Dantal College Inner Pages Vol-6 Issue-2...1453. The first forensic odontologist was Dr. Paul revere...

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The journal is printed on ACID FREE paper.

JADCH is available (full text) online:Website- www.adc.org.in/html/viewJournal.php

This journal is an official publication of Ahmedabad Dental Collegeand Hospital, published bi-annually in the month of March andSeptember.

ISSN 0976-2256E-ISSN: 2249-6653

A

Histopathology- A basic unit of oral pathology is an art of analyzing and interpreting the shapes, sizes and architectural patterns of cells and tissues within a given specific clinical background and a science by which the image through microscope is placed in the context of knowledge of pathobiology to arrive at an accurate diagnosis. Microscopes are omnipresent throughout the field of biological research.New avenues of research are opening in biological and medical fields. Everything from observation through image capturing up to data communications over the network, is operated by a series of simple mouse clicks allowing the pathologist to concentrate on the image on the screen. Digital technology is currently used for telediagnosis, telecommunication, e-learning, long-term storage, image analysis, assistance on automated quantification particularly in the field of immunohistochemistry. Now, it is necessary to use digital technologies in integrating pathology from clinics and imaging to molecular level and thus to create new developments in digital technology that have a role in oral pathology.

Editor - in - ChiefDr. Darshana Shah

Co - EditorDr. Rupal Vaidya

Editorial Board:Dr. Mihir ShahDr. Vijay BhaskarDr. Monali ChalishazarDr. A. R. ChaudharyDr. Neha VyasDr. Sonali MahadeviaDr. Shraddha ChokshiDr. Bhavin DudhiaDr. M GaneshDr. Mahadev DesaiDr. Darshit Dalal

Assistant Editor:Dr. Harsh Shah

Contents

Subscription:Rate per issue: ` 400/-, for one year: ` 750/-, for three years: ` 2,000/-Contact: Ahmedabad Dental College & Hospital Vivekanand Society, Bhadaj-Ranchhod Pura Road, Santej, Post: Rancharda, Ta: Kalol, Dist: Gandhinagar, Gujarat, India.

B

EDITORIAL

FROM THE EDITOR'S DESK .......................................................................................................................................................47DARSHANA SHAH

REVIEW ARTICLES

1) TOOTH AS A TOOL FOR FORENSIC EVIDENCE: A REVIEW ........................................................................................48

HARSH SHAH*, DARSHAN PRAJAPATI**, ANKIT PATEL***, SIDDHESH BIRADAR****

ORIGINAL ARTICLES

2) PREVALENCE OF OCCUPATIONAL INJURY AMONGST THE DENTAL STUDENTS:

A CROSS-SECTIONAL STUDY - A QUESTIONNAIRE STUDY .......................................................................................51 SANYA RANGWALA*, HARSH G SHAH**, VASUDHA SODANI***, ABHISHEK SHARMA****, SUYOG SAVANT*****

3) EVALUATION OF REDUCTION IN ANXIETY LEVELS WITH THE USE OF MUSIC THERAPY –

A STUDY ON 5 TO 12 YEAR OLD CHILDREN .................................................................................................................57 Purva B. Butala*, B. Vijay Bhaskar**, Purv S. Patel***

4) EFFECT OF ULTRASONIC SCALING ON THE SURFACE ROUGHNESS OF DIFFERENT RESTORATIVE MATERIALS........................................................................................................................65 NIHARIKA PATEL*, VYOMA SHAH**, RUPAL VAIDYA***, SHRADDHA CHOKSHI****, ZARANA SANGHVI*****

5) REASONS FOR REMOVAL OF STAINLESS STEEL PLATES IN MANDIBULAR FRACTURE PATIENTS: A

RETROSPECTIVE STUDY................................................................................................................................................71 JATIN K. VAGHASIYA*, DARSHAN PATEL**, NITU SHAH***, NEHA VYAS****

CASE REPORT

6) MANUSCRIPT TITLE: OSTEOMA OF MAXILLA: REPORT OF A RARE CASE ...............................................................76 RUTU JANI*, PARUL BHATIA**, ABHINANDAN GOKHROO***, PRUTHA NEMADE****

7) “UNTURNING THE TURNED” – DIFFERENT TECHNIQUES USED FOR TOOTH DEROTATION .................................80 SHAILI SHAH* DEEPALI AGARWAL**, NEHA ASSUDANI***, SONALI MAHADEVIA****

8) AN UNUSUAL CYST OF THE MANDIBULAR JAW-TRAUMATIC BONE CYST: A CASE REPORT ................................86 AMIT PATEL*, SACHIN MODI.**, NITU SHAH***, NEHA VYAS****

9) COMPLEX ODONTOMA FUSED TO MANDIBULAR THIRD MOLAR – AN UNUSUAL CASE.........................................89 ABHISHEK BAROT*, BHAVIN DUDHIA.**, VAISHALI DHADHAL***, DEVARSHI BHAVSAR****

10) BRINGING THE MANDIBLE FORWARD: BY FORSUS WAY (CLINICAL CASE REPORT).............................................93 ANIL SONARA*, DIPTI B. PRAJAPATI**, NEHA ASSUDANI***, SONALI MAHADEVIA.****

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Dr. Darshana ShahEditor JADCHEditorial Office:Prof. & Head Dept. of ProsthodonticsAhmedabad Dental College & Hospital,Dist.: Gandhinagar, Gujarat.Email: [email protected]

The Journal of Ahmedabad Dental College and Hospital; 6 (2), September 2015 - February 2016

____From Editor’s desk

Dear friends, The connotations of being past the year 2010 bring about thoughts of futuristic concepts as suggested by a vast array of media i.e. movies, books, the internet which have portrayed life filled with the advances in every aspect. Clinicians with decades of experience or the student of dental history can look back at the advances in dentistry and state clearly that the dental profession has experienced an exciting amount of technological growth. Today’s dental practice - often termed as ‘Digital Dentistry’ represents the high-tech, easy to implement solutions that were imagined or in thought process some years ago. Digital dentistry may be defined in a board scope as any dental technology or device that incorporates digital or computer-controlled components in contract to that of mechanical or electrical alone. This broad definition can range from the most commonly thought area of digital dentistry - CAD/CAM (computer aided design/computer aided manufacturing) - to those that may not even be recognized, such as computer-controlled delivery of nitrous oxide. As the digitalization in dentistry being implemented worldwide, it certainly has major advantages. Those are imported efficiency, improved accuracy, precision in each technique and high level of predictability of the outcome. Yet, some of the advantages may be diminished by the increased cost or technique sensitivity. List representing the digital technology in dentistry are CAD/CAM, Intraoral imaging, computer aided implant dentistry, digital radiography, lasers, occlusal and TMJ analysis, digital patient education, shade matching etc. Digital dentistry is more than just hype. When properly implemented and fully educated. return on investment can be excellent. Digital platforms are the future of dentistry, and they are changing the way we all provide dental care. Technology continues to step forward and make the delivery of dental care more comfortable, predictable, and precise. It is an exciting time to be in the dental profession as more technologies are being introduced that make dentistry easier, faster, better, and most important - enjoyable.

DIGITAL DENTISTRY

Review Article

ABSTRACT

Despite the breakthrough in science and technology natural calamities and crimes continue to persist in the life. Human identification is essential for various reasons including legal, criminal, humanitarian, and social grounds. Forensic odontology is a specialized field of dentistry which analyses dental evidence in the interest of justice. This article reviews the role of the dentist in identification of human, dental remains and crime investigation.

KEYWORDS:

Received: 02-07-2015; Review Completed: 13-08-2015; Accepted: 24-11-2015

Harsh Shah*, Darshan Prajapati**, Ankit Patel***, Siddhesh Biradar****

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Tooth as a tool for forensic evidence: A review

* Senior Lecturer, **Tutor, *** Senior Lecturer, **** Post Graduate

ADDRESS FOR AUTHOR CORROSPONDENCE : Dr. Harsh G Shah, TEL: +91 9429428940

DEPARTMENT OF PUBLIC HEALTH DENTISTRYDEPT. OF ORAL PATHOLOGY, AHMEDABAD DENTAL COLLEGE & HOSPITAL.

INTRODUCTION

Forensic Odontology, or forensic dentistry was [1]

defined by Keiser-Neilson in 1970 as “that branch of forensic medicine which, in the interest of justice deals with the proper handling and examination of dental evidence and with the proper evaluation and presentation of the dental findings”. The human body becomes disfigured to a great extent in case of burns, accidents and mass disasters like earthquake so much so that identification of the individual becomes a challenge. However dental remains can be used for identification as using them is cost effective, reliable and fast. This article sheds light on the role of the dentist in identification of human and dental remains along with recent advances in the field of forensic odontology.

History of forensic odontology:

In the year 66 A.D a female associated with Emperor Nero, who was identified after her death through the unique arrangement of her teeth. The first formalliy reported case of dental identification was that of the 80 years old warrior John Talbote in 1453. The first forensic odontologist was Dr. Paul revere who identify the disfigured body of Dr. Joseph warren in 1775. In 1867 Oscar Amoedo known as a father of forensic odontology helped to identify victims of the great fire of paris. In 1977, the body of Hitler and his wife Eva Brauma were

[2]identified.

Use of teeth in personal identification:

Proper identification of dead is required for legal and humanitarian reasons. Comparative dental identification is a procedure by which dental

evidence such as dental caries, missing teeth, restored teeth, prosthesis, alterations in shape of teeth, talons cusp, developmental defects, changes in colour of teeth collected from human remains is compared with previous records for establishing identity of the decedent. Morphology and arrangement of teeth is unique for every individual

19almost 1.8 x 10 possible combination was [3]

calculated.

