International Poster Journal of Dentistry and Oral Medicine, 03/2020

Introduction: EEC syndrome is a very rare entity and combines multiple deformities of the extremities with cleft formations and anomalies in the mouth, jaw, and face. The syndrome was first described by Eckoldt in 1804. The cause is based on a heterozygous mutation of tumour protein 63 (TP63). Furthermore, TP63-related diseases can be divided into six categories: EEC, AEC, ADULT, LMS, RHS, and SHFM4 syndrome. Material & Method: These are two case documentations in which EEC syndrome was confirmed after human genetic clarification. From an oral surgery point of view, there was a pronounced growth deficit of the midface, the jaw bases, and the alveolar process due to the double-sided cleft palate with missing intermediate jaw and hypodontia. The preprosthetic surgical treatments included dysgnathic, augmentative, mucogingival, and implant surgery. In particular, the hypoplastic V-shaped upper jaw posed a great challenge due to the absence of the intermaxillary jaw. Summary: The regaining of oral quality of life through functional rehabilitation of the stomatognathic system requires complex interdisciplinary cooperation between the specialist disciplines of maxillofacial surgery, orthodontics, and prosthetics. Discussion: People affected by the complex clinical picture of EEC syndrome can benefit from the treatment in terms of mastication, phonetics, and aesthetics. Keywords: ECC Syndrome, rare disease, hypodontics, dental implants

The successful reconstruction of mandibular and maxillary defects using a free bone block requires a precisely fitting preformation of the interponent. The problem of poor fit of iliac crest grafts with unaesthetic results, insufficient fixation zone and oversizing with a correspondingly large defect of the donor site is countered by the construction of an individual drill template for the removal of an ideally shaped bone fragment for the defect situation. With the segmentation software Mimics (Materialise, Leuven, Belgium), the DVT of the patient is evaluated and processed. The region of interest is converted into a three-dimensional model. In the area of the bone defect, the construction of an ideally adapted three-dimensional body is performed layer by layer. The outline of the interponent is used to construct a template. The outer dimensions of the outline are extended to make room for the placement of a milling cutter. By using the 3D visualisation of radiological data sets and suitable software, patient-specific solutions for the reconstruction of mandibular and maxillary defects can be simulated and realised on the computer. The virtual planning can be produced promptly in-house and cost-efficiently on one's own printer. Substance defects after traumas, malformations, or tumors can thus be reconstructed safely and effectively using individualised templates, the duration of surgery can be shortened, and the morbidity rate can be significantly reduced compared to free iliac crest removal. Keywords: Innovation, 3D print, in-house workflow, jaw reconstruction, cutting guide

Odontomas are benign, asymptomatic, slow-growing tumours of odontogenic origin comprising different dental tissues. They are considered to be hamartomas rather than true neoplasms. They develop from epithelial and mesenchymal components of the dental apparatus, producing enamel and dentin. Appearance is usually comparable to that of a normal tooth in size and shape. Occasionally, a complex variety exhibits considerable growth. Usually asymptomatic, odontomas are often discovered during routine radiological examination or when they deform the adjacent teeth. Odontomas can be classified morphologically as complex (presents as irregular masses containing different types of dental tissues) or compound (superficial anatomic similarity to even rudimentary teeth known as denticles), . Dentigerous cysts are odontogenic cysts that arise through the accumulation of fluid between reduced enamel epithelium and the tooth crown. Typically, they affect impacted teeth, in the majority of cases mandibular third molars and maxillary canines. It is commonly found in patients who are 30 years of age or younger. In this poster, we present a case report of a dentigerous cyst associated with complex odontomas in a 12-year-old female. Keywords: odontoma, dentigerous cyst, impacted teeth, dilated odontome

