Awareness and practice of Revised Code of Dental Ethics and Consumer Protection Act among dental practitioners in Andhra Pradesh: A cross sectional study

BACKGROUND

Given the imperative for dental practitioners to be familiar with the existing ethical principles and laws governing their practice, this study aimed to evaluate awareness and practice of the dentists (code of ethics) regulations 2014 and consumer protection act 2019 among dental practitioners in Andhra Pradesh state, India.

METHODS

A cross sectional study was conducted among 384 dental practitioners in Andhra Pradesh state, India. A questionnaire consisting of 25 items was used to assess awareness and practice of the dentists (code of ethics) regulations and consumer protection act. The data collected were analysed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.

RESULTS

Only 53(13.8%) dental practitioners in the study were aware that the dentists (code of ethics) regulations had been revised in 2014. About 190 (49.5%) practitioners were aware of the precise period for mandatory preservation of patient records. Most dental practitioners (278, 72.4%) accepted commissions in the form of gifts or cash from laboratories, radiologists, or pharmacists and 306 (79.7%) dental practitioners used unregistered dental lab technicians as employees in their practice. Furthermore, 297 (77.3%) practitioners were found to provide or sell drugs to patients in their clinic/office. The new regulations under consumer protection act 2019 were unknown to 194 (50.5%) dental practitioners.

CONCLUSIONS

The present study indicates that the awareness of dental practitioners towards the dentists (code of ethics) regulations 2014 and consumer protection act 2019 is inadequate. It highlights the need for training programmes and curriculum changes with a focus on ethical and legal issues in clinical dental practice.

Oral health status, treatment needs, and patterns of utilization of dental services among village volunteers in Andhra Pradesh: A cross-sectional multi-stage cluster survey

Background

Community health depends on the leadership duties of a diverse population, such as village volunteers. Hence, a study was conducted to assess oral health status, treatment needs, and patterns of utilization of dental services among village volunteers in Andhra Pradesh state.

Methodology

A cross-sectional study was conducted among 400 village volunteers in Andhra Pradesh state, India. A multi-stage cluster sampling procedure was employed in sample selection. A questionnaire was used to review the pattern of utilization of dental services. World Health Organization Oral Health assessment form 1997 was used to evaluate oral health status and treatment needs. Data collected were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Descriptive statistics were done.

Results

Out of 400, 18% had never visited the dental clinic in their lifetime. The majority (33.5%) considered that dental problems were not a serious concern. Dental caries was seen in 69.5%, and 78.5% were presented with periodontal conditions. About 19.8% and 24.3% had crowding and spacing in incisal segments, respectively. The prevalence of oral mucosal disorders and dental fluorosis was 4.25% and 8.75%, respectively. Overall, 94% of the study participants needed dental treatment for various reasons.

Conclusion

This study provides sufficient evidence to conclude that this population's oral health was poor, with increasing unmet dental treatment needs. Selected interventions and strategies should focus on these factors to decrease the burden of oral diseases among village volunteers.

Comparing traditional and comprehensive clinical training methods in dental education: a study of students' self-confidence and clinical performance

Aim To compare students' self-confidence levels and clinical performance scores between traditional and comprehensive clinical training methods in dental schools in India.Methods A snowball sampling of undergraduate dental students who had completed their final year during 2021-2022 was undertaken. A questionnaire was designed and distributed to investigate students' self-confidence in performing 35 clinical procedures on a 5-point Likert scale. Additionally, the clinical performance score in external practical assessment during final year was assessed to correlate the self-confidence levels with traditional and comprehensive clinical training methods.Results Students reported a higher level of self-confidence trained under the comprehensive (3.41 ± 0.40) compared with the traditional method (3.07 ± 0.50) (p <0.05). Interestingly, the median clinical performance score was higher for students using the traditional method (2.88) than for those using the comprehensive method (2.44); however, no significant difference was observed (p = 0.460). The correlation between self-confidence and clinical performance scores was strongly positive (r = 0.521).Conclusion This study concluded that both traditional and comprehensive clinical training methods have strengths and weaknesses. Combining these two methods could improve clinical training in India.