Dental profiling:

Dental profiling refers to the making of a dental profile which comprises a group of more or less specific individual characteristics relating to the oral cavity and/or the teeth. Acharya et al have demonstrated that dental profiling aids in person identification by identifying ethnicity, gender and age.

Identifying ethnic origin from teeth:

Physically humans are diverse species. this diversity is the result of genetic influences as well as environmental factors such as climate and geographic location. Dental features used to describe population differences are broadly categorized as metric (tooth size) and non metric (tooth shape). metric features are on based on measurements and non metrics in terms of presence or absence of a particular features like carabelli's cusp, shoveling, three cusped maxillary second

[5]molar, mandibular molar groove pattern.

Identifying sex from teeth:

Sex determination becomes the first priority in the process of identification of a person by a forensic investigator in the case of mishaps, chemical and

nuclear bomb explosions, natural disasters crime investigations. Sex determination analysis can be done either by morphological analysis or by molecular analysis. In morphological analysis Mesiodistal dimensions and buccolingual dimension of teeth Tooth dimension is the most simple and reliable method to analyze sexual dimorphism. MD dimensions of teeth in male are more than that of female because of the Greater thickness of enamel in males due to the long period of amelogenesis compared to females or because of Y chromosomes producing slower male maturation.In case of molecular analysis sex can be determined by the DNA analysis, Bar bodies

[6]bodies, and AMEL gene.

Identifying age from teeth:

Age estimation can be done from dentition by clinical methods such as eruption sequence; radiographic features like appearance of tooth germs, commencement of mineralisation, degree of mineralisation of various teeth, degree of crown and root completion, degree of root resorption of deciduous teeth, open apices, pulp to tooth ratio, volume of pulp chambers and root canals, third molar eruption, digitization of available radiographs; histologic features like neonatal line, incremental l ines of cementum, dentin translucency, dentin predentin interface using scanning electron microscopy and biochemical characteristics like C14 levels and racemication of

[7]dentin.

Use of teeth in crime investigation:

Crime investigation includes the investigation of bite marks child abuse and lip print.

Bite marks: [figure 1]

A bite mark is defined as 'a mark caused by teeth either alone or in combination with other mouth parts' and serves as a good source of forensic evidence in crime investigation. Based on etiology McDonald has classified bite marks as tooth pressure, tongue pressure and tooth scrape marks. Various steps in bite mark investigation include preliminary questions, evidence collection from the victim, case demographics, visual examination, photography, saliva swab, impression making, evidence collection from suspect, bite mark

[8]analysis, comparison and drawing conclusion.

Lip print: [figure 2]

Lip prints are an important forensic evidence in the scene of crime similar to finger prints. The study of lip prints is called cheiloscopy. Tsuchihashi et al have proposed six different types of groove patterns in the lip which could be useful in crime investigation. They are Type 1- with clear-cut vertical grooves that run across entire lip; Type I' similar to type I but not covering entire lip; Type II with branched grooves; Type III with intersected grooves; Type IV with reticular grooves and Type V with grooves that are not morphologically

[9]differentiated.

Scope for research in forensic odontology:

The use of molecular techniques and ameloglyphics for person identification, biochemical methods of age estimation requires standardization. Moreover very few studies have been carried out in the Indian population. This warrants further studies to be carried out in our country so that regional variations could be assessed.

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Harsh Shah et. al. : Tooth as a tool for forensic evidence: A review

Limitations of research in forensic odontology:

Limitations of research include

* Ethical issues in sample collection in crime investigation.

* The application of molecular and biochemical techniques in Forensic Odontology are expensive.

Challenges in the Indian scenario:

In our country awareness about the importance of record maintenance among Dental Professionals is not satisfactory which poses a great challenge for person identification both in crime investigation and mass disasters.

* Most of the dental professionals in our country do not pursue research or career in this field due to

social and cultural reasons.

Conclusions:

An analysis has been made of the literature published during the last 5 years, offering a description of the novelties referred to buccodental s tud ies in compara t ive iden t i f i ca t ion , reconstructive identification (determination of age, rugoscopy and cheiloscopy, determination of gender), human bites as a method for identifying the aggressor, and the role of DNA in dental identification. The oral cavity is a rich and noninvasive source of DNA, and can be used for the identification of individuals and for providing information needed in legal processes.

REFERENCES:

1. Keiser-Neilsen S. Bristol: John Wright and Sons; 1980. Person Identification by means of Teeth.

2. Bagi BS. Role of forensic odontology in medicine. J Indian Dent Assoc1977;49:359-63.

3. Acharya A.B. A decade of forensic odontology in India.J Forensic Dent Sci 2010;2:1

4. Prabhu S, Acharya AB, Muddapur MV. Are teeth useful in estimating stature J Forensic Leg Med. 2013;20:460-4.

5. Shafer, Hine, Levy. Text book of Oral Pathology: Elsevier 2012;879-911.

6. Tsuchihashi Y. Studies on personal identification by means of lip prints. Forensic Sci 1974 Jun;3(3):233- 48.

7. Prabhu RV, Dinkar A, Prabhu V. A study of lip print pattern in Goan dental students - A digital app

8. Schwartz TR, Schwartz EZ, Mieszerski L, McNally L, Kobilinsky L. Characterization of deoxyribonucleic acid (DNA) obtained from teeth subjected to various environmental conditions. J Forensic Sci 1991;36:979-90

9. Meissner C, Ritz-Timme S. Molecular pathology and age estimation. Forensic Sci Int 2010;203:34-43.

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Harsh Shah et. al. : Tooth as a tool for forensic evidence: A review

PREVALENCE OF OCCUPATIONAL INJURY AMONGST THE DENTAL STUDENTS: A CROSS-SECTIONAL STUDY - A QUESTIONNAIRE STUDY

Original Article

* Intern, ** Sr Lecturer, *** Sr Lecturer, **** Asso. Prof, **** Sr Lecturer

INTRODUCTION:

It is estimated that there are 35 million healthcare workers worldwide representing 12% of the

[1]working population. Two million injuries are believed to occur each year among health care

[1]workers. Dentist and dental students can also be considered amongst the health care workers. Although sharp instruments injuries are preventable, a minor injury can carry the risk of transfer of over twenty pathogens of which the most serious are Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV). These injuries result in 66,000 HBV; 16,000 HCV and 1,000 HIV infections each year among

[ 1 , 2 ]HCWs. Other estimates indicate that occupational injuries have resulted in 2.5% of HIV and 40% of HBV and HCV cases among HCWs

[3]worldwide. These blood borne viruses (BBVs) have serious consequences, including long-term

[2]illness, disability and death.

ADDRESS FOR AUTHOR CORROSPONDENCE : SANYA RANGWALA, TEL: +91 8733877704

ABSTRACT

Aim: To access the prevalence of occupational injuries amongst the third year, final year, interns, graduates and the post-graduates dental students of Ahmedabad Dental College and Hospital, Ahmedabad, India.

Materials and Methods: The present cross sectional questionnaire study was conducted in the Ahmedabad Dental College, to access the prevalence of occupational injuries amongst the third year, final year, interns, graduates and the post-graduates dental students of Ahmedabad Dental College and Hospital, Ahmedabad, India. The sample size included 165 dental students. The survey was scheduled to spread over a period of 1 month. Data was collected by using self-designed questionnaire (Annexure- C). The questionnaire was developed in English. Questionnaire was administered by the investigator himself to each participant on the scheduled days and collected back on the next visit. Collected data was coded, compiled and tabulated. The data was analysed by applying descriptive and inferential statistical analysis. Analysis was carried out using SPSS package version 17.

Result: Amongst the 165 students, females were 123 and males were 42. The prevalence of the occupational injury was incredibly high in females (94/123) as compared to males (21/42). The department causing the highest rate of injuries is in the Conservative department in both the genders, with the next being Prosthodontics and Periodontics Department. The instrument causing the highest rate of injury is the scalers and burs.

Conclusion: Thus through the inference of this questionnaire, one can conclude that the prevalence of the occupational injury using these sharp instruments is not only high but surely exceeded its limits. And this injury can surely be the major reason for the spread of blood borne transmission diseases i:e Hepatitis B etc. Thus one has to take care regarding the immunization of Hepatitis B, reporting of the injuries etc.

KEYWORDS: occupational injury, third year, final year, interns, graduates and the post-graduates dental student


Sanya Rangwala*, Harsh G Shah**, Vasudha Sodani***, Abhishek Sharma****, Suyog Savant*****

*DEPT OF PUBLIC HEALTH DENTISTRY, AHMEDABAD DENTAL COLLEGE & HOSPITAL, AHMEDABAD***DEPT OF PEDODONTICS, AHMEDABAD DENTAL COLLEGE & HOSPITAL, AHMEDABAD**** DEPT OF PUBLIC HEALTH DENTISTRY, GOVT. DENTAL COLLEGE, JAIPUR*****DEPT OF PUBLIC HEALTH DENTISTRY BHARTI VIDYAPEETH DEEMED UNIVERSITY DENTAL COLLEGE AND HOSPITAL, NAVI MUMBAI

51

Dental practice represents an occupational hazard [4]for injuries and transmission of serious infections.

Healthcare students are exposed to a number of occupational hazards in the workplace and injuries are a major concern. There is a high risk of exposure to pathogens among healthcare students while they become involved in patient's investigation and

[5,6]treatment during their clinical training. Dental students are generally considered at a higher risk because they undertake exposure prone techniques during their training years and use sharp

[4,6]instruments more often. Several studies have highlighted that knowledge and compliance among dental students is inadequate regarding prevention

[7]and management of sharps injuries. Lack of experience and skill in performing dental procedures during clinical training places dental students at risk of exposure to blood-borne viruses

[7](BBVs). The carrier rate following transmission is 20% for HBV, 80% for HCV and almost 100% for

[8]HIV.

