International Poster Journal of Dentistry and Oral Medicine, 02/2024

In autoimmune diseases such as oral lichen planus or mucosal pemphigoid, a sufficient prosthetic restoration without dental implants is often not feasible. Interdisciplinary planning between the prosthodontist and surgeon is necessary to realize an individual, mucosa-relieving treatment for the patient. Implants in patients with immunodeficiencies are therefore justified when strictly indicated and can lead to a rehabilitation of the physiological masticatory function, an increased quality of life, and a positive influence on the general state of health. Keywords: Dental implant, oral diseases, oral lichen planus, mucous membrane pemphigoid

The use of novel therapeutic protocols and immunosuppression in COVID-19 has led to a resurgence of a rare but fatal infection, mucormycosis. It’s an angioinvasive disease causing thrombosis due to fungi mucormycetes, commonly Rhizopus Oryzae. Germination of spores in COVID-19 patients occurs due to hypoxia, hyperglycaemia, acidic medium, a high iron level, immunosuppression, prolonged hospitalization, and ventilator support. Forms of mucormycosis include rhino-cerebral, pulmonary, gastrointestinal, and disseminated. This poster illustrates the institutional experience of 300 patients, the protocol for early diagnosis, minimizing predisposing risk factors, various investigations, complex pharmacological and surgical management options, and options for rehabilitation of the rhino-orbito-maxillary form of COVID-19 associated mucormycosis. Maxillectomy with debridement of necrosed bone, debridement of the maxillary, sphenoid, and ethmoid sinuses, retrobulbar injections of antifungals, and in terminal stages exenteration of the eye are surgical interventions that improve vascularity to the area, so that antifungals effectively reach the site. Postoperative rehabilitation options include soft tissue and ocular prosthesis, obturator, partial dentures, and pterygoid and zygomatic implants. The 1950 Smith and Krichner criteria are considered the gold standard for nasal findings. As it is a multidisciplinary approach, physicians and dentists should be aware of the findings of this disease to avoid diagnostic and therapeutic mishaps. Keywords: Rhino-orbito-cerebral mucormycosis, COVID-19, black fungus

Introduction: Aging is an inevitable biological phenomenon. With advancement in the medical sciences, the average life expectancy has increased, implying that older adults are a growing patient demographic for dentistry. An increase of 34 million elderly persons was seen in 2021 and is expected to increase to 56 million by 2031. Geriatric dentistry or gerodontics is defined as the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals. Aim: To find the prevalence of the various oral conditions among the geriatric patient population that visited our tertiary care institution at Tamil Nadu Government Dental College and Hospital. Materials and Methods: A hospital-based retrospective study was conducted on a total of 800 geriatric patients (males: 536 (67%); females: 264 (33%)), who visited the Department Of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital Chennai during the period of March 2019 to March 2020 (12 months). The study was approved by the ethical committee (Reference no:5/IERB/2021). These cases were retrospectively analysed based on the patients’ data available in the department. The records were classified into three groups based on age, Group I: n=653 (65 – 74 years), Group II: n=137 (75 – 84 years), Group III: n=10 (>85 years). Information such as age, sex, and diagnosis was recorded, and appropriate treatment was given to the patients as well as proper referral for timely care. The data obtained was analysed. Results and Conclusion: Group I revealed n=227 (34.7%) of dental caries, n=198 (30%) of periodontal disease, and n=84 (12%) of edentulism; Group II revealed n=40 (29%) of dental caries and n=52 (37.9%) of periodontal disease; Group III revealed n=3 (3%) dental caries and n=4 (4%) of periodontal disease. Dental caries and periodontal disease are more prevalent among the geriatric patients. A poor oral status will eventually lead to eating problems, weight loss, and dehydration, aggravating the existing problems. We arrived at an algorithm for the diagnosis, treatment, and referral of geriatric patients. This will facilitate the early diagnosis of lesions and disorders in geriatric patients and thereby improving their quality of life. The geriatric oral care should be a holistic approach to guarantee optimal oral health. Hence all tertiary care centres should avail a separate approach to geriatric health care along with dentistry. Keywords: Dentistry, geriatric, oral, health