Systematic Reviews in Dental Research: A Bibliometric Analysis of Contribution from Indian Dentists During 1948-2022

AIMS AND OBJECTIVE

Although systematic reviews (SRs) are the backbone of evidence-based dentistry, they have appeared infrequently in dental literature and their importance may not be recognized by dentists. So, this study aimed to identify SRs in dental research contributed by Indian dentists to the PubMed database during 1948-2022 and describes their epidemiological and descriptive characteristics.

MATERIALS AND METHODS

An electronic search of the PubMed database was performed from 1948 through September 2022. SRs were considered for inclusion if they were related to oral health and published by Indian dentists as the first author. From this collection, the following characteristics of SRs were described: name of the journal, type of journal (e.g., general dentistry, specialty dentistry, non-dental), year of publication, author's affiliation, and focus of the SR.

RESULTS

The search identified 439 SRs in dentistry indexed in the PubMed database during 1948-2022. There were only 5 SRs published from 2007 to 2010 with maximum publications during the year 2021 (n = 114; 25.97%). About 32.35% of the SRs (n = 142) were published in 10 journals with the maximum contribution from the Journal of Conservative Dentistry (n = 22; 5.01%). The majority of the SRs were published in the field of Pedodontics and Preventive Dentistry (n = 72; 16.40%), followed by Conservative Dentistry and Endodontics (n = 63; 14.35%).

CONCLUSION

The contribution of SRs in dental research from India is small but growing. There is a clear need to improve SRs in dental research qualitatively and quantitatively.

Comparative evaluation of the effect of adhesive restorative composite resins on the reinforcement of peri-cervical dentin: An in vitro study

Background:

Peri-cervical dentin (PCD) and its reinforcement play a crucial role in the fracture resistance of root canal-treated teeth.

Aims:

The aim of this study was to compare the fracture resistance of dual-cure, nano-hybrid, and short-fiber reinforced composite resins restored PCD with conventional hybrid composite (CHC) resin restored endodontically treated mandibular premolars.

Settings and Design:

Academic, in vitro study.

Materials and Methods:

The prepared mandibular premolar samples were randomly divided into five groups of 10 each. In Group 1, teeth were left intact. The remaining 40 teeth were endodontically treated and obturated as follows: In Group 2, teeth were obturated with gutta-percha till cementoenamel junction and restored with CHC. Teeth in Groups 3, 4, and 5 were obturated to a depth of 5 mm from the cervical line and restored with dual-cure, nano-hybrid, and short-fiber reinforced composite resins, respectively. Fracture resistance was tested using a universal testing machine.

Statistical Analysis Used:

One-way analysis of variance and post hoc Tukey's test.

Results:

Short-fiber reinforced composite resin showed a significantly higher mean fracture resistance value compared with other experimental groups. The mean fracture resistance values were obtained as Group 1 > Group 5 > Group 4 > Group 3 > Group 2.

Conclusions:

Reinforcement with short-fiber reinforced composite showed significantly higher fracture resistance compared with nano-hybrid and dual-cure composite resins.

Awareness, Knowledge, Attitude and Empathy Levels of Dental Postgraduates Towards Their Patients During Practice and Research-A Questionnaire Based Survey

Empathy is vital in ensuring the quality of the patient-clinician relationship. Empathy in the health care setting is the ability to understand a patient's experiences and feelings and communicate this understanding for better clinical outcomes in dental treatments. The study aimed to compare levels of empathy in post-graduate dental students across the different years of the master's degree course. Questionnaire forms distributed among post graduate students and awareness, knowledge, attitude, and empathy levels towards their patients were assessed. Responses of all the post-graduate students of all specialties in a dental institute were subjected to statistical analysis to know and compare their empathy towards the patients during their clinical practice and research throughout their three-year master's degree. The mean empathy score was 52.01 (maximum of 100), with a standard deviation of 6.69. The empathy scores decreased slightly from the first to the third year of the master's degree. The participant's age, marital status, place of residence, and specialties of dental post-graduation showed much significant difference in empathy levels. The study found slight significant gender differences in empathy among the participants. The empathy scores declined gradually very slightly as they were promoted to the next level in the course. The increase in empathy levels found in this study is more significant than those reported in similar studies due to the inclusion of educational and orientation programs at the time of admission into post-graduate studies.

