathologists should be able to timely recognise and intervene such tumours as they may be potentially harmful to the infant.

Assessment of Salivary Flow Rate and Antioxidant Levels in Ectodermal Dysplasia Patients: An In vivo Study

AIMS

To assess the salivary flow rate levels and total antioxidant levels in ectodermal dysplasia (ED) patients and to compare with normal individuals.

MATERIALS AND METHODS

Unstimulated saliva sample of control and case were collected from the mouth to a pre-weighed Eppendorf tube using a Pasteur pipette for 4 min. Stimulated saliva of case and control was also collected after chewing paraffin wax for 30 s. Both the Eppendorf tubes were weighed again after collection of both the saliva samples. The flow rate was calculated as difference of weight of the tube divided by time (4 min). Both unstimulated and stimulated saliva was also separately collected for estimation for total antioxidant levels.

STATISTICAL ANALYSIS

For intergroup comparison, Mann-Whitney test was used, and for intragroup comparison, Wilcoxon signed-rank test was used.

RESULTS

In the intergroup comparison of both the salivary flow rate and total antioxidant levels, there was no statistically significant difference; however, there was statistically significant difference in the intragroup comparison of salivary flow rate and total antioxidant levels in case group.

CONCLUSIONS

There was a diminished unstimulated salivary flow rate in ED group, but stimulated salivary flow rate was significantly high and the total antioxidant levels in unstimulated saliva of the case group were significantly higher than the stimulated antioxidant levels.

Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: A randomized clinical trial

Aim:

To clinically and radiographically evaluate the reparative dentin formation in indirect pulp treatment (IPT) using mineral trioxide aggregate (MTA) and light cured calcium silicate (TheraCal) in primary molars over a period of 6 months.

Materials and Methods:

A clinical trial on IPT on 43 primary molars in 21 patients between the age of 4–7 years, divided into two groups: 22 teeth in MTA group and 21 in TheraCal group. Measurement of the variation in dentin thickness was done on the digitalized radiograph at baseline, 3 months and 6 months using CorelDRAW X3 software.

Results:

Statistical analysis using an independent t-test for intragroup and intergroup comparison showed a significant increase in dentin thickness in both the MTA and TheraCal group (intragroup comparison [P < 0.05]). However, intergroup comparison between MTA and TheraCal showed no statistical difference in reparative dentin formation (P > 0.05).

Conclusion:

Clinically and radiographically, both MTA and TheraCal are good IPT materials. The better handling characteristics and comparable reparative dentin-forming ability of TheraCal make this material an alternative to MTA in pediatric restorative procedures.

Management of congenital choanal atresia: a pedodontist's role

Choanal atresia is a rare cryptic congenital anomaly with developmental failure of the nasal cavity to communicate with the nasophaynx, resulting in a significant physiological and anatomical alteration of the dento-facial complex. It is considered as a life-threatening or lethal congenital malformation in an obligatory nasal breathing neonate. Elective transnasal endoscopic repair is the most preferred and minimally invasive procedure to correct this anomaly. This case report describes the multi-disciplinary team approach that included pedodontists to manage the case of a 6-month-old infant with choanal atresia suffering from breathlessness, feeding difficulty, and disturbed sleep.

Mandibulofacial dysostosis (Treacher Collins syndrome): A case report and review of literature

Treacher Collins syndrome (TCS) or Franceschetti syndrome is an autosomal dominant disorder of craniofacial development with variable phenotypic expression. It presents with characteristic facial appearance enabling it to be easily recognizable. A case of a 10-year-old girl having TCS is briefly described in this article. A review of the etiology, clinical features, differential diagnosis, and treatment options are also discussed.

Clinical spectrum of Silver - Russell syndrome

Silver - Russell syndrome is a clinically and genetically heterogenous condition characterized by severe intrauterine and postnatal growth retardation, craniofacial disproportion and normal intelligence downward curvature of the corner of the mouth, syndactyly and webbed fingers. Diagnosis of Silver - Russell syndrome remains clinical; no definite etiology or specific tests have been established. In the recent years, it has been shown that more than 38% of patients have hypomethylation in the imprinting control region 1 of 11p15 and one-tenth of patients carry a maternal uniparental disomy of chromosome seven. The pathophysiological mechanisms resulting in the Silver - Russell phenotype remain unknown despite the recent progress in deciphering the molecular defects associated with this condition. This case report describes the clinical features of Silver - Russell syndrome in a father and daughter.

Amelogenesis imperfecta: a clinician's challenge

Defective enamel formation can be explained as defects occurring at the stages of enamel formation. Quantitative defects in matrix formation leads to hypoplastic form of amelogenesis imperfecta. Inadequate mineralization of matrix leads to hypocalcification and hypomaturation variants. The demarcation of matrix formation and mineralization is not so distinct. This paper describes a case of a 7-year-old boy with amelogenesis imperfecta - Type IA i.e., hypoplastic pitted autosomal dominant.