Sanya Rangwala et. al. : Prevalence Of Occupational Injury Amongst The Dental Students: A Cross-sectional Study - A Questionnaire Study

52

The likelihood of being infected by a virus after a single exposure is low. However, the consequences for the dental student who becomes infected are potentially serious, and include the potential of transmission of blood-borne pathogens and associated detrimental effects on their personal and

[9]professional lives. The emotional impact of needle stick injuries (NSIs) can be severe and long lasting,

[3]even if a serious infection is not resulted.

Sharps injuries are a hidden problem and the vast number go unreported and are virtually undocumented in developing countries, but probably equal or exceed those in the industrialized

[8]world.

MATERIALS & METHODS:

• The present cross sectional questionnaire study was conducted in Ahmedabad Dental College, to access the prevalence of occupational injury amongst the third year, final year, interns, graduates and the post-graduates dental students of Ahmedabad Dental College and Hospital, Ahmedabad, India.

• The study sample comprised of 200 dental students of Ahmedabad Dental College and Hospital, Ahmedabad, India.

• Sample size determination and the sample selection was carried out randomly.

• Inclusion Criteria: Third year, final year, interns, graduates and the post-graduates dental students of Ahmedabad Dental College and Hospital.

• Exclusion Criteria: Students who do not want to participate and those students who are not responding or not giving back questionnaire during the stipulated time period despite of repeated reminders.

• The survey was scheduled to spread over the period of one month. A detailed weekly schedule was prepared well in advance. Although a detailed schedule was prepared meticulously, few adjustments and changes were done due to the logistic reasons.

• Two days in a week were allotted for

conducting the study. A questionnaire related to occupational injury in the form of multiple choices was given to each participant and the response sheets were collected after 2 days.

• The data was collected by a single investigator. (principal investigator).

• A pilot study was conducted on 10% of the total sample size to check the feasibility of the study and to validate the questionnaire.

• Prior to the study, questionnaire was pre-tested and validated. The questionnaire was validated for construct and content validity, reliability and the ease of the use. Content and construct validity showed no significant changes. Questionnaire showed high degree (0.89) of agreement during test-retest of questionnaire. Those individuals who participated in the pilot study were not considered for the main study to prevent possible bias.

• Data was collected by using self-designed questionnaire. The questionnaire was developed in English. The questionnaire consisted of 8 questions pertaining to prevalence of the occupational injury faced by the dental students. Questionnaire was administered by the investigator himself to each participant on scheduled days and collected back on the next visit.

• Collected data was coded, compiled and tabulated. The data was analysed by applying the descriptive and inferential statistical analysis. Analysis was carried out using SPSS package version 17.

RESULTS:

• The present study was conducted to access the prevalence of occupational injuries amongst the third year, final year, interns, graduates and the post-graduates dental students of Ahmedabad Dental College and Hospital.

• A total of 165 participants from Ahmedabad Dental College and Hospital were included in the study population.

• Following are the results presented:

1. Distribution of participants according to their gender. Out of 165 participants, 42 are males and

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123 are female dental students.

2. Distribution of subjects according to their educational qualification. Out of 165 participants, 37 are third year, 73 are final year, 6 interns, 8 graduates and 41 are post- graduate students.

Distribution of subjects according to the prevalence of the injury. Out of 165 students, 115 (M=21/F=94) experienced the occupational injury and 50 (M=21/F=29) did not experience it.

4. Distribution of subjects according to number of injuries experienced by the participants. Out of 115 students, injury occurred once 41(M=8/F=33), twice 24 (M=3/F=21), more than twice 50 (M=10/F=40)

5. TABLE 1: Shows the distribution of subjects according to department causing injuries in a descending order. Out of 115 students, conservative department: 38 (M=10/F=28), periodontics department: 20 (M=1/F=19), orthodontics department: 19(M=2/F=17), oral surgery department: 18(M=2/F=16), prosthodontics department: 18 (M=6/F=12), pedodontics: 2(F=2)

6. TABLE 2: Shows the distribution of subjects according to the instrument causing occupational injury in a descending order. Out of 115 students, bur 23(M=7/F=16), needle 22(M=4/F=18), scaler 20(M=1/F=19), orthodontic wire 14(M=3/F=11), endodontic file 13(M=2/F=11), orthodontic band

Department Total(%) =115 Males (%) =21 Females (%)=94

Conservative 38 10 28

Periodontics 20 1 19

Orthodontics 19

2 17

Oral surgery 18

2 16

Prosthodontics 18

6 12

Pedodontics 2 - 2

6(M=1/F=5), explorer 5(M=2/F=3), suture needle 3 (F=3)

7. TABLE 3: Shows the distribution of subjects according to the procedure they were injured in a descending order. Out of 115 students, endodontic treatment 29 (M=5/F=24), collision with sharp instrument 24 (M=4/F=19), scaling 18(M=1/F=17), local anaesthesia administration 13(M=2/F=11), needle recapping 7(F=7), sharp instrument disposal 5(M=3/F=2), wasting of sharp instruments 4(M=2/F=2).

8. Distribution of subjects according to the immediate post-reaction after the injury. Out of 115 students, anxiety/stress and indifferent attitude was with the same amount of students 42, anger directed at one's self was with 31 students.

Instrument Total(%) =115 Males (%) =21 Females (%)=94

Bur 23(20%) 7 16

Needle 22(19.130%) 4 18

Scaler 20(17.39%) 1 19

Orthodontic wire 14(12.17%) 3 11

Endodontic file 13(11.30%) 2 11

Orthodontic band 6(5.21%) 1 5

Explorer

5(4.34%) 2 3

Suture needle

3(2.60%) - 3

Surgical elevater

- - -

Others

9(7.82%) 1 8


Procedure Total (%) Males (%) Females (%)

Endodontic treatment 29 5 24

Collision with sharp

instrument

24 4 19

Scaling 18 1 17

Local anaesthesia

administration

13 2 11

Needle recapping 7 - 7

Sharp instrument

disposal

5 3 2

Wasting of sharp

instruments

4 2 2

Needle exchange 2 1 1

Others

14 3 11

Prevalence of occupational injury

Yes

No

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9. Distribution of subjects according to reporting of injury done by the students. Out of 115 students, majority did not report the injury 89(M=16/F=73), and the rest reported 26(M=5/F=21)

10. Distribution of subjects according to reason of why students did not report the injury. Out of 89 students, 51 felt it was minor, 25 used self- care, 6 were busy, 4 did not know whom to report and 3 were like instrument was unused.

DISCUSSION:

Several studies have reported on occupational injuries among dental students with variable findings. Differences in reporting can attributed to the operational definitions used for investigating occupational injuries. While some studies have focused solely on Needle Stick Injuries, others have described percutaneous and occupational injuries to include other forms of injuries to which dentists can be exposed to in their work environment. The divergence of results reported in the literature has also resulted from variations in definition of the recall period, samples sizes, academic years surveyed and study design approaches.

EPIDEMIOLOGY OF OCCUPATIONAL INJURIES

The overall prevalence of sharp instruments injuries of 69.6% reported in this study is considered to be high. The most common form of injury among dentists is while using burs and scalers. The prevalence of Needle stick injuries among dental students in this survey was 25%. Prevalence rates of NSIs ranging from 23% - 75.4% were reported in

[5,7,10]dental schools. As in other studies, most [3,5,10]

students were exposed to multiple injuries. It has been reported that inadequate staff, lack of experience, insufficient training, duty overload and

[10]fatigue may lead to occupational injuries.

Dental students work in various dental departments where they can be exposed to injuries. The most frequently reported places for injuries have varied across the literature. Endodontics, surgery, prosthodontics, operative dentistry, paediatrics and

periodontics departments were reported as places [3,4,10]for injury occurrence. In this study, most

injuries were reported to occur in the conservation followed by periodontics, surgery, orthodontics, prosthodontics and pedodontics departments.

In dental practice, multiple cavity preparations, tooth preparations and scaling are carried out, which is the major cause of occupational injuries among dental professionals. In this survey, some of the students reported injuries through needles. Significant risks of work acquired infections can be attributed to hollow-bore needles that are already

[4,5]contaminated. This is because a larger volume of blood remains inside the bore of the needle as compared to a suture needle which is a solid core

[5]needle. When a student is exposed to NSIs, the risk of transmitting various types of blood-borne pathogens from an infected patient is greatly

[7]increased. In this survey students reported other instruments such as the orthodontic wire, scaler, bur, orthodontic band, suture needle and surgical elevator as causing injuries which were also

[5-7]reported in similar studies.

REPORTING OF SHARP INJURIES

Non-reporting of occupational injuries is a [7]

contentious issue within the dental profession. The under-reporting is an established fact because HIV, HBV and HCV infections have implications for personal relationships, future employment and

[12]insurance coverage. All injuries require reporting and evaluation. Reporting of incidents is important to ensure appropriate counselling and treatment of

[5]healthcare students.