Orthodontic Postgraduate Students’ Perception on Didactics and Clinical Training During the COVID-19 Crisis

Objective:

With the global crisis of the COVID-19 pandemic, orthodontic postgraduate students’ education and clinical training might be affected. The objective of this study was to explore their perception on didactics and clinical training.

Materials and Methods:

A pretested and validated 26-item online survey that addressed COVID-19’s impact on didactic components and clinical management was sent to postgraduate students in the Indian subcontinent. The survey was available for 3 days, and the responses were collected and analyzed.

Results:

Overall, 165 out of 244 (67.62%) orthodontic postgraduate students completed the survey. Of them, 88.48% noted that orthodontic education and patient management are at stake because of the ensuing crisis. The majority (66.28%) acknowledged that Internet-based education will become the significant part of postgraduate coursework. With regard to patient care, 80% felt that 2-way communication channels and a guarded approach with strict infection control protocols may be the way forward during the crisis. Many preferred attending patients with space closure stage at the follow-up (51.23%) and to postpone new case start-ups until normalcy returns. About 55% of the respondents felt that clear aligners could transform into a popular orthodontic practice regimen if the crisis continues.

Conclusions:

Orthodontic postgraduate students were concerned that the crisis would go on and affect their education. They perceived transition of face-to-face didactic learning and summative assessments to online settings as a viable approach during the COVID-19 crisis. They felt that orthodontic clinical training would benefit from teleorthodontic approaches and prioritization of care and its alignment with crowd control.

Evaluation of dentifrices of complementary and alternative medicinal systems on plaque formation and gingivitis: A randomized controlled clinical trial

Background

Bio-film formation is a natural process in the oral environment, but needs to be controlled through regular brushing in order to prevent the development of caries and periodontal diseases.

Material and Methods

A wide variety of dentifrices of complementary and alternative medicinal systems are available in the market which claims superior plaque control. A randomized controlled double-blinded concurrent parallel clinical trial was conducted with the objective to evaluate and compare the clinical effectiveness of three commercially available dentifrices of complementary and alternative medicine systems with that of a placebo dentifrice on Gingival Index (GI) and Plaque Index (PI) scores after 15, 30, 45 and 60 days of usage among 80 adults aged 35-44 years.

Results

The mean GI scores reduced by 29.19 %, 22.28 %, 32.43 % and 10.33 % in the herbal dentifrice, homeopathic dentifrice, conventional dentifrice, and placebo dentifrice groups by the end of the study period. Highest reduction of 33.5% and 34.87 % in PI scores were seen in the herbal and conventional dentifrice. This reduction was statistically significant (p=0.001).

Conclusions

The herbal dentifrice tested in the present study has demonstrated anti-gingivitis and anti-plaque efficiency equivocal to the conventional dentifrice. The homeopathic dentifrice was as good as a placebo.

Key words:CAM dentifrices, Homeopathic dentifrice, plaque, gingivitis, tooth brushing.

The 100 most cited articles in prosthodontic journals: A bibliometric analysis of articles published between 1951 and 2019

STATEMENT OF PROBLEM

Bibliometric studies to determine the characteristics of the most cited articles in prosthodontic journals are lacking.

PURPOSE

The purpose of this study was to analyze the characteristics of the 100 most cited articles in prosthodontic journals between 1951 and 2019.

MATERIAL AND METHODS

The Google Scholar database was used to retrieve the list of journals with titles containing the term "Prosthodontic" or "Prosthetic." Twelve journals were filtered, and of these, only 8 were related to dentistry and hence were included in the study. A search was then performed for each of the selected journals under "Publication Name," and articles were arranged by the category "Times Cited." The 100 most cited articles from the 8 journals were selected and analyzed with regard to journal name, year of publication, authors and their country, type of study, and area of research.

