Fabrication of Nasoalveolar Molding Devices for the Treatment of Cleft Lip and Palate, Using Stereolithography Additive Manufacturing Processes and Computer-Aided Design Manipulation Software.

INTRODUCTION: Nasoalveolar molding (NAM) is a presurgical orthopedic treatment modality that attempts to reorient misaligned bony and soft tissue structures in patients with clefting of the lip and palate. The NAM devices are implemented prior to surgical intervention in order to minimize the gap across the cleft and thereby reduce tension across the eventual repair. Currently, NAM devices are fabricated in a laboratory and then refined chairside by the provider. The present article describes the potential of three-dimensional (3D) printing and computer-aided design (CAD) software for the fabrication of NAM devices. MATERIAL AND METHODS: A workflow was developed to demonstrate the use of 3D printing and CAD software to design NAM devices. This workflow encompasses scanning an impression into CAD software, performing a series of manipulations, and then printing the digital model. RESULTS: To test the workflow, a cleft palate plaster model was scanned into CAD software. Through a series of linear and angular freeform manipulations of the body, the model was modified to display a cleft with a reduced alveolar gap. Sequential molding devices were produced which would gradually apply pressure to targeted areas of hard and soft tissue until the cleft is minimized. The resulting devices are printed using a stereolithography printer. CONCLUSIONS: The use of 3D printing and CAD software shows promise in improving the accuracy, speed, and cost-effectiveness of designing NAM devices. The accuracy and flexibility from digitally visualizing the manipulations made to an appliance before its creation can result in a more personalized device for the patient.

Pilot Evaluation of Silicone Surrogates for Oral Mucosa Simulation in Craniofacial Surgical Training.

Surgical simulators are crucial in early craniofacial and plastic surgical training, necessitating synthetic materials that accurately replicate tissue properties. Recent critiques of our lab's currently deployed silicone surrogate have highlighted numerous areas for improvement. To further refine our models, our group's objective is to find a composition of materials that is closest in fidelity to native oral mucosa during surgical rehearsal by expert craniofacial surgeons. Fifteen platinum silicone-based surrogate samples were constructed with variable hardness and slacker percentages. These samples underwent evaluation of tactile sensation, hardness, needle puncture, cut resistance, suture retention, defect repair, and tensile elasticity. Expert craniofacial surgeon evaluators provided focused qualitative feedback on selected top-performing samples for further assessment and statistical comparisons. An evaluation revealed surrogate characteristics that were satisfactory and exhibited good performance. Sample 977 exhibited the highest performance, and comparison with the original surrogate (sample 810) demonstrated significant improvements in critical areas, emphasizing the efficacy of the refined composition. The study identified a silicone composition that directly addresses the feedback received by our team's original silicone surrogate. The study underscores the delicate balance between biofidelity and practicality in surgical simulation. The need for ongoing refinement in surrogate materials is evident to optimize training experiences for early surgical learners.

Technological Advancements in External Beam Radiation Therapy (EBRT): An Indispensable Tool for Cancer Treatment.

Recent technological advancements have increased the efficacy of radiotherapy, leading to effective management of cancer patients with enhanced patient survival and improved quality of life. Several important developments like multileaf collimator, integration of imaging techniques like positron emission tomography (PET) and computed tomography (CT), involvement of advanced dose calculation algorithms, and delivery techniques have increased tumor dose distribution and decreased normal tissue toxicity. Three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), stereotactic radiotherapy, image-guided radiotherapy (IGT), and particle therapy have facilitated the planning procedures, accurate tumor delineation, and dose estimation for effective personalized treatment. In this review, we present the technological advancements in various types of EBRT methods and discuss their clinical utility and associated limitations. We also reveal novel approaches of using biocompatible yttrium oxide scintillator-photosensitizer complex (YSM) that can generate X-ray induced cytotoxic reactive oxygen species, facilitating X-ray activated photodynamic therapy (XPDT (external beam) and/or iXPDT (internal X-ray source)) and azido-derivatives of 2-deoxy-D-glucose (2-DG) as agents for site-specific radiation-induced DNA damage.

A national pediatric otolaryngology fellowship virtual dissection course using 3D printed simulators.

OBJECTIVE: Our objective was to create and evaluate a novel virtual platform dissection course to complement pediatric otolaryngology fellowship training in the setting of the COVID-19 pandemic. METHODS: A four-station, four-simulator virtual course was delivered to pediatric otolaryngology fellows virtually using teleconferencing software. The four stations consisted of microtia ear carving, airway graft carving, cleft lip repair, and cleft palate repair. Fellows were asked to complete pre- and post-course surveys to evaluate their procedural confidence, expertise, and attitudes towards the course structure. RESULTS: Statistical analysis of pre-course survey data showed fellows agreed that simulators should play an important part in surgical training (4.59 (0.62)); would like more options for training with simulators (4.31 (0.88)); and would like the option of saving their simulators for later reference (4.41 (0.85)). Fellows found the surgical simulators used in the course to be valuable as potential training tools (3.96 (0.96)), as competency or evaluation tools (3.91 (0.98)), and as rehearsal tools (4.06 (0.93)). Analysis showed a statistically significant improvement in overall surgical confidence in performing all four procedures. CONCLUSION: This virtual surgical dissection course demonstrates 3D printed surgical simulators can be utilized to teach fellows advanced surgical techniques in a low-risk, virtual environment. Virtual platforms are a viable, highly-rated option for surgical training in the setting of restricted in-person meetings and as a mechanism to increase access for fellows by reducing costs and travel requirements during unrestricted periods.

