Objective The aim of the study is to evaluate the usage of Dieffenbach's modification of Weber-Fergusons approach in the treatment of lesions involving maxilla. Study In this study five different maxillary pathologies were approached through Dieffenbach's modification of Weber-Fergusons approach. Partial and subtotal procedures were performed depending on the type of pathology and the extent of the lesion which was assessed both clinically and radiologically. The study evaluates the easy exposure of the site, post operative complications like scar formation and infra orbital nerve parasthesia. Results There were two subtotal maxillectomy procedures and three partial maxillectomy procedures approached through Dieffenbach's modification of WeberFergusson's approach. All the cases recovered well in the post operative healing period without noticeable scarring. There was parasthesia in three cases which subsided in 3 months. Conclusion The approach through Dieffenbach's modification of Weber-Fergusons incision gave better visibility and accessibility to the lesions of maxilla. Because there is direct access to the pathology, the inadvertent resection of the un-involved structures is prevented thus minimizing the morbidity.

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BackgroundThe choice of surgical versus nonsurgical treatment for fractures of the condylar process has its own limitations and remains a controversial issue. Improved knowledge of anatomy, technique, and technology combined with adequate experience with careful planning of surgical technique can avoid all the possible complications. AimTo compare open reduction and internal fixation with closed reduction and maxillomandibular fixation in the management of condylar fractures. Materials and methodA prospective study was carried out among 22 patients who had minimally displaced or displaced condylar fractures. The patients were divided into two groups of 11 each: group A patients treated with open reduction and rigid internal fixation and group B patients treated with closed reduction and maxillomandibular fixation. Follow-up examinations were performed at one week, one month, three months, and six months postoperatively. ResultsPreauricular pain was significantly decreased (p < 0.001) in both groups postoperatively but more significantly decreased in the open reduction group. There was a significant improvement in the mouth opening at every follow-up to a maximum mean of 37.36 mm in group A and a mean of 33.64 mm in group B. Significantly more improvement in protrusive and lateral movements and reduced deviation on mouth opening at every follow up was observed in the open reduction group. ConclusionBoth the treatment options for condylar fractures of the mandible yielded acceptable results with significant clinical differences in terms of occlusion, mouth opening, functional movements, and pain among patients with open reduction.

Teeth with calcific metamorphosis pose a challenge to the endodontist in achieving proper access, identification, and debridement of the root canal. With the conventional technique, radiographs and bur orientation have dictated the access cavity preparation, which leads to the removal of more sound tooth structure and iatrogenic errors. To overcome these issues, the recent diagnostic imaging techniques such as cone beam computed tomography followed by three-dimensional fabrication of template have been proposed, which aid the clinician to accurately locate and negotiate the obliterated canal. The present case report describes the importance of conservative access cavity preparation with the use of the guided endodontic technique for the treatment of calcified canals in the maxillary central incisor.

Purpose This paper aims to present a new design in the area of basal osseointegrated implant (BOI) for oral and maxillofacial surgery using a patient-specific computer-aided design (CAD) and additive manufacturing (AM) approach. The BOI was designed and fabricated according to the patient’s specific requirement, of maxilla stabilisation and dental fixation, a capacity not currently available in conventional BOI. The combination of CAD and AM techniques provides a powerful approach for optimisation and realisation of the implant in a design which helps to minimise blood loss and surgery time, translating into better patient outcomes and reduced financial burdens on healthcare providers. Design/methodology/approach The current study integrates the capabilities of conventional medical imaging techniques, CAD and metal AM to realise the BOI. The patient’s anatomy was scanned using a 128-slice spiral computed tomography scanner into a standard Digital Imaging and Communication in Medicine (DICOM) data output. The DICOM data are processed using MIMICS software to construct a digital representative patient model to aid the design process, and the final customised implant was designed using Creo software. The final, surgically implanted BOI was fabricated using direct metal laser sintering in titanium (Ti-64). Findings The current approach assisted us to design BOI customised to the patient’s unique anatomy to improve patient outcomes. The design realises a nerve relieving option and placement of porous structure at the required area based up on the analysis of patient bone structural data. Originality/value The novelty in this work is that developed BOI comprises a patient-specific design that allows for custom fabrication around the patients' nerves, provides structural support to the compromised maxilla and comprises a dual abutment design, with the capacity of supporting fixation of up to four teeth. Conventional BOIs are only available for a signal abutment capable of holding one or two teeth only. Given the customised nature of the design, the concept could easily be extended to explore a greater number of fixation abutments, abutment length/location, adjusted dental fixation size or greater levels of maxilla support. The study highlights the significance of CAD packages to construct patient-specific solution directly from medical imaging data, and the efficiency of metal AM to translate designs into a functional implant.