In this study, 78.6% of students did not report their injury. Similar studies have reported high rates of under-reporting and in one study 85% of students have acknowledged that they did not report their

[6,7,10]injuries. Reasons provided by students in this survey for not reporting injury were using self-care, injury being minor, item being unused and student being busy. Additional reasons reported in other studies by dental students for not reporting were: fear of stigmatization and discrimination, feeling embarrassed, fear of the consequences, the patient


was low risk, good local anti-sepsis undertaken at time of injury, heavy clinical schedule, students more concerned with finishing their clinical requirements and not knowing that there is a reporting protocol, negative faculty reaction and

[7,13,14]negative patient reaction. The literature has also revealed that that “most students indicate that they do not see routine universal precautions undertaken by staff and residents, and no

[15]requirement for the compliance is enforced”. Additional reasons cited by the WHO for not reporting injuries were ignoring that Post-exposure prophylaxis is available and efficient, uncertainty regarding the confidentiality of the results and a

[14,16]lack of support and encouragement to report. Fear of testing may also play an important role in the

[16]underreporting of occupational exposure. It has been suggested that such a high rate of under-reporting requires students' need for education on prevention, with the emphasis of reporting injuries and the possibilities of prophylaxis against blood

[3,10]borne diseases. Low compliance among students, especially in reporting of injuries, may be

partly explained by the perception that they are insignificant and pose no risk to them and this may be due dental students doing their own risk

[7]assessment.

CONCLUSION:

Thus, through this study one can conclude that there is a high rate of prevalence of the occupational injuries among the dental professionals. But however they lack the understanding regarding the harmful effects of not reporting the injury immediately irrespective of the injury being minor or being busy. So awareness regarding the blood borne diseases caused by these injuries, should be spread amongst the dental students. Also pre and post exposure prophylaxis should be given to the health care professionals to prevent and cure them against the blood borne disease. Thus this survey has achieved a complete response rate. And the survey is without any limitations.

REFERENCES:

1. Goniewicz M, Wloszczak-Szubzda A, Niemcewicz M, Witt M, Marciniak-Niemcewicz A, Jarosz MJ. Injuries caused by sharp instruments among healthcare workers--international and Polish perspectives. Ann Agric Environ Med 2012; 19(3): 523-527.

2. Rapiti E, Pruss-Ustan A, Hutin Y. Sharps injuries: assessing the burden of disease from sharps injuries to health-care workers at national and local levels. Geneva: World Health Organization; 2005.

3. Hashemipour H, Sadeghi A. Needlestick injuries among medical and dental students at the university of Kerman: a questionnaire study. Journal of Dentistry, Tehran University of Medical Sciences 2008; 5(2): 71-76.

4. Gaballah K, Warbuton D, Sihmbly K, Renton T. Needle stick injuries among dental students: risk factors and recommendations for prevention. Libyan J Med 2012; 7. http://dx.doi.org/10.3402/ljm.v7i0.17507

5. Hussain JSA, Ram SM, Galinde J, Jingade RRK.Occupational exposure among dental, medical and nursing students in Mahatma Ghandi Mission's Campus, Navi Mumbai, India.J Contemp Dent 2012; 2(2).

6. McCarthy GM, Britton JE. A survey of final-year dental, medical and nursing students: occupational injuries and infection control. J Can Dent Assoc2000; 66(10): 561.

7. Jaber MA. A survey of needle sticks and other sharp injuries among dental undergraduate students.Int J Infect Control 2011; 7(3).

8. Gupta N, Tak J. Needlestick Injuries in Dentistry. KUMJ 2011; 35(3): 208-212.

9. Trim JC, Elliott TS. A review of sharps injuries and preventative strategies. The Journal of Hospital Infection 2003; 53(4): 237- 242.

10. Askarian M, Malekmakan L, Memish ZA, Assadian O. Prevalence of needle stick injuries among dental, nursing and midwifery students i n S h i r a z , I r a n . G M S


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KrankenhhygInterdiszip2012; 7(1): Doc05.

11. Younai FS, Murphy DC, Kotelchuck D. Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study. J Dent Educ2001; 65(5): 436-448.

12. Ashfaq M, Chatha MR, Sohail A. Awareness of needlestick injuries among the dental health professionals at Lahore medical & dental college. PODJ 2011; 31(2).

13. Callan RS, Caughman F, Budd ML. Injury reports in a dental school: a two-year overview. J Dent Educ2006; 70(10): 1089- 1097.

14. Cuny E, Hoover TE, Kirk JS. Underreporting of bloodborne exposures in a dental school clinic.J Dent Educ2011; 75(4): 544-548.

15. Smoot EC. Practical precautions for avoiding sharp injuries and blood exposure.Plastic and reconstructive surgery 1998; 101(2): 528-534. h t tp : / /dx .do i .o rg /10 .1097 /00006534- 199802000-00045

16. Mungure E, Gankonyo J, Mamdani Z, Butt F. Awareness and experience of needle stick injuries among dental students at the University of Nairobi, Dental Hospital. East Afr Med J 2010; 87(5): 211-214.


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Original ArticleEVALUATION OF REDUCTION IN ANXIETY LEVELS WITH THE USE OF MUSIC THERAPY – A STUDY ON 5 TO 12 YEAR OLD CHILDREN

* Senior Lecturer, ** Professor & Head of Department, *** Senior Lecturer

ADDRESS FOR AUTHOR CORROSPONDENCE : Dr. Purv S. Patel, TEL: +91 9427219470

DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY DEPARTMENT, AHMEDABAD DENTAL COLLEGE & HOSPITAL.DENTAL OF ORAL MEDICINE & RADIOLOGY

57

ABSTRACT

Pain and anxiety has been associated with dental treatments in patients of all age groups since centuries. The advent of conscious sedation and general anesthesia in medicine and its use in pediatric dentistry has created possibilities of treating anxious or fearful children. Audio distraction or music therapy is one non-pharmacological modality which aims at making the dental treatment more acceptable to the pediatric patients and their parents.

Aims and Objectives: The aim of the study is to evaluate the effect of familiar Gujarati folk music in reducing the level of anxiety as compared to non-familiar vocal music in 5 – 12 year old boys and girls.

Materials and Methods: The study consisted of 104 children in 5 – 12 year age group with no previous dental experience. The children were divided into two groups of 52 children each, one group requiring use of airotor and another requiring local anaesthesia for their treatment. The children in each group were then randomly divided into further two groups of 26 children each, the first group children were made to listen to Gujarati rhymes/folk music while the second group children were made to listen vocal unknown music. Child's anxiety level is assessed by using a combination of Venham's picture test, Venham's anxiety rating scale, pulse rate and oxygen saturation as objective measurements of anxiety level.

Results: A significant reduction in anxiety levels was noted in children of both groups with the use of familiar music therapy as compared to unknown music therapy. However, the anxiety reduction was better in familiar music therapy group as compared to non familiar music therapy group.

Conclusion: Children showed better involvement in the procedure when asked for music selection and given familiar folk song/rhymes music therapy. Hence, familiar music therapy is an effective tool in reducing the anxiety levels in pediatric dental patients in the unfamiliar dental clinical environment.

KEYWORDS: Music Therapy Venham’s Picture test. Venham’s Anxiety Rating Scale.


Purva B. Butala*, B. Vijay Bhaskar**, Purv S. Patel***

INTRODUCTION & REVIEW

Complementary and alternative medicine and dentistry such as aroma therapy, herbal therapy and music therapy have been a burning topic these days because of the need for increasingly high quality

1medical and dental care. Interventions aimed at improving the health and wellbeing of children may also cause pain and anxiety. Managing the behavior and anxiety of a child so as to become a co-operative

2patient is critical to the success of dental treatment.

Recently, the term psychosomatic medicine has been coined to refer to a point of view which regards all illness, even health, as having a psychological, as well as physical aspect, in both its cause and manifestations. We have become very much aware of the importance in treating "the whole person" as an integrated functioning unit, recognizing

3psychologic factors along with structure.

Pharmacotherapy has been shown to be effective in reducing some of the pain and anxiety associated

with medical procedures but it may come with worrisome side effects. Thus although, traditional techniques may be successful, the attitude of parents and dental professionals towards these techniques is changing. This is the reason why new non-aversive techniques, which are more effective and more acceptable to the parents, are being used. Audio distraction is one such non-aversive technique in which patient listens to music during the dental procedure. Because of its success in

4medical settings and in adult dental patients, many dentists believe that this technique may be successfully used in managing the pediatric dental

2patients.

A familiar clinical environment created using familiar music therapy may help reduce/eliminate anxiety in young dental patients. The aim of the study is to evaluate the effect of familiar Gujarati folk music/rhymes in reducing the level of anxiety in children and adolescents as compared to non-familiar vocal music. The objectives are to evaluate

58

the effectiveness of familiar Gujarati musical poems and folk music in reducing the level of anxiety in children 5 – 12years old as compared to unknown vocal music group during fear provoking situations and to compare the effectiveness of familiar Gujarati musical poems and folk music in reducing the level of anxiety in girls and boys.

MATERIALS & METHODS

â The study was conducted in the Pedodontics and Preventive Dentistry Department of the institute.

Selection of subjects

â The study included 104 randomly selected subjects (consisting of 52 boys & 52 girls) selected from the outpatient attending the department of Pedodontics and Preventive Dentistry having chronologic age ranging from 5 years to 12 years.

â The subjects who required the use of either airotor or local anaesthesia (LA) for dental treatment and whose guardians agreed for the dental treatment and for participation in the study were included in the study.

â The subjects who did not require the use of airotor or LA for dental treatment and those who were physically or mentally challenged or had behavioural problems were excluded from the study.

â After selection of the subject for the study, the subject and their guardian were informed about the procedure of the study and informed consent was obtained from them.

