Three-Dimensional Evaluation of Alveolar Cleft Volume and Nasomaxillary Form in Patients with Unilateral Cleft Lip and Palate.

OBJECTIVE: To evaluate the alveolar cleft volume (ACV) and to study its correlation with the nasomaxillary form in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective study. SETTING: University Academic Hospital. PATIENTS/PARTICIPANTS: 30 patients with UCLP and 30 non-cleft patients. INTERVENTIONS: Cone beam computed tomography (CBCT) scans. RESULTS: The Maxillary sinus volume (MSV) and Nasal cavity volume (NCV) were significantly reduced on the affected side in patients with UCLP (P < .001) and also in the cleft group when compared to the noncleft group (P < .01). The septal deviation measured at anterior, mid and posterior nasal spine were increased in the UCLP group significantly when compared to the non-cleft group (P < .01) and maximum deviation was seen at the mid-level. The mean ACV was found to be 0.587 + 0.396 cm3.The nasomaxillary complex was affected in UCLP patients irrespective of cleft size and a statistically significant correlation of ACV was found with septal height only (r value = -0.508). Parameters like septal height, anterior and middle maxillary width were significantly reduced (P < .01) in the cleft group when compared to the non-cleft group. CONCLUSION: The patients with UCLP showed significant differences among various parameters within the nasomaxillary complex when compared to the control group. Within the cleft group, the MSV and NCV were significantly decreased on the cleft side and also a significant negative correlation of ACV was found with septal height only.

Thidiazuron, a phenyl-urea cytokinin, inhibits ergosterol synthesis and attenuates biofilm formation of Candida albicans.

Candida albicans is a common human fungal pathogen that colonizes mucosa and develops biofilm in the oral cavity that causes oral candidiasis. It has been reported that cytochrome P450 enzyme (CYP51), a vital part of the ergosterol synthesis cascade, is associated with Candida infections and its biofilm formation. Thidiazuron, a phenyl-urea cytokinin, exhibits anti-senescence and elicitor activity against fungal infection in plants. However, how Thidiazuron impacts C. albicans biofilm formation is still uncertain. Here, we aimed to investigate the effects of a Thidiazuron against the growth and biofilm formation properties of C. albicans using in silico and in vitro experimental approaches. A preliminary molecular docking study revealed potential interaction between Thidiazuron and amino acid residues of CYP51. Further in vitro antifungal susceptibility test, scanning electron microscopy (SEM) and time kill analysis revealed the anti-fungal activity of Thidiazuron in both dose and time-dependent manner. Crystal violet staining, 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) reduction assay revealed 50% inhibition in C. albicans biofilm by Thidiazuron at concentrations 11 and 19 µM respectively. Acridine orange staining assay visually confirmed the biofilm inhibitory potential of Thidiazuron. The gene expression study showed that Thidiazuron treatment down regulated the expression of genes involved in ergosterol synthesis (ERG3, ERG11, ERG25), cell adhesion (ASL3, EAP1), and hyphae development (EFG1, HWP1, SAP5) in C. albicans. Wherease, the expression of negative transcription regulator of hyphae (NRG1) was upregulated (5.7-fold) by Thidiazuron treatment. Collectively, our data suggest that Thidiazuron is a robust antifungal compound and an outstanding biofilm inhibitor, which may promise further therapeutic development due to CYP51 binding and inhibition of ergosterol formation against C. albicans.

Comparative finite element analysis of bracket deformation in tie wings and slot region during simulated torque.

INTRODUCTION: Torque in orthodontics is the activation of the archwire for the third-order movement of teeth. During this force transfer mechanism from the twisted archwire, the bracket is prone to deformation. This study aimed to compare the deformation in tie wings and the slot region of the bracket during torque using finite element analysis. METHODS: Three-dimensionally modeled 0.017 × 0.025-in and 0.019 × 0.025-in stainless steel (SS) and titanium molybdenum alloy archwires were assembled in 0.018-in and 0.022-in solid modeled SS edgewise brackets, respectively. The finite element model of the bracket-archwire combinations was developed with contact boundary conditions. The deformation between tie wings and the slot was analyzed for various angles of twist. RESULTS: For SS archwires at 30° angle of twist, the tie wings deformation in 0.018-in and 0.022-in brackets were 48.67 µm and 34.87 µm, respectively. The slot deformations of 0.018-in and 0.022-in brackets were 66.33 µm and 45.69 µm, respectively. Similarly, the amount of deformation in the bracket-titanium molybdenum alloy archwire combinations were also presented. CONCLUSIONS: The slot deformation was more than the tie wings deformation as the slot walls bear the immediate torque force. Thus, orthodontic researchers should know that the torque-relevant bracket deformation should ideally be evaluated in the slot region rather than the tie wings.