RESULTS

The 100 most cited articles were published between 1958 and 2013, with the numbers of citations ranging between 2368 and 343. The journal with the largest number of the articles cited was the "Journal of Prosthetic Dentistry" with 72 articles, followed by the "International Journal of Prosthodontics" with 25 articles. The decade with most articles published was the 1990s with 33 articles. Many of the authors of most cited articles were from the United States or Sweden. Most articles reported reviews (35 articles), followed by experimental studies (34); the most commonly cited area of research was related to dental implants.

CONCLUSIONS

This bibliometric analysis of the 100 most cited articles revealed interesting facts about scientific progress in the field of prosthodontics.

Correction to: Antimicrobial Drugs Encapsulated in Fibrin Nanoparticles for Treating Microbial Infested Wounds

In the original manuscript, the Figure 2 a-i is inadvertently repeated as Figure 2 a-ii. This mistake has been rectified and the corrected Figure 2 is presented below.

Impact of periodontal knowledge and attitude on the status of the periodontium: A profile on West Godavari district, Andhra Pradesh, India

Background:

Although regular patient education regarding the periodontal health/disease is advocated as a means of improving oral health, impregnable associations of periodontal knowledge and attitude with periodontal status have not been demonstrated.

Materials and Methods:

In a cross-sectional study conducted, 2400 participants were surveyed using a specially designed pretested pro forma to evaluate the knowledge and attitude concerning periodontal health and disease. The oral exanimation included recording of oral hygiene index, gingival index (GI), community periodontal index (CPI), and loss of attachment. Ethical clearance was obtained from the institutional review board. The data were analyzed using IBM SPSS version 21.0.

Results:

The mean age of the study population was 41.6 ± 9.5 years. The greater portion of individuals had high knowledge score (55.9%) and negative attitude (68.4%) toward periodontal health/disease. The mean oral hygiene index scores and GI scores were higher among individuals with high knowledge score and with negative attitude, and the differences were statistically significant among the groups. There was no difference in the mean plaque scores among individuals with different knowledge scores, but a higher score for individuals with negative attitude (1.24 ± 0.87) was evident. The proportion of individuals with healthy periodontium (score 0 for CPI and loss of attachment) had low knowledge score (54.3%); however, a positive attitude was elicited in 51.9% of the population.

Conclusion:

High knowledge score and negative attitude were related to periodontal status in West Godavari. Therefore, it can be emphasized that the presence of a positive attitude plays a key role in achieving better periodontal status.

Correction: Flexible, micro-porous chitosan–gelatin hydrogel/nanofibrin composite bandages for treating burn wounds

Correction for ‘Flexible, micro-porous chitosan–gelatin hydrogel/nanofibrin composite bandages for treating burn wounds’ by P. T. Sudheesh Kumar et al., RSC Adv., 2014, 4, 65081–65087.

The revised Declaration of Geneva, 2017, and India's contradictory legal provisions

The World Medical Association (WMA) provides ethical guidance to physicians through its Declarations, Resolutions and Statements. WMA first adopted its resolution on physician participation in capital punishment in 1981, which then amended in 2000 and 2008. The revised Declaration of Geneva was adopted by the World Medical Association General Assembly on October 14, 2017, in Chicago. WMA reaffirmed that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions. Indian Medical Association (IMA) is signatory to all these policies and resolutions since it is a founder member of WMA. Most other national and international associations of Medical and other health professionals also forbid participation of their members in capital punishment.

Awareness, Attitude, and Prevalence of usage of magnification devices among the dental practitioners in the state of Andhra Pradesh - A questionnaire-based study

Background:

Dentistry, dealing with teeth and supporting tissues in the oral cavity is not only an ever-evolving science but also an art combined with good eye-hand coordination. It not only encompasses clinical and theoretical skills which play a crucial role in the success of therapy but also a lot of intrinsic work is accomplished in dentistry. In a journey to fulfill the above accomplishments and for facilitating early diagnosis of pathologies which usually go unnoticed, a clearer and magnified field of vision are also essential. The purpose of this study is to evaluate the awareness, attitude, and prevalence of the usage of magnification devices among the dental practitioners in the state of Andhra Pradesh.

Materials and Methods:

A questionnaire-based study was conducted to assess the awareness, attitude, and prevalence of magnification devices among the 370 dental practitioners in Andhra Pradesh. All the participants were provided with a prestructured questionnaire comprising of 24 questions and answering was completely self-based.