In autoimmune diseases, such as oral lichen ruber planus, a sufficient prosthetic restoration without dental implants is often not possible. Due to the extreme vulnerability of the oral mucosa, the indication for an implant restoration should be considered, especially for tegument relief. Interdisciplinary planning between prosthodontist and surgeon is necessary to realize an individual, mucosa-relieving treatment for the patient. Implants in patients with immunodeficiencies are therefore justified when strictly indicated and can lead to a rehabilitation of the physiological masticatory function, an increased quality of life, and a positive influence on the general state of health. Keywords: Oral lichen planus, implant, oral mucosal diseases

Ameloblastoma is a benign but locally aggressive epithelial odontogenic neoplasm having different histopathological variants. Granular cell ameloblastoma (GAB) is one of the rare histological variants of ameloblastoma accounting for about 1-5% of cases. It appears to be an aggressive lesion with marked chances of recurrence. Several cases of this type have been reported to be metastasizing and there is marked transformation of the cytoplasm, usually of stellate reticulum-like cells which leads to granular eosinophilic appearance. Here I present three cases of Granular cell ameloblastoma. Keywords: Odontogenic tumors, ameloblastoma, GAB

This case series reports the rehabilitation of the anterior maxilla using immediate implant placement and provisional restoration in combination with preservation of the alveolar foramen. Four patients presented to the Department of Oral and Maxillofacial Surgery with a non-preservable maxillary incisor following dental trauma. Treatment planning was performed digitally using Co-DiagnostiX software. The treatment protocol included atraumatic extraction followed by immediate implant placement and provisional restoration with an implant-supported single crown. In all cases, the non-salvageable tooth was carefully extracted and a dental implant (2 BLT, 2 BLX, Straumann) was placed using a flapless approach. Augmentation was performed with a combination of autogenous and xenogenous material, and the soft tissue was augmented with a connective tissue graft. After surgery, intraoral scans were taken and a CAD-CAM provisional crown was fabricated and placed on the same day as surgery. The final ceramic crown was placed after three to six months. The soft tissue profile was compared by superimposing the baseline intraoral scans (before and immediately after surgery) with the follow-up scans. Six months after surgery, soft tissue changes were considered minimal compared to baseline. Keywords: Dental implants, immediacy, digital planning, soft tissue

Adenomatoid odontogenic tumour (AOT) is the fourth most common odontogenic tumour. It is benign and slow growing, comprising of three variants; follicular, extrafollicular, and peripheral. A follicular variety of AOT will be associated with an impacted tooth and is most commonly confused with a dentigerous cyst. It is a known fact that odontogenic cysts can be associated with odontogenic tumours. There are very few case reports of AOT arising within the dentigerous cyst. Here, we report a case of AOT arising from a dentigerous cyst with an impacted canine in the anterior maxilla of a 14 year-old female with emphasis on clinical, radiographical, and histological features. Keywords: Adenomatoid odontogenic tumour, dentigerous cyst, impacted canine

Introduction: Over the decades many non-surgical as well as surgical techniques have been developed to remove melanin-induced hyper-pigmentation of gingival tissue with comparable efficacies. Nowadays, minimally traumatising the surgical field and gaining maximum outputs with help of microsurgical instruments has attained a level of utmost importance in any surgical procedure. This case series is therefore aimed at determining the clinical, aesthetic and patient-related outcomes of gingival depigmentation performed using microsurgery vs conventional surgical technique. Methods: Five patients with gingival melanin pigmentation participated in this case series. Depigmentation was performed using a conventional approach by #15 blade through unaided vision in one segment and using keratome and magnification loupes through a microsurgical approach in the other segment. Variations in Dummett Oral Pigmentation Index (DOPI), Hedin Melanin Index (HMI), clinical parameters such as bleeding, redness, swelling, wound healing, gingival colour, gingival morphology, periodontal parameters, patient-related outcome measures (PROMs) such as post-operative pain perception/discomfort on a visual analog scale (VAS), and patient’s preference/ aesthetic satisfaction were considered for each patient at 24 hours, 1 week, 1 month, 3 months, and 6 months. Results: All the reported cases demonstrated significant improvement in clinical parameters at the end of 6 months follow-up (p<0.05). Better improvements in clinical parameters were observed in the segments treated with microsurgical technique at 24 hrs, 1 week, and 1 month. Three out of five patients reported less post-operative discomfort (at 24 hours and 1 week) after the microsurgical approach. Higher DOPI (2.1±0.7) and HMI (1.8±0.7) scores reflecting reoccurrence were observed at the end of 6 months in two cases treated with conventional technique. No difference between the treatment modalities was found in relation to overall aesthetic satisfaction of the patient. Conclusions: A microsurgical approach for gingival depigmentation is associated with retaining the clinical outcomes longer than conventional approach. Post-operative pain is reported to be less using microsurgery, but aesthetic outcomes are similar. Keywords: Gingival depigmentation, scalpel, microsurgery, loupes, keratome, aesthetics

