Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis.

Anterior maxillary distraction osteogenesis (AMDO) is often used for the correction of maxillary retrognathia in select cleft lip and palate cases. The restoration of alveolar arch continuity is desirable before the initiation of AMDO in these cleft maxillary deformities; however, AMDO is technically difficult in a patient with coexisting alveolar cleft where there is a discontinuity of the defect that presents a challenge in terms of adequate vector control of the movement of the anterior segment and the potential risk of tipping of teeth, which already have compromised anchorage/bone support on the cleft side. The treatment becomes more challenging when ongoing management is compounded by failed previous alveolar cleft grafting procedures, along with the patient's reluctance to undergo further grafting of alveolar clefts. This technical note demonstrates a novel application of the modification of the Hyrax screw where an initially fully opened Hyrax screw was utilised as an interim assembly for accomplishing the single-step closure of a small alveolar cleft before the commencement of anterior maxillary distraction osteogenesis. This technique may prove to be feasible for patients presenting with alveolar cleft defects of smaller widths of up to 5 mm and relatively well-aligned upper arches.

A Study on the Attitude and Perception of Bachelor of Medicine and Bachelor of Surgery (MBBS) Students Regarding Post-MBBS Compulsory Service Bond in Uttar Pradesh, India.

Background To increase the availability of doctors in the public healthcare delivery system, the state government of Uttar Pradesh, India, has implemented a two-year compulsory service bond since 2018. Students of the 2018 batch are going to complete their Bachelor of Medicine, Bachelor of Surgery (MBBS) in 2023 and are supposed to serve through this bond. There are many dilemmas in the minds of medical students regarding their compulsory service bond. Hence, there is a need to know their attitude and perceptions regarding the compulsory service bond. This study was conducted to assess the attitude and perception of undergraduate medical students toward compulsory service bonds. Methods This was a mixed-method study conducted in July-September 2022 among undergraduate medical students at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India. For quantitative data, a structured questionnaire was developed using Google Forms (Google LLC, Mountain View, California, United States) and circulated via WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States) through the random sampling method. Focused group discussions were carried out to collect the qualitative data. Result Regarding the compulsory service bond after MBBS, 100 (31.8%) medical students were found to be interested and 56 (17.8%) were disinterested. The majority (n=158; 50.4%) of participants were neutral, while 278 (88.6%) medical students perceived it as an opportunity to help poor people. Higher possibilities of social recognition and respect were some noticeable perceptions of 243 (77.4%) MBBS students. Lack of confidence to tackle serious cases without a senior doctor's supervision was perceived as an important hurdle by 286 (91%) participants. Non-availability of advanced medical facilities, issues like the safety of doctors, and the lack of availability of electricity, roads, and infrastructure were also perceived as hurdles. Conclusions and recommendations Students perceived the compulsory service bond as an opportunity if met with certain conditions like a transparent method of posting and basic facilities or an incentive for accommodation and transportation. The compulsory service bond for addressing the shortfall of doctors in the public healthcare delivery system may be more effective if these hurdles are corrected and certain opportunities are met, as mentioned in the present study. This will help the government move smoothly towards achieving Universal Health Coverage (UHC).

Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up.

Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.

A Comparative Study of Morphometric Analysis of Nucleolar Organizer Regions in Oral Leukoplakia and Oral Squamous Cell Carcinoma and Significance of AgNOR as a Diagnostic Tool.

Background Silver stainable nucleolar organizer regions (AgNORs) have proven to exhibit utmost importance due to their higher occurrence in the nucleus especially in malignant cells than in normal. Thus, they assist in the examination of nucleolar structures and variations in nucleolar activity. Aim Quantitative and qualitative analysis in relation to the number and area of AgNOR in tissue sections of the normal oral mucosa (NOM), oral leukoplakia (OL), and oral squamous cell carcinoma (OSCC) was the main aim of the study. Materials & method A total of 50 cases comprising 20 OL with dysplasia, 20 OSCC cases, and 10 samples of normal oral mucosa were taken. Silver nitrate (Sol A) & gelatin (Sol B) solutions were freshly prepared for staining the lesional slides. Results The mean value of nuclear profile area (A Nuc) was comparatively higher in oral leukoplakia i.e. 41.97 and in oral squamous cell carcinoma i.e. 62.36 in comparison to the control group where it was 36.19. The mean value of a single AgNOR profile area per nucleus (A NOR) was found to be comparatively lower in both study groups i.e. oral leukoplakia (2.76) and oral squamous cell carcinoma (1.61) in comparison to the control group (3.45) . The mean value of total AgNOR profile area per nucleus (TA NOR) and the number of profiles of AgNORs per nucleus (n NOR) were found higher in both study groups (oral leukoplakia and oral squamous cell carcinoma) as compared to normal oral mucosa of the control group. However, the findings of all four parameters of morphometric analysis were found to be significantly associated with disorder of oral mucosa i.e. cases of oral leukoplakia and oral squamous cell carcinoma (P value <0.01). Conclusion It can thus be suggested that the mean AgNOR count displayed a higher value in OSCC. Hence, the number of AgNORs in nuclei increases as epithelial cells undergo malignant transformation which is designated that mean AgNOR count may contribute to establishing the prognosis of a lesion.