Results:

Among the participants, majority were aware about magnification in dentistry (91.1%), and also of the different types of magnification devices available (90.5%). On the other hand, when the reason for not using magnification devices was taken into consideration, 32.7% attributed that they have not experienced the devices and 32.4% felt that devices were too expensive. Moreover, when regarding the usage of devices was taken into account, only 23.8% of the total participants were exposed to the usage of magnification aids.

Conclusion:

Among the selected group of participants, even though majority were aware of magnification in dentistry its application in practice was very less.

A Randomized Controlled Study Comparing Efficacy of Classical and Gow-Gates Technique for Providing Anesthesia During Surgical Removal of Impacted Mandibular Third Molar: A Split Mouth Design

INTRODUCTION

Reliable profound mandibular block anesthesia is questionable when depositing the anesthetic solution at the lingula. The Gow-Gates technique is an useful alternative to the classical inferior alveolar nerve block and the incidence of unsuccessful anesthesia may be as high as classical technique. The aim of this study is to compare the clinical efficacy, degree of patient acceptability, advantages, disadvantages and limitations of the classical and Gow-Gates techniques for providing anesthesia in patients undergoing bilateral symmetrical surgical removal of impacted mandibular third molar under local anesthesia.

MATERIAL AND METHODS

The split mouth design study was conducted on 100 patients aged between 20 to 40 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar performed by the same maxillofacial surgeon. 2 ml of 2 % lignocaine hydrochloride with 1:80,000 adrenaline was used as a standard local anesthetic solution in all the cases. By using four-digit numbers from a random number table, either Gow-Gates or classical inferior alveolar nerve block were randomly assigned to either left or right sides in each patient. The injections were administered by another surgeon who was blinded to the experiment. The patient was assessed for Pain experienced during injection, frequency of positive aspirations, Onset and duration of anesthesia and Nerves anesthetized.

RESULTS

Results were statistically analyzed by Mann-Whitney and chi square test. A 'P' value of less than 0.05 was considered for statistical significance. Higher mean pain during injection was recorded in classical group, was found to be statistically significant. No significant association was observed between aspiration and the groups. Higher mean onset of anesthesia was recorded in Gow-gates group, was found to be statistically significant. Higher mean duration of anesthesia was recorded in Gow-gates group, was not statistically significant. Higher success rate was recorded in Gow-gates group and was statistically significant.

CONCLUSION

If we ignore delayed onset of anesthesia of Gow gates technique, it is found to be more reliable, beneficial and have higher success rate than classical inferior alveolar nerve block technique.

Innovative dual impression technique for patients with atrophia idiopathica mucosa oris

Atrophia idiopathica mucosa oris is an oral fibrosing disease resulting in marked rigidity and an eventual inability to open the mouth or had limited mouth opening. Patients with limited mouth opening are a common occurrence in prosthodontic practice. The majority of these patients can be treated with exercise and stretching movements before impressions are made. Some will not respond to these procedures because of facial scarring and surgical manipulation of the facial muscles. This article presents an impression procedure for overcoming difficulties encountered in such reduced mouth opening patients that can be assembled intraorally, disassembled intraorally, and reassembled extraorally.

Potential use of drug loaded nano composite pectin scaffolds for the treatment of ovarian cancer

Ovarian cancer is the ninth most common cancer amongst women and ranked as fifth in terms of the cause of cancer related mortality accounting for more deaths than any other cancer of the female reproductive system. Gemcitabine is the most common chemotherapeutic agent used in the treatment of ovarian cancer despite of its disadvantage of having a very lesser half life. In this study, we have envisaged the use of a highly porous, biomimetic and implantable pectin scaffold embedded with gemcitabine loaded fibrin nanoconstructs to improve the half life of the drug, thereby providing localized therapy for ovarian cancer. The controlled and sustained release of the chemokine from the scaffold system was extensively analyzed in vitro different pH environments. The composite scaffolds were found to be highly biocompatible when tested with mammalian cell lines. The excellent cytotoxicity and apoptosis responses induced in ovarian cancer, PA- 1 cell lines proved that the nanocomposite Pectin scaffolds loaded with specific chemokine can be used as implantable "therapeutic wafers" for distracting metastatic cancer cells and thus improve the survival rate of ovarian cancer afflicted individuals.

