Hemisection: A Silver Lining for the Mandibular Molar

Hemisection of mandibular molar refers to a procedure involving sectioning a multi-rooted tooth with its crown portion followed by the removal of the sectioned tooth with unfavorable prognosis. Hemisection helps in retention of the tooth which otherwise would have undergone extraction. This case report highlights hemisection of mandibular molar with advanced furcation involvement and concomitant endo-perio lesion. This case report also aims at focusing attention in proper diagnosis, treatment planning and management of teeth with advanced periodontal involvemen

The Role of Periodontitis as Modifiable Risk Factor for Alzheimer’s Disease- A Recent Update

Alzheimer’s disease (AD) is among the most common form of dementia affecting geriatric population. Various studies have been carried out to understand the etiopathogenesis of the disease. However, no definite cause has been established and thereby, there is no definite treatment/cure available for eradication of same. The solution for managing the disease is to control the risk factors or triggering factors related to progression or worsening of the condition. Among various risk factors of AD, invasion of the oral pathogens in the brain tissue due to periodontitis (PD) has been associated as risk factor. Various studies had been carried out to state an association between PD and AD. Thereby, this article will discuss most recent evidences available to claim the role of PD as modifiable risk factor in mechanism of AD

Exceptional serological and radiological response to sorafenib in 2 patients with advanced hepatocellular carcinoma and chronic hepatitis C viral infection:case report and review of the literature

BACKGROUND: In patients with advanced hepatocellular carcinoma (HCC), the multikinase inhibitor sorafenib is the only systemic treatment that has been shown to increase overall survival. However, similar to other tyrosine kinase inhibitors, most patients achieve disease stabilisation radiologically, and only 2–3% of patients achieve a partial response. Recent exploratory subgroup analyses of the large phase 3 trials have demonstrated that patients with chronic hepatitis C virus (HCV) infection associated HCC survive longer than those who are negative for HCV. The mechanism underlying this currently remains unknown. A small number of cases of complete response to sorafenib treatment have now been reported worldwide, however a prolonged response has only been reported in 2 cases, both of whom had HCV-related HCC. CASE PRESENTATION: A 55 year old gentleman was diagnosed with hepatocellular carcinoma and concomitant chronic hepatitis C viral infection. He progressed following transarterial chemoemoblisation treatment and was commenced on sorafenib treatment. His serum alphafetoprotein level normalised within 2 months of treatment and he achieved an almost complete radiological response. This response was maintained for 20 months before the patient progressed. A 75 year old lady was diagnosed with advanced hepatocellular carcinoma and concomitant chronic hepatitis C viral infection. She was commenced on sorafenib treatment but required early dose reductions due to palmar plantar erythrodysesthesia, and liver decompensation. Despite this she achieved an excellent serological and radiological response that was maintained for 24 months. CONCLUSIONS: Our two cases show that patients with HCV-associated HCC can attain excellent responses to sorafenib treatment that is durable. Furthermore, such exceptional responses can be achieved even with dose reductions and treatment breaks

A Two-year Outcome of Various Techniques of Discectomy On Complications: A Multicentric Retrospective Study

Objective Various techniques of performing lumbar discectomy are prevalent, each having its rationale and claimed benefits. The authors ventured to assess the total complication rate of lumbar discectomy as well as the complication rates of individual complications, namely CSF leaks, superficial wound infections, deep wound infections, recurrence rates, re-operation rates, and wrong level surgery. Methods This was a retrospective study of patients operated using open discectomy (OD), microdiscectomy (MD), microendoscopic discectomy (MED), interlaminar endoscopic lumbar discectomy (IELD), transforaminal endoscopic lumbar discectomy (TELD), and Destandau techniques (DT) with a minimum follow-up of 2 years. The inclusion criteria were age>15 years, failed conservative treatment for 4-6 weeks, and the involvement of a single lumbar level. Results There is no statistically significant association between surgical technique and complications. The total complication rate was 12.89% in 946 operated cases. The most common complication was recurrence (5.81%), followed by re-operation (3.69%), CSF leak (1.90%), wrong level surgery (0.63%), superficial infection (0.52%) and deep infection (0.31%). There were minor differences in the incidence of complications between techniques. Conclusion This is the first study to compare the complication rates of all the prevalent discectomy techniques across the globe in 946 patients. Although there were minor differences in incidences of complications between individual techniques, there was no statistical significance. The various rates of individual complications provide a reference value for future studies related to complications following discectomy