Rubinstein Taybi syndrome

Rubinstein Taybi syndrome or Broad Thumb and Hallux syndrome is a genetic multisystem disorder characterized by facial dysmorphism, growth retardation and mental deficiency. A ten-year-old boy who had come to the Department of Pedodontics, Ragas Dental College, Chennai, with the chief complaint of unaesthetic appearance with extra teeth revealed delay in the developmental milestones. The patient appeared to be hyperactive and mentally retarded. Extra oral features revealed distinctive facial appearance with a broad fore head, hypertelorism, broad nasal bridge and beaked nose. Intra oral features observed were talons cusps in the upper central and lateral incisors, mesiodens, carious teeth and plaque accumulation. Since the patient was hyper active and mentally retarded, the dental treatment was done under GA. The treatment plan and dental management of this patient are discussed in this case report.

Comparative evaluation of tensile-bond strength, fracture mode and microleakage of fifth, and sixth generation adhesive systems in primary dentition

Conservative procedures using dentin-bonding agents are one of the important aspects of pediatric dental practice. The objectives of this in vitro study was to comparatively evaluate the tensile-bond strength, fracture mode (under SEM) and microleakage of total etching single bottle system to self-etching adhesive system in primary dentition. The flat buccal/lingual surfaces of 20 teeth were divided into two groups and treated with Single Bond (Group 1) and Adper Prompt (Group 2) to develop a composite resin cone. Then tensile-bond strength was measured using Instron machine. Fracture mode was evaluated in three specimens from each group under SEM. Microleakage of Class V composite restorations (in 20 teeth) with the above-mentioned adhesives was assessed under stereomicroscope after Basic fuschin dye immersion. Results showed no statistically significant difference between two groups. It was concluded that concerning the single step application with similar efficacy, the self-etching adhesive is better for bonding in primary dentition.

Evaluation of efficacy of Sofscale. A clinical and SEM study

Efficacy of Sofscale in the case of removal of calculus from the root surface as claimed by manufacturers was evaluated in the present study. 32 patients suffering from chronic periodontitis, having calculus deposits in the lower incisors were selected for the study. A double blind study was conducted to evaluate the ease with which calculus could be removed. In the second part of study, a SEM study of the root surface subjected to root planing alone and root planing after application of Sofscale was done to see whether any remnants of calculus was left behind. In the double blind study conducted on 32 patients, it was found in 21 patients, calculus could be removed with greater ease and less time in experimental area compared to the control. 17 patients were able to correctly identify the product side as easier to Sofscale. Patients did not complain of increased sensitivity of teeth or discomfort following application of Sofscale. Under SEM the root surface after root planing showed the presence of smear layer whereas after Sofscale application root surface appeared devoid of smear layer. No other significant difference were noticed between the root surfaces.

Efficacy of minocycline as a root conditioner in comparison to citric acid and tetracycline. An in vitro evaluation

This study compared the root surface characteristics produced by Minocycline HCl, Citric acid and Tetracycline HCl. when used as a root conditioner. This study included 5 groups of 10 extracted teeth each with advanced periodontal disease. Diseased root surfaces of group B,C,D and E were planed with Gracy curets and solutions of Citric acid, Tetracycline HCl, Monocycline Hcl and Tween 80 of PH 2.5, were applied to the surface in respective groups with cotton pellets for 5 mts. Group A was not subjected to root planning or application of any root conditioner and was used as a control. The teeth in all five groups were then washed, sectioned processed and examined under scanning electron microscope. These results revealed that the surfaces of acid treated sites differed from each other and with specimens treated sites differed from each other and with specimens treated with root panning alone. The efficacy of Minocycline and tetracycline in the removal of smear layer and exposure of dentinal tubules were comparable and Minocycline HCl though not as effective as Citric acid can probably be recommended in view of its antibactrial activity, anti collagense and substantivity properties.

Biodegradable dental implants of ciprofloxacin beta-cyclodextrin inclusion complex in the treatment of periodontitis

Dental implants of ciprofloxacin beta-cyclodextrin inclusion complex were formulated using poly (epsilon-caprolactone), a biodegradable polymer and evaluated. Clinical evaluation was carried out in ten patients with acute peridontitis. Various clinical parameters, viz. gingival index, plaque score, attachment gain, reduction in pocket depth were evaluated at 10, 20, 30, 40 days of treatment and compared with placebo as control. A significant (P < 0.0001) improvement in the healing of periodontal pockets treated with ciprofloxacin beta-cyclodextrin implant was observed in most of the clinical parameters. Estimation of gingival crevicular fluids (GCF) for the drug content revealed that drug levels above the minimum inhibitory concentration (10.2 micrograms/mg) for many of the periodontal pathogens were maintained throughout the period of study (40 days). This confirms the clinical efficacy of the dose and the duration of the study. It was found that biodegradable carrier was better accepted than the non-biodegradable carriers reported earlier.