Autism is a behavioural disorder. It is characterised by social deficits and hindered sensory-motor development. Motor skills are compromised to the extent that it affects the day-to-day activities of the individual. Even grasping a toothbrush poses a difficulty for children with autism. This makes them vulnerable to various periodontal conditions. Nurturing an autistic individual's motor skills by apt interventions can improve his/her overall lifestyle. One of the many intervention techniques is music therapy, the most effective of which is self-musical instrument playing. An individual with motor skill impairment can benefit by being trained in the art of playing an Indian percussion instrument like the Tabla. This can help the autistic individual in grasping the toothbrush with more dexterity and thereby improve his/her oral health. Rhythm-mediated interventions like playing the Tabla can also boost the social skills of autistic individuals. These include co-operation, assertion, self-control, imitation, interpersonal skills, etc. This poster depicts a study that focuses on training autistic individuals between the age of 6 to 12 years in the art of playing Tabla and thereby improve their oral health status, motor skills, and social skills. An informed consent was obtained from the foundation where the autistic children belonged. The children were trained for a total of 30 clinical hours. The results showed improvement in motor skills, plaque index, social participation, and detrimental social behaviour in all five participants. Gingival index and social reciprocity showed an upswing in 4 out of 5 participants. Keywords: Autism, music therapy, oral health, social skills, motor skills, Tabla

Head and Neck cancer is one of the most common cancers in the world, nearly two-thirds of which occur in the developing countries. Oral cancer detection at a late stage leads to high mortality and morbidity. The time of diagnosis influences the treatment and survival rate. It is often difficult to distinguish neoplastic and premalignant disorders with standard white light illumination. Biopsy of the lesion with histopathological examination will always be the gold standard for diagnosis of oral cancer, which, however, has some limitations. It is time consuming, expensive, invasive, and needs a trained health care provider. Optical spectroscopy has the potential to detect malignant lesions before they become macroscopically visible, by probing tissue biochemistry and morphology in vivo in real time. During the development of premalignant and malignant changes, epithelial cells undergo a transformation that results in modified rates of metabolic activity, cellular proliferation, and/or death. Autofluorescence and diffuse reflectance spectroscopy have been studied as non-invasive in vivo tools for the detection of malignant and potentially malignant tissue alterations. Fast and non-invasive, diagnostic techniques based on fluorescence spectroscopy have the potential to link the biochemical and morphological properties of tissues to individual patient care. The use of endogenous and exogenous fluorescent markers, with tumour-localizing properties, for the clinical detection of early cancer in vivo has been investigated by several studies. Autofluorescence of tissues under excitation with light is produced by several endogenous fluorophores. These include fluorophores from tissue matrix molecules and intracellular molecules like collagen, elastin, keratin, FAD, and NADH. The presence of disease changes the concentration of these fluorophores, which makes autofluorescence spectroscopy sensitive to tissue alterations. Diffuse reflectance is the result of single and multiple backscattering of the white excitation light. Early diagnosis is made possible with Raman spectroscopy systems based on the principle that optical spectrum acquired from a tissue and biological fluids from blood, urine, and saliva will contain information about its histological and biochemical characteristics. This poster highlights our three research studies on optical diagnostic aids; autofluorescence, diffuse reflectance spectroscopy and Raman spectroscopy in differentiating normal, premalignant, and malignant conditions. Keywords: Oral cancer, optical diagnosis, early diagnosis, potentially malignant disorders

The styloid process is a bony projection that originates from the inferior aspect of temporal bone. It is connected to the lesser cornua of the hyoid bone by the stylohyoid ligament. The carotid arteries lie on either side. Elongation of the styloid has been reported in 18 to 40 percent of the population. The mineralisation is usually bilateral, but may be unilateral. Most of the cases are asymptomatic, but a few patients experience symptoms known as Eagle's syndrome, caused by compression of adjacent nerves or blood vessels. Patients presenting with vague head and neck pain can lead to wide ranges of differential diagnoses. Elongation of the styloid process is one of the etiological factors for cervical pain, pharyngodynia, and dysphagia. Symptomatic elongation or mineralisation of the stylohyoid ligament is referred to as Eagle's syndrome. It has symptoms like recurrent throat pain, dysphagia, and otalgia and neck pain. History and physical examination play a vital role in diagnosing this condition, and further radiological investigation confirms the diagnosis. The preferred radiologic modality is 3D computed tomography, which gives length, angulation, type of elongation, and its relation to vital structures. Patients presenting with radiating cervico-fascial pain should be examined for the possibility of Eagle's syndrome as it is considered to be rare. Clinicians should be well aware of this condition. Local injections of corticosteroids provide relief in mild cases, but in severe cases, surgical excision of the styloid process is recommended. This poster describes the clinical approach, imaging investigations, and management of a case of Eagle's syndrome. Keywords: Styloid process, Eagle's syndrome, cervical pain, stylohyoid ligament