Study groups

â The children were divided into two main groups:

• One group consisted of 52 children who required use of airotor for their treatment

• Second group consisted of 52 children who required local anaesthesia for their treatment

Study subgroups

â The children in both of the above groupswere then randomly divided into further two subgroups:

• Subgroup 1 (consisting of 26 children) was Gujarati rhymes/folk music group for whom the choice of the type of music whether Gujarati

rhyme or folk song depended upon the patient's selection. The patients in the music group listened to the selected audio presentation through headphones throughout the treatment

• Subgroup 2 (consisting of 26 children) was Vocal unknown music group who listened to the unknown music audio through headphones throughout the treatment

Method

Anxiety level assessment

â Child's anxiety level was assessed by using a combination of following four measures:

• Venham's picture test using Venham picture scale as a subjective measurement of anxiety (Figure 1 & 2)

• Venham's anxiety rating scale as an objective measurement by the dentist (Figure 3)

Purva B. Butala Et. Al. : Evaluation Of Reduction In Anxiety Levels With The Use Of Music Therapy – A Study On 5 To 12 Year Old Children

Figure 1: Venham picture scale for

Boys

Figure 2: Venham picture scale for

Girls

59

• Pulse rate and

• Oxygen saturat ion as object ive measurements of anxiety level

â These measurements were taken three times in the same visit:

• first, in the waiting area with no music therapy and then with either type of music being played

• second, while sitting on dental chair (Figure 4)

• third, while LA delivery or airotor use

â Pulse rate and oxygen saturation were measured by using pulse oximeter (Figure 5)

â All the values were noted down in the individual patient proforma specially designed for the study by the principal investigator

Statistical analysis

â The statistical analysis was done using independent t test

RESULTS

In our study, the Venham anxiety scores were significantly higher in girls as compared to boys while they were in the waiting room before any intervention. (Table 1)

In the airotor group with unknown music therapy,

Figure 4: Patient undergoing treatment while

listening music with headphones

Figure 5: Pulse rate and Oxygen saturation

measurement using pulse oximeter


Figure 3: Venham’s anxiety rating scale

pulse rate increased significantly on sitting on chair. However upon use of airotor there was no significant difference in pulse rate and hence the anxiety level. There was no significant difference in oxygen saturation at any point of time during the visit. (Table 2)

Venham picture score reduced significantly indicating reduction in anxiety level both on sitting on the chair and on use of airotor. The Venham anxiety and behavior score showed significant reduction in anxiety upon airotor use. (Table 2)

In the airotor group with familiar Gujarati music therapy, pulse rate reduced significantly (p= 0.004) on airotor use thus reducing the anxiety level. Venham picture test score showed reduction indicating reduction in anxiety. Venham anxiety and behavior ratings showed significant reduction of anxiety upon sitting on chair and listening to familiar music. (Table 2)

In the local anaesthesia group with familiar Gujarati music therapy, pulse rate showed non -significant difference indicating no change in anxiety level. Oxygen saturation showed non-significant difference on L.A. delivery while significant difference on sitting on the chair showing reduced anxiety. (Table 2)

Venham picture test showed significant reduction in anxiety levels during sitting on chair and upon L.A. delivery while Venham anxiety and behavior score showed significant reduction of anxiety upon sitting on the chair, but non-significant difference upon L.A. delivery. (Table 2)

In the local anaesthesia group with unknown music therapy, pulse rate showed significant increase on L.A. delivery indicating higher anxiety levels, Oxygen saturation showed significant increase on

Sex No. Pulse rateMean (std dev)

O2 saturationMean(std dev)

VPT scoreMean(std dev)

Venham anxiety

Mean (std dev)

Venham behavior

Mean (std dev)

MALE 59

FEMALE

45

SIGNIFICANCE

90.56 (12.8) 96.98 (1.06) 0.93 (1.127) 0.71 ( 0.697) 0.61 ( 0.64)

92.89 (8.77) 97.29 (1.44) 1.89 (1.555) 1.00 ( 0.70) 0.82 ( 0.65)

0.2974

(ns)

0.2088 (ns) 0.0004 (s) 0.0383 (s) 0.1027 (ns)

ns= non-significant, s= significant

TABLE 1: Measured Values of Anxiety Level in the Waiting room before Music therapy or Any Intervention

L.A. delivery indicating higher anxiety level. Venham picture test showed significantly lower scores both during sitting on dental chair and upon L.A. delivery. Venham anxiety and behavior score showed non-significant difference upon sitting on the chair, but significant decrease upon L.A. delivery. (Table 2)

The anxiety level is reduced significantly upon delivery of anaesthesia and use of airotor when familiar music was used as music therapy compared to unknown music group considering pulse rate, O2 saturation, and Venham scales as measures of anxiety level. (Table 3)


60

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TABLE 2: Comparison of groups and subgroups based on the differences between the measured values upon sitting on chair and baseline value (in the waiting room) & upon L.A. delivery/airotor use and baseline value

s= significant, ns= non-significant

GROUPS Measured values upon sitting on Measured value upon L.A.

delivery/airotor use – Base line value

Mean Significance value mean Significance value

AIROTOR

UNKNOWN

MUSIC GROUP

PULSE 3.154 0.015 (s) -1.577 0.136 (ns)

O2 -0.231 0.523 (ns) 0.692 0.089 (ns)

VPT -2.111 0.016 (s) -3.734 0.002 (s)

Venham anxiety -0.535 1.000 (ns) -4.332 0.000 (s)

Venham behavior -0.206 1.265 (ns) -4.613 0.000 (s)

AIROTOR

GUJARATI

MUSIC GROUP

PULSE 0.423 0.719 (ns) -3.308 0.004 (s)

O2 1.192 0.001 (s) 1.308 0.000 (s)

VPT -2.835 0.005 (s) -2.508 0.012 (s)

Venham anxiety -4.491 0.000 (s) -1.265 0.206 (ns)

Venham behavior -4.025 0.000 (s) -0.832 0.405 (ns)

L.A. GUJARATI

MUSIC GROUP

PULSE -2.385 0.075 (ns) 0.615 0.206 (ns)

O2 -0.615 0.043 (s) -0.154 0.516 (ns)

VPT -2.835 0.005 (s) -2.508 0.012 (s)

Venham anxiety -4.491 0.000 (s) -1.265 0.206 (ns)

Venham behavior -4.025 0.000 (s) -0.832 0.405 (ns)

L.A.UNKNOWN

MUSIC GROUP

PULSE 4.615 0.001 (ns) 5.423 0.000 (s)

O2 0.731 0.095 (ns) 1.231 0.007 (s)

VPT -2.111 0.035 (s) -3.734 0.000 (s)

Venham anxiety -0.535 0.593 (ns) -4.332 0.000 (s)

Venham behavior -1.265 0.206 (ns) -4.613 0.000 (s)

chair– Base line value


TABLE 3 Comparison between familiar Gujarati music and unknown music groups

Score on

sitting on

chair: Mean

Standard

Deviation

Score on LA.

Delivery/airotor

use: Mean

Standard

deviation

Mean of score

(column

3)and score (column 5)

GUJARATI

MUSIC GROUP

Pulse rate 88.23 10.182 87.87 12.193 88.05

O2

97.42 1.319 97.71 1.194 97.56

VPT 0.50 0.642 0.73 0.68 0.615

Venham

anxiety

0.46 0.641 0.83 0.43 0.645

Venham

behaviour

0.33 0.513 0.67 0.47 0.5

UNKNOWN

MUSIC

GROUP

Pulse rate 97.81 9.896 95.85 9.995 96.83

O2 97.35 1.235 98.06 0.777 97.70

VPT 1.75 1.412 2.46 1.553 2.1

Venham anxiety

0.83 0.617 2.15 0.872 1.49

Venham behaviour

0.52 0.610 1.87 0.687 1.195

P VALUE

Pulse 0.0001 (s)

0.251 (ns)

0.215 (ns)

0.0034 (s)

0.0886 (ns)

0.0004 (s)

0.0794 (ns)

0.0001 (s)

0.0001 (s)

0.0001 (s)

O2

VPT

Venham anxiety

Venham behaviour

s= significant, ns= nonsignificant, std deviation = standard deviation


62


DISCUSSION

Music is a set of information, which in the form of impulses, reaches the human nervous system. By affecting the metabolism it can change our behavior, develop emotions or bring memories to our minds. In all the above literature term 'suitable

5 6music' is used. Best obtained very favorable results in dentistry by supplying music via earphones built

7into the headrest. Brown, Livingston, and Willard reported the use of "silent music" to soothe surgical patients. They reported that the selection of the correct type of music is very important. It must be a melody that will calm and soothe the patient and not excite or stimulate him, yet it must hold his

3attention. Thus the aim of this study was to evaluate the efficacy of familiar folk or cultural music distraction therapy in management of anxious pediatric dental patients as compared to the unknown music in the unfamiliar dental clinical set up and to know which type of music influences pediatric dental patient's tension and behavior.

In this study, 104 Gujarati children were assessed, sample size being quite larger as compared to few

8,9previous studies. They were divided into two groups according to whether use of airotor or local anaesthesia syringe is required, because sight of syringe, receiving L.A. injection and getting the tooth drilled are the most fear provoking dental

10situations according to a survey done.

Children in each of these groups were further divided into known Gujarati folk song/rhymes and unknown music groups randomly. It has already been proven that music therapy is effective for

11,12pediatric dental patients. However, there are few studies that showed little or no effect of music

[13,14]distraction. Using familiar and unfamiliar music could make a difference. In children and adults, factors that influence music preference include increased repetition or exposure, degree of liking, and cultural environment (Hargreaves, 1984; Morrison, 1998; Morrison & Yeh, 1999; Siebenaler, 1999; Stratton & Zalanowski, 1984; Thaut & Davis, 1993). Walworth (2003) found that playing an individual's preferred genre or artist is as effective in reducing anxiety as playing a specific song indicated as relaxing by the person when compared with the anxiety levels of a person receiving no

15music. The choice of music in our study was left to

16the patient as indicated by Klein and Winkelstein

because playing familiar songs will help child gain control over the unpleasant stimulus, make themselves feel connected to the dental clinical set up and give them a feeling of being in the familiar environment.