Flexible, micro-porous chitosan–gelatin hydrogel/nanofibrin composite bandages for treating burn wounds

Fibrin nanoparticles were incorporated into a chitosan–gelatin hydrogel matrix to develop a composite bandage with wound-healing potential.

In vitro and in vivo evaluation of microporous chitosan hydrogel/nanofibrin composite bandage for skin tissue regeneration

In this work, we have developed chitosan hydrogel/nanofibrin composite bandages (CFBs) and characterized using Fourier transform-infrared spectroscopy and scanning electron microscopy. The homogeneous distribution of nanofibrin in the prepared chitosan hydrogel matrix was confirmed by phosphotungstic acid-hematoxylin staining. The mechanical strength, swelling, biodegradation, porosity, whole-blood clotting, and platelet activation studies were carried out. In addition, the cell viability, cell attachment, and infiltration of the prepared CFBs were evaluated using human umbilical vein endothelial cells (HUVECs) and human dermal fibroblast (HDF) cells. It was found that the CFBs were microporous, flexible, biodegradable, and showed enhanced blood clotting and platelet activity compared to the one without nanofibrin. The prepared CFBs were capable of absorbing fluid and this was confirmed when immersed in phosphate buffered saline. Cell viability studies on HUVECs and HDF cells proved the nontoxic nature of the CFBs. Cell attachment and infiltration studies showed that the cells were found attached and proliferated on the CFBs. In vivo experiments were carried out in Sprague-Dawley rats and found that the wound healing occurred within 2 weeks when treated with CFBs than compared to the bare wound and wound treated with Kaltostat. The deposition of collagen was found to be more on CFB-treated wounds compared to the control. The above results proved the use of these CFBs as an ideal candidate for skin tissue regeneration and wound healing.

A rare variation in the formation of the lower trunk of the brachial plexus its embryological basis and clinical importance - a case report

Brachial plexus is the plexus of nerves, that supplies the upper limb.Variations in the branches of brachial plexus are common but variations in the roots and trunks are very rare. Here, we report one of the such rare variations in the formations of the lower trunk of the brachial plexus in the right upper limb of a male cadaver. In the present case the lower trunk was formed by the union of ventral rami of C7,C8 and T1 nerve roots. The middle trunk was absent. Upper trunk formation was normal. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 49-52 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6727

Anomalous third part of axillary artery- anatomical, embryological and clinical relevance

DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6711 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 43-47

Fibrin nanoconstructs: a novel processing method and their use as controlled delivery agents

Fibrin nanoconstructs (FNCs) were prepared through a modified water-in-oil emulsification-diffusion route without the use of any surfactants, resulting in a high yield synthesis of fibrin nanotubes (FNTs) and fibrin nanoparticles (FNPs). The fibrin nanoconstructs formed an aligned structure with self-assembled nanotubes with closed heads that eventually formed spherical nanoparticles of size ~250 nm. The nanotubes were typically ~700 nm long and 150-300 nm in diameter, with a wall thickness of ~50 nm and pore diameter of about 150-250 nm. These constructs showed high stability against aggregation indicated by a zeta potential of -44 mV and an excellent temperature stability upto 200 °C. Furthermore, they were found to be enzymatically degradable, thereby precluding any long term toxicity effects. These unique fibrin nanostructures were analyzed for their ability to deliver tacrolimus, an immunosuppressive drug that is used widely to prevent the initial phase of tissue rejection during allogenic transplantation surgeries. Upon conjugation with tacrolimus, a drug encapsulation efficiency of 66% was achieved, with the in vitro release studies in PBS depicting a sustained and complete drug release over a period of one week at the physiological pH of 7.4. At a more acidic pH, the drug release was very slow, suggesting their potential for oral-intestinal drug administration as well. The in vivo drug absorption rates analyzed in Sprague Dawley rats further confirmed the sustained release pattern of tacrolimus for both oral and parenteral delivery routes. The novel fibrin nanoconstructs developed using a green chemistry approach thus proved to be excellent biodegradable nanocarriers for oral as well as parenteral administrations, with remarkable potential also for delivering specific growth factors in tissue engineering scaffolds.