Oral submucous fibrosis (OSMF) is a chronic disease of insidious onset sometimes preceded by vesicle formation or stomatitis and always associated with juxta-epithelial inflammatory reaction and fibroelastic changes of lamina propria with epithelial atrophy. This study was planned to know the prevalence and clinical profile of OSMF. Methodology: A hospital based study was conducted on a total of 122 (n 22) OSMF cases who visited the Department Of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, during the period of May 2015 and October 2015 (6 months). These cases were retrospectively analysed based on the patients' data available in the department. Information such as age, sex, demographic data, socioeconomic status, habits and their duration, symptoms like burning sensation, dysphagia, and clinical signs such as difficulty in mouth opening, tongue protrusion, assessment of clinical staging and grading based on Lai DR classification (1995) of maximum interincisal distance (Group A - >35mm, Group B – 30-35mm, Group C -20-30mm, Group D - 20 mm) along with drug administered and their responses were analysed and the results obtained. Result: The total number of cases included in the study was 122. There were 105 males and 17 female patients, thus giving a predominance of male over female. The majority of our patients were in the 21 to 40-year age group. Most of them were educated (n 103) and had a middle (n 45) and low (n 77) socioeconomic status, thus indicating chewing habits are more prevalent in the younger age group and educated class. Personal oral habits were present in all patients (n 122); Pan Masala chewing (n 98) contributed to a greater number of OSMF cases followed by tobacco (n 11) and betel nut (n 6) and multiple (n 4) chewing habits. The duration of these habits was up to 5 years (n 93) and greater than 5 years (n 29) in these patients. The majority of our cases reported with symptoms to our institution had habits within the first 5 years. Symptoms such as a burning sensation of oral cavity (n 116) and inability to open the mouth (n 113) was present in most of the OSMF patients. Other symptoms such as inability to protrude the tongue (n 44) and difficulty in swallowing (n 9) were also present. All cases had changes in colour of buccal mucosa and palpable fibrotic bands in the oral cavity. According to Lai Dr (1995) classification5, patients in Group B (n 22), Group C (n 60), and Group D (n 40). The majority of our cases belonged to Group C. Patients in Groups C and D showed increased duration of chewing habit and severe burning sensation and restricted mouth opening. Conclusion: The majority of the patients were in the younger age group with male predominance. Patients with a longer duration of habit showed increased severity of burning sensation and restricted mouth opening affecting their quality of life. Early diagnosis and early intervention can prevent progression of OSMF to malignant transformation. Early intervention of OSMF can be achieved through proper counselling and motivation of patients. OSMF can be easily preventable through appropriate measures such as health education and creating awareness regarding the ill effects of the consumption of tobacco products at a community level. Keywords: Oral submucous fibrosis, trismus, potentially malignant