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

A Comparison of Clinical Efficacy of Dentifrices Containing Calcium Sodium Phosphosilicate, Nanoparticle Hydroxyapatite and a Dentifrice Containing Casein Phosphopeptide Amorphous Calcium Phosphate on Dentinal Hypersensitivity- A Comparative Triple Blind Randomized Study

Aim : A considerable number of agents are effective in the treatment of dentin hypersensitivity. This3 month randomized clinical trial compares a dentifrice containing Calcium Sodium Phosphosilicate, Nanoparticle Hydroxyapatite and Casein Phosphopeptide-Amorphous Calicium Phosphate. Materials and Method : Eighty teeth were selected in each group. The volunteers selected at baseline had a history of dentin hypersensitivity caused by gingival recession or after scaling and root planing. Patients were evaluated for dentin hypersensitivity using visual analog score and Schiff test. Patients were required to have a visual analog scale score of ‡2 to be included in the study. After sensitivity scores for controlled air stimulus and cold water at baseline were recorded, subjects were given toothpastes randomly and sensitivity scores were measured again at 2nd week, 4th week, 2nd month and 3rd month. Results : All three groups showed reduction in sensitivity scores at 2weeks, 4 weeks and at 3 months for air stimulus and cold water. The nanoparticle hydroxyapatite group was found to be significantly better in reducing the visual analog scale score as well as Schiff test score and at any time point for both measures of sensitivity. Conclusion : The Nanoparticle Hydroxyapatite group showed comparable reduction in the symptoms of dentin hypersensitivity

Idiopathic Gingival Enlargement - A Case Report

Background: Idiopathic gingival fibromatosis is a rare hereditary condition that has no definite cause. The pathogenesis of gingival fibromatosis is still unknown but an increase in proliferation of the gingival fibroblasts as well as increased collagen synthesis may be involved. In modern times, a mutation in the son of sevenless -1 (SOS-1) gene has been suggested as a possible cause of isolated (non-syndromic) gingival fibromatosis, but no definite linkage has been established. A twenty four year old patient presented with gingival enlargement since one year. Based on clinical and radiographic examination, laboratory tests, and thorough oral hygiene instructions, an external bevel gingivectomy was performed to remove excess gingival tissue. There was recurrence within two months following the surgery. The exact cause of the gingival enlargement was not identified, although amelioration of the fibrotic, enlarged gingiva was observed which recurred within two month after performing conventional gingivectomy. Recurrence of gingival fibromatosis in such patients can also be attributed to genetic predisposition

Recurrent peripheral cemento-ossifying fibroma

Peripheral cement-ossifying fibroma (PCOF) is a rare osteogenic neoplasm that ordinarily presents as an epulis-like growth. It frequently occurs in maxillary anterior region in teenagers and young adults. We report a case of PCOF in a 42-year-old male, which was previously surgically excised and recurred after a period of 2 years. PCOF should be considered in the differential diagnosis of reactive hyperplastic lesions originating from gingiva. Hence, early diagnosis with proper surgical excision and aggressive curettage of the adjacent tissues is essential for prevention of recurrence

A Case Report of Ridge Augmentation using Onlay Interpositional Graft: An Approach to Improve Prosthetic Prognosis of a Deficit Ridge

Background: Periodontal therapy has developed beyond the scope of the treatment of periodontal pathoses. Periodontal plastic surgery consists of the reconstructive procedures designed to enhance the both function and esthetics. Deficient ridges pose a severe problem to the restorative dentist in restoring the natural form, function and esthetics of the prosthesis replacing the natural dentition. Depending upon the severity, location of these defects and the prosthetic option chosen, hard and soft tissue ridge augmentation or non-surgical approach or a combination may help to address them. The present clinical report describes a soft tissue ridge augmentation of a localized ridge defect in maxillary aesthetic region using onlay interpositional graft followed by fixed partial denture

Multiple Pyogenic Granulomas: A Case Report

Background: Pyogenic granuloma is primarily a reactive tumour like overgrowth seen in the oral cavity caused due to irritation, physical trauma or hormonal factors. Pyogenic granuloma is not an infectious but a reactive lesion, and causes functional and esthetic challenges. This case report describes the occurrence of multiple pyogenic granulomas; a rare entity; in the oral cavity of a 35 year old female patient. Diagnosis and treatment of pyogenic granuloma is important to prevent its recurrence. Based on clinical findings and histopathological reports a proper diagnosis was achieved and the multiple lesions were treated using a minimally invasive technique of excision using a diode laser