Venham's picture test, which is used in this study, is the most reliable measure of self-reported anxiety in

17children. The drawback of Venham picture scale which shows only images of boys was overcome in this study by designing similar scale with images of

18 girls for female patients. Venham's anxiety rating scale is also an effective means of assessing anxiety

17in children. Since, pulse oximetry is a direct measure of physiologic arousal and its increase is attributed to stress during dental procedure and therefore pulse rate and O saturation is an index of 2

19patient response to dental stimuli.

In other studies, anxiety levels were assessed in 9multiple visits. Few studies showed that anxiety

levels reduce with increase in number of visits 20 whereas few others showed no difference. So in the

present study anxiety levels of all children were assessed in the same visit so that all the subjects were exposed to the unknown dental stimuli for the first time.

Distractors such as music that can involve or interest a person can block certain pain pathways

8and diminish the amount of perceived pain. The results obtained in this study that there was an overall reduction of anxiety with music therapy were similar to those previously done by Marwah et

2 9al (2005) and Yamini et al (2010) in smaller age group children and in multiple visits respectively. Walworth (2003) found that playing an individual's preferred genre or artist is as effective in reducing anxiety as playing a specific song indicated as

15relaxing by the person. Similarly in our study it was observed by the results obtained that music preference and involvement into the played familiar folk song/rhymes resulted in reduced anxiety in more fearful situations like sight of local anaesthesia syringe and receiving an anaesthesia injection as compared to the unknown music group.

CONCLUSION

â The girls showed higher anxiety levels, while they were in the waiting room than the boys.

â In both the unknown and familiar music groups, there was a reduction in anxiety levels.

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â Anxiety levels reduced considerably with the familiar music therapy especially on local anaesthesia delivery and during use of airotor.

â Children showed better involvement in the procedure when asked for music selection and given familiar folk song/rhymes music therapy

â The present study concludes that familiar music therapy is an effective tool in reducing the


anxiety levels in pediatric dental patients in the unfamiliar dental clinical environment.

REFERENCES:

1. Kemper K, Vohra S, Walls R. The use of Complementary and alternative medicine in Pediatrics. Pediatrics 2008; 122(6): 1374 – 86.

2. Marwah N, Prabhakar AR, Raju OS. Music distraction – its efficacy in management of anxious pediatric dental patients. J Indian Soc Pedod Prev Dent2005; 23(4): 168 – 70.

3. Harold GG. Musical Therapeutics. J Dent Res 1952; 31: 871 – 4.

4. White JM. State of the science of music interventions: Critical care and perioperative practice. Crit Care Nurs Clin North Am 2000;12:219 – 25.

5. Iwona O, Maciej Y. Does music during dental t r e a t m e n t m a k e a d i f f e r e n c e ? i w o n a @ o l s z e w s k a . n e t , [email protected].

6. BestES.The Psychology of Pain Control. J Am Dent Assoc 1935; 20: 256 – 68.

7. BrownRE, LivingstonHM, Willard J. Silent Music Soothes the Surgical Patient. Mod. Hosp 1949.

8. Jeffrey AK, Yuanyuan L, Lisa T,Terry PK, Lisa H. Music for Pain and Anxiety in Children Undergoing Medical Procedures: A Systematic Review of Randomized Controlled Trials. Ambulatory Pediatrics 2008;8:117–28.

9. Yamini V, Sandeep N, Anant B, Nirmala S, Sivakumar N. Effectiveness of music distraction in the management of anxious pediatric dental patient. Annals and Essence of Dentistry 2010; 2(2): 1 – 5.

10. Malamed S. Pain and Anxiety in Dentistry. In Sedation: a guide for patient management. 5th

ed. St. Louis, Mo: Mosby; 2010: 5.

11. Ingersoll BD, Nash DA, Gamber C. The use of contingent audio taped material with pediatric dental patients. JADA 1984; 109:717-9.

12. Corah NL, Gale EN, Illig SJ. The use of relaxation and distraction to reduce psychological stress during dental procedures. J Am Dent Assoc 1979; 98: 390 – 4.

13. Parkin SF. The effect of ambient music upon the reactions of children undergoing dental treatment. J Dent Child 1981; 48: 430 – 2.

14. Aitkin JC, Wilson S, Coury D, Moursi AM. Effect of music distraction on pain, anxiety and behavior in pediatric dental patients. Pediatr Dent 2002; 24: 114 – 8.

15. Darcy DW. ProceduralSupport Music Therapy in the Healthcare Setting: A Cost–Effectiveness Analysis. Journal of Pediatric Nursing 2005; 20(4): 276 – 84.

16. Klein SA, Winkelstein ML. Enhancing pediatric health care with music. J Ped Health Care 1996; 10: 74 – 81.

17. Newton JD, Buck DJ. Anxiety and pain measures in dentistry. J Am Dent Assoc 2000; 131: 1449 – 57.

18. Buchanan H, Niven N.Validation of a Facial Image Scale to assess child dental anxiety. IntJPaediatrDent2002; 12: 47–52.

19. Yelderman M, William N. Evaluation of pulse oximetry. Eur J Anaesthesiol 1983; 59: 349 – 52.

20. Venham L, Bengston D, Cipes M. Children's Response to Sequential Dental Visits. J Dent Res 1977; 56(5): 454 – 9.

EFFECT OF ULTRASONIC SCALING ON THE SURFACE ROUGHNESS OF DIFFERENT RESTORATIVE MATERIALS

ABSTRACT

The surface roughness of dental restorative materials has a crucial effect on the health of dental and periodontal tissues as well as for the longevity of restorations. Aim: This study evaluated the effect of ultrasonic scaling on surface roughness of four different tooth-colored class V restorations. Material and method: Out of 48 freshly extracted human teeth, 12 teeth were randomly selected for each group, marked with the outline of class V cavity. Class V cavities were prepared on the facial surfaces of teeth of all groups except the control group. These cavities were then restored with GIC, Nanohybrid composite (Filtek Z 250 XT) and Nanofilled (Filtek Z 350 XT) composite. All the specimens were stored in artificial saliva at 37o C for 1 month. Initial surface roughness values (Ra in μm) of restorations were evaluated with the surface roughness tester. Ultrasonic instrumentation was then carried out for 60 s on the restoration surface and final roughness values were evaluated. Data were analyzed with Paired t-test, One-way ANOVA.Results: Mean Pre-instrumentation surface roughness was highest with GIC, whereas it was least in case of Filtek Z 350 XT. Mean post-instrumentation surface roughness was highest with GIC, whereas it is least in case of Filtek Z 350 XT.Conclusion: Highest surface roughness was seen in GIC, followed by control group, Nanohybrid (Filtek Z250 XT) and Nanofilled group (Filtek Z350 XT) when subjected to ultrasonic scaling.

KEYWORDS: Class V restorations, Filtek Z250 XT, GIC, Filtek Z350 XT, nanohybrid composite, nanofilled composite, surface roughness, ultrasonic scalingReceived: 09-04-2015; Review Completed: 24-08-2015; Accepted: 28-12-2015

Niharika Patel*, Vyoma Shah**, Rupal Vaidya***, Shraddha Chokshi****, Zarana Sanghvi*****

65

Original Article

INTRODUCTION:

Sonic and ultrasonic scaling techniques are widely used in periodontal prophylaxis. The vibration of sonic scaler inserts ranges between 3,000 and 8,000 cycles per second, while the vibration of ultrasonic scaler operate between 18,000 and 45,000 cycles per second. Studies have confirmed that both techniques appear to attain similar results as hand instruments for removing plaque, calculus and endotoxin. The cleaning procedures, however, may increase surface roughness, which will influence bacterial colonization and increase the rate of plaque formation. Although the effects of periodontal instrumentation on tooth surfaces have been well investigated, very few studies have looked at their effects on restorative materials.

Bjornson demonstrated that all three types of periodontal instrumentation, the curette, the Cavitron scaler and the Titan-S scaler, altered the surface of resin composites but found that hand curettes yielded the most significant alterations. Prophylactic instruments may also cause surface

deterioration of metal crown margins. It was reported that high goldcontent was the least resistant to surface deterioration, and the ultrasonic scaler caused the greatest surface deterioration to all of the metals tested.

However, Lee and others1 found that the use of ultrasonic scalers and hand scalers had no influence on the initially smooth porcelain surface. The relationship between dental restorations and periodontal health has been thoroughly investigated for many years. Studies have focused on different aspectsof periodontal-restorative interaction, such as surface roughness, the position of the restoration in respect tothe gingival margin, the presence of an overhang and the presence of marginal leakage. The surface roughness of restorative materials can influence staining, plaque accumulation, gingival irritation, recurrent caries and aesthetic appearance.

2Bollen and others demonstrated that roughness beyond 0.2 µm results in a simultaneousincrease in plaque deposits and increases the risk for caries and periodontal inflammation. Furthermore, Jones and

* Post Graduate, ** Post Graduate, *** Head of the Dept., **** Professor, ***** Professor, ****** Reader

ADDRESS FOR AUTHOR CORROSPONDENCE : Dr. Niharika Patel, TEL: +91 9974580795

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS, AHMEDABAD DENTAL COLLEGE & HOSPITAL.