Inhibitory potential of EGCG on Streptococcus mutans biofilm: A new approach to prevent Cariogenesis.

Dental caries is a common cause for tooth loss and Streptococcus mutans is identified as the etiologic pathogen. This study evaluates the inhibitory potential of Epigallocatechin gallate (EGCG) on S.mutans glucansucrase enzyme and its biofilm. Glucansucrase binding and the inhibitory potential of EGCG was validated using AutoDock tool and enzyme inhibitory assay. Biofilm inhibitory potential was also confirmed using Scanning Electron Microscopic (SEM) analysis in human tooth samples. Molecular docking revealed that EGCG interacted with GLU 515 and TRP 517 amino acids and binds to glucansucrase. SEM analysis revealed inhibition of S.mutans biofilm by various concentrations of EGCG on surfaces of tooth samples. Bioinformatics and biological assays confirmed that EGCG potentially binds to the S. mutans glucansucrase and inhibits its enzymatic activity. Enzymatic inhibition of glucansucrase attenuated biofilm formation potential of S. mutans on tooth surface. Thus, we conclude that EGCG inhibitory potential of S. mutans biofilm on the tooth surface is a novel approach in prevention of dental caries.

Gustatory Dysfunction as an Early Symptom in COVID-19 Screening.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from Wuhan, China in December 2019 leads to the present coronavirus disease 2019 (COVID-19) pandemic. The various symptoms identified for COVID-19 are fever, dry cough, sore throat, dyspnea, fatigue, myalgia, and headache. Olfactory and gustatory dysfunctions are emerging as a new symptom more in the European patients. Taste disturbances are common in various oral and systemic diseases. Varying severity and onset of taste disturbances are reported in COVID-19 positive patients in this pandemic. But a sudden onset of taste disturbances without an established and recognized cause should raise suspicion of COVID-19. This article will analyze the various studies focusing on taste disturbances as a reliable early symptom for COVID-19 screening.

Analysis of Clinical Significance of the Pterygospinous and Pterygoalar Bars.

Presence of ossified structures at the skull base near the sphenoid bone in the infra temporal fossa are clinically significant. We studied the incidence of pterygospinous bar (PSB) and pterygoalar bar (PAB) in 140 dried human skulls. The incidence of pterygospinous bar was 22% and pterygoalar bar was 11%. An unusual large pterygspinous foramen was present in one of the skulls on the left side. Clinical significance of these bars are reviewed.

Saliva as a Potential Diagnostic Specimen for COVID-19 Testing.

The current outbreak of the highly contagious, animal origin SARS-CoV-2 virus causes the disease COVID-19. The disease is globally pandemic and as per World Health Organization (WHO) has spread to 235 countries. There is global lockdown for containment of the virus transmission. Testing of symptomatic patients, healthcare workers and suspected individuals and mass screening is vital. WHO recommends nasopharyngeal (NP) and oropharyngeal (OP) swab for the quantitative assessment of SARS-CoV-2 RNA level through real-time reverse transcription polymerase chain reaction (rRT-PCR). The virus is shown to be consistently present in saliva and rRTPCR of saliva specimens and have advantages over NP and OP swabs such as self-collection of saliva, avoidance of healthcare workers for specimen collection, cost-effectiveness, etc. This article explores the current literature and suggests saliva as an emerging potential diagnostic specimen for COVID-19 testing.

Krishnan's Comprehensive Classification for Distraction Osteogenesis of Maxilla and Mandible.

Distraction osteogenesis technique has gained popularity and has been established as a successful procedure in the management of cranio-maxillofacial deformities for more than 2 decades. Varieties of distractor designs were evolved for the procedures in the maxilla and mandible. Various distraction parameters are clinically important as planned in each case. Inspite of distraction osteogenesis as a well-accepted procedure, currently there is no single classification available for the distraction procedure in maxilla and mandible taking into consideration all the relevant parameters. A simple and user-friendly classification was designed with coding all the relevant parameters. A retrospective data collection from distracted case records were used to validate the classification. A survey from maxillofacial surgeons in a regional meeting was also carried out. The validation and the survey showed that the new classification is comprehensive, simple, easy to use and beneficial for communication, data storage, research, coding, and billing purposes.

Supplemental Internal Wire Suspension in Orthognathic Surgery Fixation.

Internal wire suspensions were previously used in the management of maxillary trauma and orthognathic surgery, but currently the gold standard is rigid internal fixation with bone plates and screws. The authors report a case of bimaxillary osteotomy in a skeletal class III patient where a supplemental circum-zygomatic-mandibular suspension was done to stabilize the maxilla because of the instability after rigid internal fixation due to poor bone thickness.