Aim: The aim of this study is to analyse the effectiveness of Peroxygen Powdered System for rapid disinfection of gutta-percha cones and compare it with conventional disinfection methods. Materials and Methods: 110 gutta-percha cones of size 45 were used in the study and divided in to five groups. All the samples of gutta-percha were contaminated by immersing the cones in test tubes containing a bacterial suspension of E. faecalis strain ATCC 29212 and were incubated at 37°C for 24 hours. The initial colony forming units were determined by randomly immersing two gutta-percha cones from each group in vials containing sterile physiologic saline for 1 minute, and samples were obtained for colony forming units (CFU) count. Then, the cones from each group were tested for disinfection efficacy of the chemical agents, which were 3% sodium hypochlorite (Group I), 2% chlorhexidine (Group II), Peroxygen Powdered System [0.4 % peracetic acid] (Group III), and distilled water (Group IV) as a control, for 5 minutes. After disinfection, two cones from each group were passively rinsed in sterile water and agitated in vials containing sterile physiologic saline solution for 1 minute, and the samples were seeded in BHI agar, and incubated for 24 hours. The final bacterial colonies were counted with a colony counter. The remaining cones were stored in test tubes containing BHI broth and incubated, and then observed for turbidity for 72 hours. Conclusion: Peroxygen Powdered System containing 0.4% peracetic acid was found to be as effective as 3% sodium hypochlorite for the rapid disinfection of gutta-percha cones. Keywords: Gutta-percha, disinfection, peracetic acid

Aim: The aim of this study was to evaluate the prevalence of hypodontia and supernumerary teeth in an exemplary German cleft lip (with/without) palate (CL/P) population dependent on cleft type and severity. Methods and material: Radiographs and dental records of cleft patients who had been treated and followed up in the Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Campus, Dresden, Germany (Jan 1994-Nov 2016) were evaluated concerning hypodontia and supernumerary teeth dependent on cleft type and severity of the cleft. Of 386 records, 108 patients met the inclusion criteria: non-syndromic cleft of the alveolus with/without palate, at least one clear panoramic x-ray, sufficient dental records. Statistical analysis was performed using x-square and binominal tests (p≤0.05). Results: Fifty-four individuals (50%) showed hypodontia and thirty-six (33.3%) supernumerary teeth. A total of 102 teeth were missing, of which 86 were missing in the upper and 16 in the lower jaw. Supernumerary teeth were exclusively present in the upper jaw, counting 43 teeth. Hypodontia occurred with a frequency of 70.6% in bilateral clefts and 46.2% in unilateral clefts, whereas supernumerary teeth were more frequent in unilateral clefts (36.3% vs. 4.2%). The cleft side was most often affected by both anomalies (cleft vs. non-cleft side: hypodontia - 63% vs.18.5%; supernumerary teeth - 83.8% vs. 13.5%). Conclusion: Cleft patients have a significant risk for hypodontia and supernumerary teeth, which are more common on the cleft side. Clear associations with cleft type and severity of the cleft could be detected. Keywords: hypodontia, supernumerary teeth, dental anomaly, cleft lip and palate, cleft lip and alveolus

Introduction: Paediatric patients feel anxious and apprehensive at their first dental visit because of fear of the unknown. Behaviour modification techniques involving pre-exposure to dental equipment will give children a first-hand experience of their use, sounds, and clinical effects. Making the child patient play a smartphone dental game (Tell Play Do/TPD) helps to introduce dental procedures and equipment in an interactive manner, which acts as a distraction technique. Along with this, parental presence may give a sense of safety to the child, making them less apprehensive. Methods: In this pilot study, four different behaviour modification techniques were compared in children with Frankl's negative or definitely negative rated behaviour. Forty children in the age group of 4-5 years, visiting a dentist for the first time, and requiring pit & fissure restorations were randomly divided equally into Group A (Tell Show Do/TSD), Group B (TSD + Parental Presence), Group C (TPD), and Group D (TPD + Parental Presence) by chit method. Behaviour was assessed using RMS-PS6 (Raghavendra M sethi, M Khandelwal, S Rath- Pictorial scale) and FLACC7 (Face, Legs, Activity, Cry, Consolability) scale during treatment. The RMS-PS value of 1 to 3 and FLACC value of 0 to 1 were recorded as acceptable behaviour. Results: In groups A, B, C, and D, acceptable RMS-PS values were scored as 40%, 60%, 60% and 80%, respectively, whereas acceptable FLACC values in groups A, B, C, and D were scored as 20%, 40%, 40% and 60%, respectively. Both scales showed comparable results in all groups, but group D showed the best results. Keywords: Tell-Show-Do, Tell-Play-Do, parental presence, smartphone dental game