66

3others claimed that a restoration surface should have a maximum roughness of less than 0.50 µm if it is not to be detected by the patient.

Several restorative materials are now available for Class V cavities. In addition to conventional resin composites and glass ionomer cements, more-recently developed tooth-colored filling materials, particularly resin-modified glass ionomer cements, polyacid-modified resin composites and flowable composites, have now broadened treatment options. The potential use of each of these five types of mater ials has i ts own advantages and disadvantages. As calculus and plaque deposits are often heaviest in the cervical area of teeth, restorations of Class V cavities are inadvertently exposed to these maintenance procedures. The effect of periodontal instrumentation on the surface roughness of these materials should be of interest.

This study investigated the effects of sonic and ultrasonic scaling on the surface roughness of five different types of restorative materials commonly used in cervical lesions.

MATERIALS AND METHODS

Fourty eight freshly extracted human teeth excluding mandibular incisors were used in this study. Out of these, 12 teeth were randomly selected and included in the control group (Group I). These were marked with area of 2 × 4 mm to simulate outline of class V cavity; however, no cavity preparation was done on them. Class V cavities of 4 mm width, 2 mm length, and 1.5 mm depth were prepared on facial surface of remaining 36 teeth with FG1 and FG 271 carbide bur (Fig 1).

Fig 1 : Cavity prepared on teeth

Each pair of these burs was discarded after preparation of eight class V cavities. These 36 class V cavities were randomly and equally divided into 3 groups (n = 15) according to type they were restored with:

Group II: GIC (EASY MIX, 3 M ESPE)

Group III: Nanohybrid composite (Filtek Z 250 XT, 3M ESPE, St. Paul, MN, USA ).

Group IV: Nanofilled composite (Filtek Z 350 XT, 3M ESPE, St. Paul, MN, USA).

Restorative materials in each group were manipulated according to manufacturer's instructions and placed into the prepared cavity. A transparent matrix band was placed over it, and pressure was applied to extrude excess material. Restorations in Group 3 and Group 4 were cured against a Mylar strip with light curing unit for 40 seconds. After initial set of each material, excess was carefully removed. Restorations in Group II were covered with petroleum jelly and allowed to set in 100% humidity. All specimens were then stored in artificial saliva prepared by Oshiro's method4 at 37o C for 1 month. (Fig 2)

Specimens in each group were rinsed in running tap water for 30 seconds and further cleaned in an ultrasonic cleaner for 6 minutes. They were air dried, and initial surface roughness was evaluated in terms of Ra value (μm) using Surface Roughness Tester with stylus moving at the speed 0.5 mm/s.

Later, ultrasonic scaling was performed on all specimens with SATELLAC (Satellac, Cedex, France) ultrasonic scaler having N1 insert/tip under copious water flow for 60 seconds at level 2 power setting. The scaling tip was angled approximately

Fig 2 : Teeth stored in artificial saliva

Niharika Patel Et. Al. : Effect of Ultrasonic Scaling on The Surface Roughness of Different Restorative Materials

67

15o to the restoration surface. The direction of scaling was approximately perpendicular to the long axis of the tooth in the horizontal plane, moving the scaler insert slowly from gingival to co rona l t h i rd o f t he r e s to r a t i on . A l l instrumentations were performed by one experienced periodontist who was not aware of the type of restorative material and their groups. The specimens were rinsed in running tap water for 30 seconds and cleaned in an ultrasonic bath for 6 minutes. All specimens were air dried, and post-ultrasonic instrumentation roughness was then evaluated as mentioned previously (Fig 3). Data were analyzed with paired t-test, one-way ANOVA, Tukey's test.

RESULTS

Initial surface roughness values (Ra) from highest to lowest were in the order of control group, GIC, Filtek Z 250 XT, and Filtek Z 350 XT, whereas post-instrumentation surface roughness were in the order of GIC, control group, Filtek Z 250 and Filtek Z 350 XT.

The difference (δ) between the mean pre-instrumentation and post-instrumentation roughness, which gives actual effect of ultrasonic scaling on the surface roughness of control and test group, was highest in case of GIC, followed by control group, Filtek Z 250 XT and Filtek Z 350 XT [table 1]. Though initial surface roughness values of all the groups were significantly different, there was no correlation found between initial surface roughness and change in mean surface roughness (δ).

Fig 3 : Teeth being tested under surface roughness tester

PAIRED T TEST FOR COMPARING BEFORE AND AFTER

DISCUSSION

Class V caries usually develops due to many reasons like unclean tooth surface, caries inducing diet, gingival recession, a reduced salivary flow caused by certain medical conditions (e.g., Sjogren's syndrome), medication or head and neck

5radiation therapy. The other cervical lesions that need to be restored are abrasion, abfraction, and erosion. 5 To restore such defects, materials used should have qualities and properties such as strength, longevity, ease of use, past success, esthetics, being able to bond to tooth structure, good

5finishing and polishing ability. Glass ionomer cements are typically used to restore cervical lesions because of its true adhesion, anticariogenic property and high flexural strength6.However, recently it has been found that nanohybrid composites also possess better flexural properties

7,8.and low surface roughness

Glass ionomers have the initial setting time ranging from 4-7 minutes, but entire setting reaction continues for several weeks (ion-exchange mechanism). In this study, prior to ultrasonic instrumentation, we have stored all the specimens in artificial saliva for 1 month to simulate oral conditions that may have effect on surface characteristics of restorations.

Ultrasonics, which basically works on acoustic streaming, acoustic turbulence, and cavitation phenomenon are widely used in routine dental practice for diagnostic, therapeutic as well as for

9cleaning of the instruments before sterilization . Its 9

main uses are scaling and root planning of the teeth . In Endodontics, they are used for access refinement, finding calcified canals, and removal of attached pulp stones, removal of intracanal obstructions

GROUP Mean N Std. Deviation

Paired Differences T df P VALUE

Mean Difference

Std. Deviation

CONTROL before 3.163333 12 2.738196 -0.27 3.245531 -0.288 11 0.779

After 3.433333 12 2.099495

GIC before 2.739167 12 1.741068 -1.2775 1.421166 -3.114 11 0.01

After 4.016667 12 2.269094

FILTEK 250XT

before

2.409167

12

1.479997 -0.23 2.008373 -0.397 11 0.699

After

2.639167

12

1.668873

FILTEK Z350

XT

before

1.866667

12

1.100391 -0.42417 1.547957 -0.949 11 0.363

After

2.290833

12

1.10328


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(separated instruments, root canal posts, silver points, and fractured metallic posts), to enhance the action of the irrigating solution, condensation of gutta percha, placement of mineral trioxide aggregate (MTA), and root canal preparation. In surgical endodontics; it is used for root-end cavity preparation, placement and refinement of root-end

10obturation.

Ultrasonic scaling is essential part of periodontal therapy that includes elimination of plaque, calculus, and bacterial endotoxins from the tooth and exposed root surfaces. Ultrasonic scaling is routine oral prophylaxis advocated by periodontist

11by every 6 months . Plaque and calculus are deposited heavily in cervical regions of the teeth; thus, class V restorations also need regular periodontal prophylaxis. These cleaning procedures may lead to a number of unintended side effects most commonly increase in the surface roughness of dental hard tissues and restorative

1materials. This kind of surface irregularities increases the available surface area 2 to 3 times, which provides the niche to attach and grow to the microorganisms leading to quicker plaque

3accumulation and more difficult plaque removal . Eid et al. have mentioned that bacterial adhesion is directly proportional to surface roughness of the restorations. Ikeda et al., also stated that surface roughness has a positive influence on S. mutans

12biofilm adherence .

In this study, no additional finishing and polishing procedure were carried out to avoid intergroup variation. Bjorson et al. mentioned that the smoothest surface of a composite resin is produced when restoration is cured against a Mylar strip. Pre- and post-instrumentation roughness were calculated in terms of Ra values (μm). Ra can be defined as the arithmetic mean of the departure of the profile from a mean line derived from the top and bottom of the undulations on the trace.

Ultrasonic instrumentation has significantly altered the surface roughness of all the specimens. This may be due to the preferential removal weak matrix phase; thus leaving the harder unreacted glass or

13,14filler particles protruding out from the surface . Eid et al. also mentioned that differences in the roughness of different composites is due to differences in their size and content of filler particles.[17] That means higher the powder

particle size of test group higher will be the post-ultrasonic roughness. Nanofilled composites have shown to have round-shaped nanoclusters, while the nanohybrids present irregular-shaped small and medium particles,

The nanohybrid composites contain a small fraction of filler particles in the nanoparticle size range (less than 0.1µ or 100 nm), they also contain a range of substantially larger filler particles. The nanohybrids have some particles in the nanofiller size range less than 100 nm (0.1um), but they also contain particles in the submicron range (0.2 to 1µ).When any of these materials are subjected to abrasion, the resin between and around the particles is lost, leading to protruding filler particles (bumps). Eventually the entire filler particle is plucked from the surface, resulting in craters. These bumps and craters create

15a roughened surface

Whereas, Filtek Z 350 XT showed least pre- and post-ultrasonic instrumentation roughness, which is attributable to a unique combination of individual nanoparticles and nanoclusters. Nanoparticles are discrete nonagglomerated and nonaggregated particles of 20 nm in size. Nanocluster fillers are loosely bound agglomerates of nano-sized particles. The agglomerates act as a single unit enabling high filler loading and high strength when compared to other test groups.

Also, the difference might be due to the difference in their compositions. Nanofilledresin composites presented Silicon (Si) and Zirconia (Zr) as the main components of the inorganic fillers, wherein zirconia leads to an increase in strength and density

19and hence a decrease in porosity of the composites . While, the nanohybrids presented Silica and Barium as main components and also presented a small amount of Aluminium, which is the same as

16traditional hybrids.