Biocompatibility Studies of Nanoengineered Polycaprolactone and Nanohydroxyapatite Scaffold for Craniomaxillofacial Bone Regeneration.

Currently there is an increased demand for synthetic bone substitute materials (SBSMs) due to avoidance of donor-site surgery and morbidity. Attempts are done to create SBSM mimicking the bone microarchitecture for enhanced healing. In this study, the authors nanoengineered polycaprolactone (PCL) and nanohydroxyapatite (nHAp) composite scaffold by electrospinning. The nHAp is synthesized via hydrothermal process followed by microwave irradiation. In vitro biocompatibility evaluation with MG63 osteoblastic cell line showed enhanced cell proliferation in the PCL-nHAp scaffold than plain PCL by MTT assay and fluorescence microscopy. Increased osteogenesis in the PCL-nHAp scaffold was shown by the increased calcium load, alkaline phosphatase activity, and expression of osteogenic biomarkers namely osteocalcin, osteonectin, and osteopontin. In vivo studies conducted in rabbit femur bone defects showed increased bone regeneration in PCL-nHAp implanted defects. The results show that PCL-nHAp electrospun scaffold is biomimetic and highly osteogenic and thus a potential SBSM for critical size craniomaxillofacial bone defect applications.

Analysis of Intramaxillary and Mid-Face Skeletal Asymmetry in a Three-Dimensional Model With Complete Unilateral Cleft Lip and Palate.

Cleft lip and palate is the commonest congenital craniofacial anomaly and also affects the facial bones. In a unilateral cleft lip and palate (UCLP), there is asymmetry in the mid-face and also within the maxilla between the cleft and non-cleft sides. The aim of this study is to develop a 3-dimensional model of an UCLP skull from a patient's cone-beam computed tomography and measure the asymmetry. The model is constructed with manual segmentation of all regions using MIMICS v14.0 and measurements were done by 3-matic software. Measurements in the mid-face and maxilla were carried out in all planes of interest. Asymmetry was present not only in the maxilla but extends to the orbital, zygomatic, and frontal bones. Through this methodology and model, asymmetric variations <0.5 mm could be assessed precisely thus having potential applications in treatment planning of craniofacial deformities.

Finite element analysis of slot wall deformation in stainless steel and titanium orthodontic brackets during simulated palatal root torque.

INTRODUCTION: Torque applied on anterior teeth is vital for root positioning and stability. The aim of this study was to evaluate the detailed slot wall deformation in stainless steel (SS) and titanium (Ti) edgewise brackets during palatal root torque using finite element analysis. METHODS: A finite element model was developed from a maxillary central incisor SS bracket (0.022 in). The generated torque values from an SS rectangular archwire (0.019 × 0.025 in) while twisting from 5° to 40° were obtained experimentally by a spine tester, and the calculated torque force was applied in the bracket slot. The deformations of the slot walls in both SS and Ti brackets were measured at various locations. RESULTS: There were gradual increases in the deformations of both bracket slot walls from the bottom to top locations. In the SS bracket slot for the 40° twist, the deformations were 9.28, 36.8, and 44.8 µm in the bottom, middle, and top slot wall locations, respectively. Similarly, in the Ti bracket slot for the 40° twist, the deformations were 39.2, 62.4, and 76.2 µm in the bottom, middle, and top slot wall locations, respectively. The elastic limits were reached at 28° for SS and at 37° for Ti. CONCLUSIONS: Both SS and Ti bracket slots underwent deformation during torque application. There are variations in the deformations at different locations in the slot walls and between the materials.

RadioVisioGraphy: A Simplified Nasal Bone Radiographic Imaging Tool.

Nasal fractures account for approximately 50% of all facial fractures. Although nasal fractures are the most common facial fracture, they often go unnoticed by physicians and patients. A simple radiographic imaging of the isolated nasal bone can be done by RadioVisioGraphy dental imaging system with high resolution and less radiation.

Analysis of Stress Trajectories in Human Adult Cleft Skull.

The craniofacial skeleton is designed to withstand the functional forces during mastication. Distribution of these forces is along the stress trajectories that can vary in a cleft skull compared with a normal skull. In this study, the authors constructed finite element models of cleft and normal skull and subjected them for occlusal loading in the posterior teeth. The results showed variation in the trajectories between the models and between the cleft and noncleft sides within the cleft model.

Closure of large midline diastema by a "HIV-Spring".

Midline diastema is a common orthodontic problem in mixed dentition caused by various factors like genetic, supernumery teeth, abnormal frenum attachment, habits and microdontia etc. Large diastemas need closure for the eruption of adjacent teeth. I present here a newly designed customized self active HIV-Spring (Hari Inverted 'V' Spring) for closing a large diastema with minimum orthodontic materials and less activation visits. The spring can be modfied for the three dimensional movement of central incisors.