Introduction: Oral potentially malignant disorders (OPMDs) are conditions comprising of a variety of clinico pathological alterations with variable malignant transformation. Common OPMDs are leukoplakia, erythroplakia, oral lichen planus, and oral submucus fibrosis. Oral squamous cell carcinoma (OSCC) is a common type of malignancy mostly preceded by OPMD which may show histopathological changes called oral epithelial dysplasia. When compared to other cancers, OSCC has a low five-year survival rate, which is roughly 20% when diagnosed at an advanced stage and up to 80% when discovered at an early stage. Lack of effective screening methods to identify OPMDs developing into malignancy is a major barrier for its early detection. Hence the need of biomarkers arose, and the current review looked at the role of various biomarkers in OPMDs for better screening, diagnosis, and prognosis. Aim: To review the role of diagnostic and prognostic utility of various biomarkers reported in OPMDs. Materials and methods: A comprehensive search of online databases including PUBMED, MEDLINE and SCOPUS were conducted to identify studies from published data between January 2013 to December 2022 (last 10 years) using key words “biomarkers in OPMDs”, “salivary biomarkers in OPMDs”, “biomarkers of epithelial mesenchymal transition”. Relevant data from 50 articles was tabulated based on the type of specimens used. Result: A total of 134 studies from 50 articles were evaluated and 64 biomarkers were identified in tissues, 41 in saliva, 6 in blood, and 8 in cells cytology. Conclusion: Biomarkers play a crucial role in identifying high risk individuals and assessing the progression of OPMDs towards malignancy. The use of biomarkers in clinical practice holds promise for enhancing the accuracy of diagnosis and better treatment approaches. Keywords: OPMDs, biomarkers, miR, microRNA

Introduction: Oral cancer is a deadly disease that affects millions of people worldwide. Early detection of oral cancer is crucial for effective treatment and increased survival rates. The detection of cancer is a complex process that demands a comprehensive array of tools and a high degree of expertise. Therefore, it is pertinent to underscore the utilization of artificial intelligence (AI) in this sphere, as it holds great potential for enhancing accuracy and efficiency in cancer diagnosis. Aim: To evaluate the use of artificial intelligence with whole slide imaging in the detection of oral cancer. Method: A comprehensive search of online databases including PubMed and Google Scholar was conducted to identify studies that evaluated the use of AI in oral cancer detection. The search keywords included "artificial intelligence," "oral cancer," "diagnosis," ,"detection", “whole slide imaging”. A total of 10 articles fulfilled the inclusion and exclusion criteria and were included. The pertinent data was extracted and recorded. Result: The studies included in this review used different AI techniques, including machine learning (ML) algorithms, deep learning (DL), and neural networks (NN) in detecting oral cancer. The accuracy of AI-based methods was compared with conventional diagnostic methods, such as biopsy and histopathology. AI-based methods showed higher sensitivity, specificity, and accuracy compared to traditional diagnostic methods. Conclusion: AI-based methods can complement traditional diagnostic methods and provide a faster and more cost-effective diagnosis, leading to improved patient outcomes. Keywords: artificial intelligence, oral cancer, diagnosis ,detection, whole slide imaging