Sailing through the COVID-19 Pandemic and Beyond: An Evidence-Based Analysis for Dental Healthcare and Practice.

This integrative review aims to provide a consolidated evidence-based appraisal of the most up-to-date guidelines and recommendations of international public and professional health regulatory bodies in relation to preparedness framework for restructuring safe delivery of dental services amid and beyond the coronavirus disease-2019 (COVID-19) pandemic. Most recent updated guidelines for dental professionals from major international health regulatory bodies were reviewed. PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, WHO COVID-19 and LILACS databases, along with relevant preprints were searched, and citations were checked up to January 23, 2021. The search was performed by one author. Shortlisted articles were read and brought to consensus to be included in the study by at least two co-authors. In case of any disagreement between the judgements, an independent co-author's decision was taken as final. Of 849 records searched, 61 articles were included in the study. Following content analysis of the global guidelines and the collected prevailing evidence, the common themes and recommendations of different guidance documents were collated and summarized into seven domains. Most guidelines have a consensus regarding implementation of rigorous administrative, engineering and environmental infection control strategies. However, variations do exist with regard to the use of respirators in non-aerosol-generating procedure (non-AGP) settings, employment of airborne precautions during non-AGPs, use of supplemental air-handling systems, and preoperative use of mouthwashes. This evidence-based analysis can serve as a useful reopening resource tool and facilitate effective restructuring for delivery of optimal, equitable and safe dental practices globally, during and while emerging from the pandemic.

Comprehensive management of Crouzon syndrome: A case report with three-year follow-up.

Crouzon syndrome is one of the most common craniosynostosis facial syndromes caused by a mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Less commonly, there is a mutation of the FGFR3 gene which results in Crouzon syndrome syndrome with acanthosis nigricans. It involves the premature fusion of sutures of the cranial vault, base, orbital and maxillary region. The clinical presentation of this congenital deformity depends on the pattern and timing of sutural fusion. The present report describes the features and management of this syndrome in an 18-year-old woman. The patient presented with a hypoplastic maxilla, deficient midface, exorbitism due to shallow orbits, severe crowding and bilateral crossbite. A multidisciplinary approach involving orthodontics and surgical intervention with distraction osteogenesis brought about marked improvement in the facial profile, occlusion and upper airway. The aesthetics and function were greatly enhanced, and the results were found to be stable at the end of three years.

Minimally invasive intraarticular platelet rich plasma injection for refractory temporomandibular joint dysfunction syndrome in comparison to arthrocentesis.

CONTEXT: Internal derangements of temporomandibular joint (TMJ) with associated symptoms which do not respond to conservative therapies are refractory cases of temporomandibular joint dysfunction syndrome (TMD). Minimally invasive techniques like arthrocentesis and platelet rich plasma (PRP) injections are usually employed to improve TMJ symptoms and function in these cases. AIMS: To compare PRP with arthrocentesis for evaluating the effectiveness of PRP in relieving symptoms of refractory TMJ pain dysfunction syndrome. SETTING AND DESIGN: A clinical study was carried out on 52 patients of refractory Temporomandibular joint dysfunction syndrome. The patients were divided in two groups that is Group A - test group and Group B -control Group. METHODS AND MATERIAL: Group A consisted of 26 patients who underwent intraarticular PRP injection in TMJ and Arthrocentesis of TMJ was done in 26 patients of Group B. TMJ pain, Maximium Interincisal opening and TMJ clicking were assessed among the group as well as between the groups over a period of 6 months. STATISTICAL ANALYSIS USED: Repeated Measure ANOVA was used to compare the parameters within the groups and T test was used for group comparison at 0.05 level of significance. RESULT: There was statistically significant difference in pain intensity improvement 1 ± 0.75 versus 3.17 ± 2.13, maximum interincisal opening 39.86 ± 2.86 versus 37.59 ± 4.03 and clicking 6 versus 16 between the PRP group and arthrocentesis group at P < 0.05. CONCLUSIONS: Intraarticular PRP injection for the management of refractory TMD is more effective than arthrocentesis in reducing symptoms and functional improvement.

Awareness and preparedness of dentists at handling medical emergencies in Delhi-National Capital Region - A cross-sectional survey.