Left inferior accessory renal arteries its embryological basis and clinical significance

The variations in origin of renal arteries are very common. During routine dissection of a male cadaver we found left accessory renal artery. The origin of accessory renal artery is immediately below main renal artery. The left inferior accessory renal arteries run towards inferior pole of left kidney, in the area where the left renal vein was leaving the left kidney. The vascular variations are very important for vascular surgeons, urologists, nephrologists, radiologists. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5976 JCMSN 2011; 7(1): 65-68

Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique

BACKGROUND

The methods frequently used for surgical removal of impacted third molars are bur technique, lingual split and simplified split bone technique. The morbidity rates following the use of these different surgical techniques are not completely resolved. The use of a surgical method with minimum postoperative complication is needed.

AIM

This study was conducted to compare the morbidity rates of the three different surgical techniques and their efficacy with regard to postoperative pain, swelling, labial and lingual sensation.

MATERIALS AND METHODS

Ninety patients with a symptomatic impacted mandibular third molar with the age range of 14-62 years were divided into three groups of 30 patients each for surgical bur technique, lingual split technique and simplified split bone technique. All patients were operated by the same surgeon under local anesthesia (2% lignocaine) in the dental chair. The severity of pain and swelling was recorded on a visual analogue scale and the presence or absence of sensory disturbance at 6, 24, 48 hours and seven days after operation. The pain was scored according to a visual analogue 4-point scale. Patients were asked to indicate which side was more swollen and to record this assessment on the swelling scale.

RESULTS

Lingual split technique was more painful than the other two techniques. Surgical bur technique had more swelling than the other two techniques. Labial and lingual sensations were not altered in all the techniques.

CONCLUSION

The simplified split bone technique had the least morbidity than the lingual split and surgical bur technique.

Variant insertion of coracobrachialis muscle-morphological significance, embryological basis and clinical importance

The coracobrachialis muscle in the arm is morphologically the sole representative of adductor group muscle in the arm, but such function during the process of evolution became insignificant in man. It is more important morphologically than functionally. Variant insertion of the coracobrachialis muscle was found during routine dissection of an adult male cadaver in the Department of Anatomy, College of Medical Sciences, and Bharatpur, Nepal. Normally the coracobrachialis muscle is inserted into the middle of the medial border of the humerus. In the present case an additional slender tendon passed inferiorly, crossing anterior to the median nerve and brachial artery, before attaching to the medial epicondyle of the humerus. Most of the proximal part of the tendon gave rise to an aponeurotic expansion that inserted into the distal medial border of the humerus. The tendinous insertion and aponeurotic expansion may represent a variant of the coracobrachialis longus (Wood's) muscle and the internal brachial ligament or the ligament of Struthers. The ulnar nerve was found to be traversing below the aponeurotic expansion. This type of anomalous insertion of coracobrachialis muscle may lead to compression of median nerve, brachial artery and ulnar nerve. Key words: Coracobrachialis muscle; ligament of Struthers; median nerve; brachial artery; ulnar nerve. DOI: 10.3126/jcmsn.v6i2.3616 Journal of college of Medical Sciences-Nepal, 2010, Vol.6, No-2, 42-46

Formation of median nerve by three roots: A case report

During routine dissection of an adult male cadaver in the Department of Anatomy, College of Medical Sciences, Bharatpur, Nepal, the right median nerve was found to be formed by three roots. The finding was noted after thorough and meticulous dissection of the upper limbs of both sides (axilla, arm, forearm and palm). Out of the three roots forming the anomalous median nerve, two were from lateral cord and one from medial cord of brachial plexus. However, the distribution of the anomalous median nerve was normal in arm, forearm and palm. The arterial pattern in the arm (axillary and brachial arteries) was also normal. Key words: Cadaver; median nerve; brachial plexus DOI: 10.3126/jcmsn.v6i1.3602 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 47-50