The barriers for tobacco cessation counseling in teaching health care institutions: A qualitative data analysis using MAXQDA software.

INTRODUCTION: Recently, Dental Council of India directed all the teaching dental institutions in the country to set up tobacco cessation centers (TCC). International experiences suggest that there are many barriers for the provision of tobacco cessation counseling at dental clinics. In this context, it is important to understand the dental students' attitudes toward this initiative of tobacco cessation counseling at dental settings. MATERIALS AND METHODS: This qualitative study to document the dental students' perspectives toward the provision of tobacco cessation counseling using focus group interviews was conducted in two teaching dental institutions in the state of Andhra Pradesh, India. 133 house surgeons from two dental institutions participated in the study and were interviewed as 13 focus groups. MAXQDA (version 12, VERBI GmbH, Berlin, Germany) was used for data analysis. All the interviews were audio recorded and the transcripts were open coded by three independent investigators. RESULTS: The response rate in this study was 78.45%. The following themes were extracted from the views and opinions shared by the students: the reluctance of patients to discuss tobacco-related problems; tobacco use among students discouraging them to actively participate in counseling; an opinion that dental clinics are not suitable for the provision of tobacco cessation counseling; belief among students that they are not qualified enough. CONCLUSION: The directives given by the Ministry of Health and Family Welfare in association with Dental council of India to set up TCC at every teaching dental institution are laudable and demonstrate the commitment at policy level toward bringing down tobacco consumption in the country. However, few reforms need to be made in the curriculum to better execute the delegated responsibilities, which include orientation programs for dental students on the scope of the dental profession and workshops on tobacco cessation counseling.

Evaluation of occlusal fracture resistance of three different core materials using the Nayyar core technique.

AIM: The aim and purpose of this study was to determine the occlusal fracture resistance of three core buildup materials using the Nayyar technique. MATERIALS AND METHODS: Thirty human extracted maxillary premolars were used for the study. The test samples were decoronated till the cementoenamel junction (CEJ) and proper cleaning and shaping was done with protaper niti files till the F3. Corresponding f3 protaper(Dentysply)gutta pecha cones were selected and obturated. The gutta-percha was removed till the depth of 4 mm from the coronal orifice with Gates Glidden (GG) drills for all the samples; then the samples were randomly divided into three different groups. Group I was restored with universal composite Z350XT, group II was restored with light curable glass ionomer cement (GIC), and group III was restored with miracle mix. The coronal buildup was done using compound supported matrix. The fracture resistance strength of all the specimen groups was tested under a universal testing machine. RESULTS: The data of the study were statistically analyzed by one-way analysis of variance (ANOVA) and Bonferroni's comparison test. Results of the study showed that group I that was restored with the universal composite Z350XT showed much higher fracture resistance strength compared to the other two groups. Statistically significant difference was noted between group I and group II and also between group I and group III. CONCLUSION: It can be concluded that the core buildup done with composite offered better occlusal fracture resistance strength compared to light curable GIC and miracle mix.

Dental Service Utilization: Patterns and Barriers among Rural Elderly in Guntur District, Andhra Pradesh.

INTRODUCTION: The biological process of ageing is outside human control and has its own dynamics. It is a known fact that elderly people have more treatment needs compared to the younger population and at the same time elderly people are facing a multitude of barriers in utilization of health care as well as oral health care. AIM: To identify the utilization patterns of oral health care and barriers for utilization among rural population. MATERIALS AND METHODS: A cross-sectional study was done on 621 rural elderly subjects to identify the utilization of oral health care services and the barriers for utilization. Using stratified cluster sampling study area was stratified into 13 rural clusters, fifty houses were randomly selected from each stratum. All the elderly subjects, as defined by the age criteria were considered for study. The data were analysed using SPSS 20 v and Chi-square tests were used to analyse the data. RESULTS: Only 31.9% of participants reported visiting a dentist in the past while 36.7% reported experiencing a dental problem at some point in their life. There were no significant differences in utilization of dental services based on gender, socio-economic status, age groups and religion. However, significant differences were found in utilization of dental services based on the response of participants to past experience of dental problems. CONCLUSION: The present study results conclude that fear was one of the most commonly reported barriers for utilisation of dental services and there is a need for oral health education and promotion among elderly population.