CONTEXT: A medical emergency (ME) may come as a surprise during our busy appointment schedules. Whether or not the office has prepared for this emergency generally decides how it will turn out. AIM: This cross-sectional survey aimed to evaluate the awareness and preparedness of dentists at handling MEs in a dental office. SETTINGS AND DESIGN: The study was conducted over three months (December 2015 - February 2016) at two dental colleges of Delhi-National Capital Region (NCR). Materials and. METHODS: The total number of participants was 384, which were divided into four groups of ninety-six participants each, i.e., Group 1 (Interns); Group 2 (Academicians); Group 3 (Postgraduate students (PG)) and Group 4 (Private practitioners (PP)). STATISTICAL ANALYSIS: The collected data was analysed on the Statistical Package for Social Sciences (SPSS) version 20 and subjected to ANOVA and Posthoc Bonferroni tests. RESULTS: Academicians were found to have the maximum awareness about MEs occurring in the dental office, while, interns had the minimum preparedness for the same and their difference with the other groups was statistically significant (P < 0.05). CONCLUSION: A huge gap exists between the awareness and preparedness of dentists at managing MEs. Sound knowledge of essential drugs reinforced by regular practical training, mock drills and properly equipped dental offices is the need of the hour.

Different approaches for management of Class III siblings: A long-term follow-up of two case reports.

Class III malocclusion can be varied in presentation and progression. This report describes the presentation, course of treatment and long-term follow-up of two siblings with Class III malocclusion. Two cases discussed in this report were different in their presentation. Sibling 1, a 19-year-old male patient had developed skeletal Class III malocclusion with severe maxillomandibular discrepancy, showing both components of maxillary hypoplasia and mandibular prognathism & asymmetry with average growth pattern. Sibling 2, a 13-year-old male patient had developed a Class III malocclusion with maxillary retrognathism with vertical growth pattern. An insight into the similarities and dissimilarities in the presentation, course of treatment and long-term follow-up of the two cases is provided. The two cases were successfully managed with entirely different treatment approaches. Sibling 1 underwent maxillary advancement with Le Fort I surgery and mandibular set back and rotation with bilateral sagittal split osteotomy which was preceded by pre-surgical orthodontic treatment with extraction of upper first premolars for orthodontic decompensation. Sibling 2 was treated with skeletally anchored facemask therapy followed by fixed mechanotherapy. Acceptable clinical outcome with long-term stability of the treatment results was observed in the two siblings. Orthognathic surgery may be completely avoided later if early orthopaedic treatment to advance the maxilla is initiated at an appropriate age.

Individualized Surgical Orthodontic Rehabilitation of Class III Dentofacial Deformities.

INTRODUCTION: Treatment of Class III dentofacial deformities present a complex clinical challenge. MATERIALS AND METHODS: This article demonstrates the successful surgical-orthodontic rehabilitation of two patients with skeletal Class III deformities. Meticulously planned and well-executed conventional combination of presurgical orthodontics, orthognathic surgery and postsurgical orthodontic therapy helped optimally achieve an aesthetic facial profile, pleasing smile and well-interdigitated occlusion. RESULTS: The results showed excellent stability at 3-year follow-up in both cases. DISCUSSION: Various clinical criteria and protocol crucial for realization of stable aesthetic, structural and functional outcomes are also discussed.

Technique of Dual Distraction for Correction of Unilateral Temporomandibular Joint Ankylosis With Facial Asymmetry: A Case Series.

PURPOSE: Temporomandibular joint (TMJ) ankylosis, not only results in joint hypomobility, but also causes considerable facial deformity. Its unilateral variant can cause facial asymmetry, leading to major psychosocial effects on the individual. PATIENTS AND METHODS: We present the cases of 7 patients with unilateral TMJ ankylosis and facial asymmetry of various grades who have been treated using gap arthroplasty and simultaneous dual distraction. Considerable debate has surrounded the sequencing of TMJ release and distraction osteogenesis; however, the simultaneous approach has recently become popular. The use of a single distractor simultaneously with TMJ release has been widely reported. However, one disadvantage with this technique is that the proximal condylar segment remains unstable. Dual distraction is a newer technique which we have proposed as a single-stage approach for the correction of TMJ ankylosis and facial asymmetry and to address the problems resulting from the use of a single distractor. RESULTS: After treatment, all the patients showed a mouth opening ranging from 35 to 50 mm and satisfactory facial symmetry. CONCLUSIONS: Dual distraction is a promising technique in the correction of facial asymmetry. However, further studies with adequate statistical analysis and larger sample size are required.

Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study.

