Case Report: A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure.
Conclusion: Dislodged metal orthodontic appliance in oral wound acts as a foreign body that may exert allergic reactions, infection, or inflammation. Pre- and postoperative intraoral examination of fixed orthodontic appliances including its count should be recorded in orthognathic surgery protocol.
METHODS: A cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test.
RESULTS: A total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05).
CONCLUSIONS: The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.