CLINICAL EFFICACY OF BIODEGRADABLE DENTAL IMPLANTS OF TINIDAZOLE IN PERIODONTITIS

Dental implants of tinidazole were formulated using poly (ε-caprolactone), a biodegradable polymer and evaluated. Clinical evaluation was carried out in ten patients with acute peridontitis. Various clinical parameters viz., gingival index, plaque score, attachment gain, reduction in pocket depth were evaluated after 10, 20, 30 and 40 days of treatment and compared with placebo as control. There was significant improvement in the healing of periodontal pockets treated with tinidazole implants as compared to the control sites. Estimation of tinidazole in gingival crevicular fluid (GCF) revealed that the drug levels above the minimum inhibitory concentration (5.9 μg/mg) for many of the periodontal pathogens was maintained throughout the period of study (40 days). This confirms the clinical efficacy of the dose and the duration of the study. It was found that biodegradable carrier was better accepted than the non-biodegradable carriers reported earlier.

Efficacy of Chitra granule and powder (hydroxyapatite) in alveolar bone regeneration in rabbits. A histological evaluation

The reconstruction or restoration of osseous defects caused by inflammatory periodontal disease is a continuing challenge in periodontal therapy. Great strides are being made to this effect using alloplasts such as hydroxyapatite. The present study was designed in Newzealand dwarf rabbits to observe the biologic response of periodontal tissues to synthetically prepared hydroxyapatite in both powder and granule forms by Srichitra Tirunal Institute for Medical Sciences & Technology, Trivandrum and to compare it with that of a commercially available, pure resorbable hydroxyapatite, OsteoGen (HA Resorb). The test materials were implanted in the artificially created bonydefects in the mandible via an intraoral approach. The wounds were allowed to heal upto 26 weeks postimplantation. The clinical evaluation at 12 weeks and 26 weeks postimplantation revealed neither any evidence of inflammation, infection or abscess formation nor any exposure or exfoliation of test materials. The histological examination of the implant sites at 12 and 26 weeks postimplantation revealed varying extent of formation of new osseous tissue and periodontal fibers. A comparison between test materials and control suggested that Chitra granules exhibit a relatively greater potential for newbone and periodontal fibre formation.

Metastasis to maxillary gingiva from carcinoma of breast. A case report

A rare case of metastatic infiltrating duct carcinoma involving gingiva in relation to maxillary left canine-premolar of a 40 year old female is presented. The unilateral gingival enlargement in canine-premolar region was quite unusual. Pertinent history and histological examination revealed that the tumor was a metastatic carcinoma, the primary lesion of which was in the breast. The differential diagnosis of gingival enlargements is discussed in this paper. The resemblance of this mass to an inflammatory hyperplastic condition reflects the need for a detailed case history and examination.

Clinical significance of furcation anatomy of the maxillary first premolar: a biometric study on extracted teeth

Multirooted teeth in which chronic periodontitis has progressed to involve the furcation present special problems in treatment. The apical placement of furcation, narrow furcation entrance, concavities on the root surface, and the undesirable root configuration make instrumentation and plaque control difficult. Furcation involvement, when present in maxillary first premolars in particular, presents a poor prognosis as the furcation opens mesiodistally. This study on 100 extracted maxillary first premolars is an attempt to determine the frequency of bifurcation, the proximity of bifurcation to cemento-enamel junction, the depth of concavities on the root trunk and the furcal aspect of root, the diameter of furcation entrance, and the extent of root divergence.

Periodontal implications of Class II restorations. Clinical and SEM evaluation

30 subjects with class II silver amalgam restorations were studied to evaluate the influence of these restorations on periodontal health of the adjacent region. The incidence of overhangings were noted. The periodontal changes were recorded with the help of indices. The surface of the restoration and the interface between the restoration and the cavity margin were observed on extracted teeth under SEM. The gingival and periodontal status at the site of the restoration were affected by the restoration and the restoration showed a rough surface as compared to the enamel on SEM examination.

Antibacterial activity of ciprofloxacin-beta-cyclodextrin complex and its efficacy in dental implants

Ciprofloxacin forms an inclusion complex with beta-cyclodextrin. The in vitro antibacterial activity of ciprofloxacin on E. coli and Staphylococcus aureus was found better on complexation. The complex was found very effective as a local antibacterial agent when used in dental implants. Significant reduction in the gingival index, probing pocket depth and microbial growth coupled with gain in attachment at the test site compared to control on the 14th day was observed when the implants containing 2.0 mg of the complex equivalent to 0.4 mg of ciprofloxacin was used in clinical trials.