The other reason might be the form of the restorative materials in which they are supplied. Composite is a single component material, whereas in case of Glass ionomers, powder has to be mixed with liquid, therefore risking the more air bubble

17incorporation and increased porosity . These porosities may get enhanced after ultrasonic instrumentation leading to greater surface roughness.

When the critical threshold roughness for plaque


69

2(0.2 μm) is considered , initial surface roughness of control and all the test groups except GC2 was well below it. Post-ultrasonic instrumentation roughnesses of all except Filtek Z 350 XT were well above this critical level. Thus, Filtek Z 350 XT has been found to withstand the vibrations of ultrasonic instrumentation better than other test groups and will cause no problem regarding plaque accumulation and patient discomfort.

However, the results of this in-vitro study may vary in in-vivo conditions as they are frequently subjected to various deleterious actions inside oral cavity like abrasion (brushing), attrition and erosion (citrus drinks, fruit, soft drinks, alcoholic and non-alcoholic beverages), exogenous substances including acids, bases, salts, alcohol, oxygen, etc. contacting the restoration surfaces during food and fluid intake and also to the cyclic flexural forces in the cervical region during occlusal loading. However, Roselino et al. and Zuryatietal. concluded that abrasiveness of dentifrice and home bleaching procedure did not change the surface roughness of

18the composites. In contrast, Uppalet al. have

concluded that oral hygiene maintenance procedure can significantly increase the roughness of the restorations. Results after ultrasonic scaling are also subjected to vary depending on operator, power setting, tip to surface angle, sharpness of the working edge, instrumentation time after placement of the restoration, which may require further long-term studies for different time periods.

CONCLUSION

Within the limitations of this study, ultrasonic instrumentation has caused significant changes in the surface roughness of both control and test specimen. Type II GIC had highest, whereas nanofilled composites had lowest pre- and post-instrumentation roughness values. Nanofilled composites are found to withstand the US instrumentation better than other tested materials, but still we would like to pass a message that carry out the routine ultrasonic scaling with caution, and subsequently polish the roughened restorations after scaling.

REFERENCES:

1. Lai YL, Lin YC, Chang CS, Lee SY. Effects of sonic and ultrasonic scaling on the surface roughness of tooth-colored restorative materials for cervical lesions. Oper Dent. 2007;32:273–8. [PubMed

2. Bollen CM, Papaioanno W, Van Eldere J, Schepers E, Quirynen M, van Steenberghe D. The influence of abutment surface roughness on plaque accumulation and peri-implant mucosit is . Clin Oral Implants Res. 1996;7:201–11.

3. Jones CS, Billington RW, Pearson GJ. The in vivo perception of roughness of restorations. Br Dent J. 2004;196:42–5.

4. Oshiro M, Yamaguchi K, Takamizawa T, Inage H, Watanabe T, Irokawa A, et al. Effect of CPP-ACP paste on tooth mineralization: An FE-SEM study. J Oral Sci. 2007;49:115–20.

5. Roberson TM. Fundamentals in tooth preparation. In: Roberson TM, Heymann HO, Swift EJ, editors. Sturdervant's Art and Science of operative Dentistry. 5th ed. Haryana (India):

Elsevier; 2010. pp. 281–324.

6. Prosser HJ, Powis DR, Wilson AD. Glass-ionomer cements of improved flexural strength. J Dent Res. 1986;65:146–8.

7. Melander J, Dunn WP, Link MP, Wang Y, Xu C, Walker MP. Comparison of flexural properties and surface roughness of nanohybrid and microhybrid dental composites. Gen Dent. 2011;59:342–7.

8. Sideridou ID, Karabela MM, Vouvoudi EC. Physical properties of current dental nanohybrid and nanofill light-cured resin composites. Dent Mater. 2011;27:598–607.

9. De Paolis G, Vincenti V, Prencipe M, Milana V, Plotino G. Ultrasonics in endodontic surgery: A review of the literature. Ann Stomatol (Roma) 2010;1:6–10.

10. Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: A review of the literature. J Endod. 2007;33:81–95.

11. Merin RL. Supportive periodontal treatment. In: Newman MG, Takei HH, Klokkevold PR,


70

Carranza FA, editors. Carranza's Clinical Periodontology. 10th ed. New Delhi (India): Elsevier; 2007. pp. 1194–205.

12. Ikeda M, Matin K, Nikaido T, Foxton RM, Tagami J. Effect of surface characteristics on adherence of S. mutans biofilms to indirect r e s i n c o m p o s i t e s . D e n t M a t e r J . 2007;26:915–23.

13. Gladys S, Van Meerbeek B, Braem M, Lambrechts P, Vanherle G. Comparative physico-mechanical characterization of new hybrid restorative materials with conventional glass-ionomer and resin composite restorative materials. J Dent Res. 1997;76:883–94.

14. Folwaczny M, Loher C, Mehl A, Kunzelmann KH, Hinkel R. Tooth-colored filling materials for the restoration of cervical lesions: A 24-month follow-up study. Oper Dent. 2000;25:251–8.

15. Filtek Z 350 XT product profile, 3M ESPE

16. R. R. Moraes, L. S. Gonçalves, A. C. Lancellotti, S. Consani, L. Correr-Sobrinho,

and M. A. Sinhoreti (2009) Nanohybrid Resin Composites: Nanofiller Loaded Materials or Traditional Microhybrid Resins?. Operative Dentistry: September 2009, Vol. 34, No. 5, pp. 551-557.

17. Jyothi K, Annapurna S, Kumar AS, Venugopal P, Jayashankara C. Clinical evaluation of giomer and resin modified glass ionomer cement in class V noncarious cervical lesions: An in vivo study. J Conserv Dent. 2011;14:409–13.

18. Uppal M, Ganesh A, Balagopal S, Kaur G. Profilometric analysis of two composite resins' surface repolished after tooth brush abrasion with three polishing systems. J Conserv Dent. 2013;16:309–13.

19. M. MoazzamHossen, F.-U.-Z. Chowdhury, M. A. Gafur, A.K.M. Abdul Hakim, M. BelalHossen. Effect of Zirconia Substitution on Structural and Mechanical Properties of ZTA Composites. IOSR Journal of Mechanical and Civil Engineering (IOSR-JMCE) e-ISSN: 2278-1684,p-ISSN: 2320-334X, Volume 11, Issue 2 Ver. I (Mar- Apr. 2014), PP 01-07.


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REASONS FOR REMOVAL OF STAINLESS STEEL PLATES INMANDIBULAR FRACTURE PATIENTS: A RETROSPECTIVE STUDY

* PG Student, ** Senior Lecturer, *** Professor, **** Professor and Head

ADDRESS FOR AUTHOR CORROSPONDENCE : Dr. JATIN K. VAGHASIYA, TEL: +91 : 9429322534

ABSTRACT

Introduction. The aim of this retrospective study was to assess incidences and reasons for the removal of stainless steel miniplates over a 2-year period in patients with mandibular fractures who had received treatment at the Oral and Maxillofacial Surgery Unit, Ahmedabad Dental College And Hospital.

Material and Method. The medical records of all patients who underwent removal of bone plates after mandibular fractures were reviewed over a 2-year period (June 2013 to June 2015). Data concerning gender distribution, reason for removal, site of removal, and general medical factors were evaluated for each patient.

Results. Mandibular bone fractures in 114 cases were underwent open reduction and internal fixation using stainless steel miniplates and screws for osteosynthesis with that in 150 plates were fixated. From 114 cases, in 5 cases (4 males and 1 females), and from 150 bone plates, 8 bone plates were removed. Out of 8 boneplates, 3 were removed from mandibular symphysis region (37.4%), 3 from mandibular body region (37.4%), 1 from mandibular parasymphysis region (12.5%) and 1 from mandibular angle region. (12.5%).

Conclusions. Based on this study, the incidence of bone plate removal was relatively low. Mandibular symphysis and body was the common site of bone plate removal followed by mandibular parasymphysis and angle region. The most common cause for bone plate removal was infection/discharging sinus followed by pain, loosening of screws and paresthesia.KEYWORDS: Osteosynthesis, Causes of removal of miniplates, Stainless steel plates.Received: 23-04-2015; Review Completed: 19-08-2015; Accepted: 11-12-2015

Jatin K. Vaghasiya*, Darshan Patel**, Nitu Shah***, Neha Vyas****

DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, AHMEDABAD DENTAL COLLEGE AND HOSPITAL, AHMEDABAD, GUJARAT, INDIA

Original Article

INTRODUCTION:

Injuries to the cranio- maxillofacial area affect a significant number of trauma patients, and consequences of trauma to this region can include any combination of dental, bone and soft tissue injury.

Osteosynthesis using bone plates and screws has been used in the facial region since last 19th century. In the maxillofacial region modern internal fixation devices have gained more popularity in 1978 when Champhy adapted technique from Michelet et al. and now a days these devices form an important part in management of facial bone trauma ,and also orthognathic and mandibular reconstructive surgery. Today open reduction and internal fixation can be achived with a variety of different plating systems either using an intraoral approach or an extraoral approach.

The application of internal fixation in mandibular fracture cases is among the great advances that have been made in the field. The use of this technique has resulted many advantages like stable intra operative

mandibular position, the avoidance or reduce time of maxillomandibular fixation and long term stability for the patients. However, complications can arise. The most common complications include infection, malunion, paresthesia, iatrogenic piercing of the tooth roots or the mandibular canal, hardware exposure, pain, and plate palpation

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