AIM/OBJECTIVE: The mandibular third molar is the most frequently impacted tooth with incidence varies from 9.5% to 68% in different populations. Hence, the aim was to study the prevalence and pattern of mandibular impacted third molar among Delhi-National Capital Region (NCR) population. MATERIALS AND METHODS: The study was conducted with data collected from registered hospitals and dental clinics of Delhi NCR region. The study represents a retrospective analysis of panoramic radiographs and intraoral periapical radiograph of patients at these centers from June 2014 to June 2016. RESULTS: Out of 960 patients with the third molar investigated, a total of 250 patients having impacted mandibular third molar (152 [60.8%] males and 98 [39.2%]) females between June 2014 and June 2016 were included in the study. The age ranged from 20 to 55 years, with a mean age of 27.6 years and the standard deviation was 5.8 years. The prevalence of impacted mandibular third molars for this study was 26.04%. CONCLUSION: This study demonstrated that males (60.8%) were more likely to present with impacted mandibular third molars than females (39.2%). The prevalence of third molar impactions was almost the same on both the left (45.8%) and right (54.2%) sides. This study also noted that mesioangular impactions (49.2%) were the most common type of impaction. The least common form of impactions was the transverse types (2%). The prevalence of impacted mandibular third molars for this study was 26.04%.

Staged therapeutic approach for rehabilitation of severe asymmetric Class II dentofacial deformity secondary to long standing unilateral temporomandibular joint ankylosis.

Despite being one of the most pervasive debilitating skeletal problems in the craniofacial region, surgical-orthodontic management of long-standing asymmetric Class II dentofacial deformities is often a unique challenge posed to the clinicians. This case report describes the encouraging results of systematically sequenced and staged therapeutic approach adopted for successful rehabilitation of an adult patient with asymmetric Class II dentofacial deformity with mandibular micrognathia secondary to unilateral TMJ ankylosis. Concurrent gap arthroplasty and bilateral distraction of mandibular body were performed during the first operation for functional restoration of mandibular movements and correction of mandibular micrognathia and associated asymmetry. After 13 months of post-distraction orthodontic treatment, Le Fort I osteotomy for inferior repositioning and sagittal advancement of maxilla was performed during the second operation, in conjunction with adjunctive alloplastic reconstruction of inferior border of mandible for optimization of facial aesthetics. Postsurgical orthodontic detailing facilitated achievement of stable, balanced interdigitation. The total active treatment period was 29 months. After treatment, both the skeletal disharmony and the functional stability were significantly improved with establishment of functional occlusion. The morphological and functionally acceptable results were reasonably well-maintained during three-year follow-up. The merits of mandibular osteodistraction vs. conventional mandibular orthognathic surgery and the potential advantages of staged surgical approach are discussed.

Comparison of Pain Perception Using Conventional Versus Computer-Controlled Intraligamentary Local Anesthetic Injection for Extraction of Primary Molars.

This study was conducted to compare pain perception of intraligamentary anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLADS) versus a conventional intraligamentary injection for extraction of primary molars. A randomized controlled trial was designed where 82 children requiring 102 primary molar extractions were given ILA of 2% lidocaine with 1:80,000 epinephrine with either the conventional method or a CCLADS. Pain during injection and extraction was assessed using the Sound, Eye, Motor (SEM) scale and heart rate recording. Faces Pain Scale-Revised (FPS) scores were self-reported by patients. The Mann-Whitney test was used for evaluation of FPS and SEM scores and Student's t test for evaluation of heart rate readings. Heart rate values during injection were found to be higher, but not statistically significantly higher (p = .077), for conventional injection versus CCLADS; however, heart rate values during extraction were significantly higher for the conventional method (p = .009). Both FPS and SEM values were found to be significantly higher for conventional ILA technique (p < .05). ILA can be an effective alternative means of anesthesia for primary molar extractions, and CCLADS devices can make ILA more effective and less painful.

Mucormycotic osteomyelitis of maxilla following maxillofacial trauma: The disease of the diseased.

Mucormycosis is a rare opportunistic fungal infection with acute, aggressive, and invasive nature, seen in immunocompromised/debilitated patients, especially with diabetes mellitus. The key to successful therapy is the early diagnosis of signs and symptoms of the disease, correction of the underlying medical disorder(s), and aggressive medical and surgical intervention. The case presented here is mucormycotic osteomyelitis of the nasomaxillary-zygomatic complex following trauma in a middle-aged man. Preoperative amphotericin B therapy along with surgical resection of necrotic tissue was done followed by prosthetic rehabilitation with an obturator. There was no sign of recurrence of the diseases for the follow-up period of 1 year.

Facial asymmetry revisited: Part I- diagnosis and treatment planning.

Facial asymmetry is an individualized characteristic and is commonly observed sub clinically in overall population. However, clinically significant facial asymmetry with associated morphologic, esthetic and stomatognathic problems warrant investigation of the underlying etiology and comprehensive clinical examination in conjunction with imaging studies for diagnosis, localization of asymmetry and treatment planning. The principal aim of this article is to present an invaluable insight into etiopathogenesis, myriad classifications and various systematic diagnostic approaches indispensable for formulation of treatment plan and appropriate management of facial asymmetry.