Fractal analysis of mandibular trabecular pattern following protraction facemask therapy : A pilot study.

OBJECTIVE: To assess the remodeling effects of protraction facemask therapy on the trabecular pattern of the mandible and identify quantitatively the regions of the mandible undergoing maximum changes in the trabecular pattern. MATERIALS AND METHODS: The retrospective study was conducted in 30 subjects divided into two groups. The treatment group (group 1) consisted of 15 subjects with skeletal class III malocclusion treated with a facemask (mean age: 9.1 ± 2.1 years). Digital panoramic radiographs (OPG) were obtained before treatment (T0) and at the end of active facemask therapy (T1) with a mean duration of 16.1 ± 2.5 months. In all, 15 skeletal class I subjects who did not undergo any orthodontic treatment (mean age 9.1 ± 2.2 years) comprised the control group (group 2) who had two OPGs at a mean interval of 13.6 ± 2.2 months. The fractal dimensional (FD) value was calculated in three regions: angular, condylar, and corpus region. RESULTS: Intragroup comparisons revealed a significant increase in the FD values in the right condylar (T0 = 1.2 ± 0.2; T1 = 1.4 ± 0.1) and left condylar (T0 = 1.2 ± 0.1; T1 = 1.4 ± 0.1) region (p < 0.05) and in the corpus region (FD values: right T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; left T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; p < 0.05). The intergroup comparison demonstrated that the treatment group showed greater changes compared with the controls in the condylar process (mean difference: right = 0.19, left = 0.20; p < 0.05) and the corpus region (0.172; p < 0.05). CONCLUSION: FD analysis demonstrated that the condylar process and the corpus region underwent the most significant change in the trabecular pattern in subjects treated with protraction facemask therapy.

Ethical principles in dental healthcare: Relevance in the current technological era of artificial intelligence.

In the current technological era, dental practitioners are faced with various ethical challenges, highlighting the importance of bioethics in this healthcare discipline. The rise of artificial intelligence has recently sparked a debate regarding the privacy of patient data. While the advancements may offer innovative treatment options, their long-term effects may not be fully understood, raising questions about the responsible implementation of such methods. Thus, conscientious and ethical AI use in dentistry encompasses that patients be notified about how their data is used and also about the involvement of AI-based decision-making. This paper explores the key bioethical considerations in dental healthcare, with a focus on evidence-based AI development and use. The framework of ethical principles and guidelines provided would foster trust between the clinician and patients, while promoting the highest standards of care.

Stress distribution and displacement with four different types of MARPE on craniofacial complex: A three-dimensional finite element analysis.

BACKGROUND: Various designs of mini-implants assisted rapid palatal expander (MARPE) appliances can impact treatment effectiveness through their biomechanical effects. The purpose of the study was to study the stress distribution and displacement with four different designs of the MARPE appliance on the craniofacial complex. METHODS: A 3D finite element model of the craniofacial complex was created from CBCT DICOM data, comprising four distinct groups. Each group consisted of one 4-hole expansion screw positioned between the second premolar and first molar in all models. Group 1 used four single-cortical mini-implants (1.5×8mm) engaging only the palatal cortex. Group 2 employed four mini-implants (1.5×11mm) engaging both the palatal and nasal cortices. Group 3 had monocortical implants on the palatal slopes, while Group 4 was similar to group 3 with implants in the acrylic wings. Comparisons between groups were made for anchorage (groups 1 and 2), mini-implant position (groups 1 and 3) and surface effect (groups 3 and 4). Von Mises stresses and displacements at various skeletal and dental points were evaluated using ANSYS software. RESULTS: The highest stresses were observed in the maxillary, pterygoid and zygomatic bones, as well as in the mid- palatal suture in all four groups. Downward and forward rotation of the craniofacial complex was noted. Group 2 showed greater skeletal expansion than group 1. Among groups 1 and 3, group 3 showed a better stress distribution. Group 4 showed less dentoalveolar rotation than group 3. CONCLUSIONS: The MARPE appliances had an impact on the craniofacial complex with stresses on the mid-palatal suture, maxillary bone, pterygoid bones and anterior teeth. Clockwise rotation of the maxilla, zygomatic bones and dentition was noted, while the pterygoid bones and pterygoid suture were displaced backwards. MARPE with bicortical anchorage produces better skeletal expansion. Placing implants on the palatal slopes with acrylic wings results in better skeletal expansion with less clockwise rotation of the dentition.

Association, diagnostic accuracy and optimal threshold of salivary IGF-1 and vitamin DBP levels for estimation of pubertal growth spurt: A cross sectional study.

AIM: To determine the association of salivary IGF-1 and vitamin D Binding Protein with cervical vertebral maturation index (CVMI) across the pubertal stages and to determine the diagnostic accuracy and optimal threshold of these biomarkers for estimation of pubertal growth. DESIGN: Cross-sectional observational study. SETTING: Material and methods. All patients in the age group of 8-23 years from the Outpatient Department of Orthodontics and Dentofacial orthopaedics, between the period of July 2020 to December 2020 meeting the eligibility criteria were included. Lateral cephalograms obtained from the patients were divided into pre pubertal, pubertal & post pubertal groups based on CVMI by Baccetti et al. Unstimulated whole saliva was collected by a swab-based method & analyzed with ELISA. RESULTS: Ninety-four participants were divided in three stages: prebubertal (30), pubertal (33), post pubertal (31). A significant difference was observed in the salivary IGF-1 & DBP across the three stages. Post-hoc test revealed significantly higher mean salivary IGF-1 & DBP in pubertal group than in pre & post-pubertal group. Receiver operator characteristic curve revealed excellent diagnostic accuracy for salivary IGF-1with areas under the curve (AUC) of 0.962, satisfactory for vitamin DBP with AUC of 0.831 and poor diagnostic accuracy for age with AUC of 0.536. Youden index revealed the optimal threshold to be 3.96ng/ml and 124.13pg/ml for salivary IGF-1 and vitamin DBP respectively. CONCLUSION: The levels of Salivary IGF-1 and Vitamin DBP increased during C3 and C4 stages. Compared to vitamin DBP diagnostic accuracy of salivary IGF-1 was excellent and an optimal threshold of 3.96ng/ml can be utilized to distinguish pubertal & non-pubertal participants.

Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis.

INTRODUCTION: The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. OBJECTIVE: This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. METHODS: A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. RESULTS: The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. CONCLUSIONS: The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.

Serum biomarkers associated with radiographic skeletal maturity indicators: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the relevant scientific literature to determine the association between different serum biomarker levels and radiographic skeletal maturity indicators. DATA SEARCH, SCREENING AND ELIGIBILITY: A literature search was carried out on PubMed, Cochrane Library, Google Scholar, Semantic Scholar, Science Direct and Opengrey.eu up to November 2021 and 7466 records were retrieved via the electronic search. Study selection, data extraction and subsequent risk of bias assessment (RoB) was carried out independently by two authors. In case of any discrepancy, a third author was consulted. RESULTS: After the exclusion of duplicates and the application of inclusion exclusion criteria, 19 studies (published in 25 articles) were included in the systematic review out of which 17 had a cross-sectional and two had a cohort study design. For the meta-analysis, based on the homogeneity, five cross-sectional studies measuring serum IGF-1 levels were incorporated. The meta-analysis revealed that the serum IGF-1 levels peak at the CS4 stage (401.77 ng/mL [333.50 - 470.05]) in the pooled group. However, in the subgroup analysis, it was found that the serum IGF-1 levels peak at CS3 in girls (422.82 ng/mL [377.46-468.18]) and CS4 in boys (487.04 ng/mL [391.83-582.25]). CONCLUSION: Among the various biomarkers evaluated, serum IGF-1 was the most associated with different stages of radiographic skeletal maturity indicators with its levels peaking at CS3 in girls and CS4 in boys.

Psychosocial Maternal Perception of the Outcome of Pre Surgical Infant Orthopedics in Infants Born with Cleft Lip and Palate.

BACKGROUND: The setback of having a child with cleft lip and palate deeply affects the parents psychology. The Pre Surgical Infant Orthopaedics(PSIO) is a promising procedure for improvement in facial morphology prior to primary lip repair. OBJECTIVE: The current study examines the perception of effects of PSIO procedures on the facial appearance of newborns with cleft lip/palate by their mothers and finds its correlation if any, with the change in psychosocial status of the mothers. STUDY DESIGN: The mothers of 50 infants(0-6 months) born with cleft lip/palate rated the nasal morphology, extent of cleft defect and overall facial morphology on a Likert's scale before and after PSIO procedure. This was correlated with changes in mother's depression, anxiety and stress levels by using the validated Hindi-version of Depression Anxiety and Stress scale(DASS-42) index before and after PSIO. RESULTS: The mothers reported a significant improvement in all the morphological parameters for their infants with PSIO which correlated well with significant reduction in the DASS scores from 22.54(severe) to 7.10(normal) for depression, 20.64(extremely severe) to 6.46(normal) for anxiety and 24.7(severe) to 8.4(normal) for stress. CONCLUSIONS: The changes in facial morphology by PSIO procedures are well perceived by mothers and significantly improves their depression, anxiety and stress levels.

Impact of photobiomodulation on external root resorption during orthodontic tooth movement in humans - A systematic review and meta-analysis.

Background: Photobiomodulation has been gaining traction as a plausible therapy to control orthodontically induced root resorption. Aim: The aim of the present review was to systematically appraise randomized controlled trials conducted to study the influence of photobiomodulation on external root resorption during orthodontic movement in humans. Method: ology - A systematic search was carried out employing keywords in various electronic databases namely MEDLINE (Pubmed), Cochrane Library, Google Scholar, Semantic Scholar, ScienceDirect and Opengrey.eu for studies up to March 2020. Pre-defined inclusion and exclusion criteria were used to select the studies. Data extraction was carried out and the risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analysis was conducted using random effects model for selected studies. Subgroup analysis was conducted for resorption on each axial surface of the tooth root viz. mesial, buccal, distal and palatal as well as for vertical thirds viz. cervical, middle and apical third. Summary of Findings was formulated according to GRADE Profile. Results: The search retrieved 1509 results out of which six studies were included for the systematic review. Two studies showed low overall risk of bias and the remaining four showed unclear risk of bias. The meta-analysis was conducted for three studies with an overall sample size of 120 teeth which showed a pooled mean difference of 0.08 (95% CI 0.15 - (-0.02) to 1.96, p=<0.0001) in favour of photobiomodulation group with respect to mean total resorption per tooth. I2 index revealed 88% heterogeneity. Conclusion: It is concluded that there is moderate grade of evidence to suggest beneficial effect of photobiomodulation on root resorption. Further high-quality randomized controlled trials with standardized intervention parameters are recommended. Registration: PROSPERO registration number - CRD42020167291.

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.

Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis

ABSTRACT Introduction: The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. Objective: This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. Methods: A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. Results: The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. Conclusions: The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.

RESUMO Introdução: A protração maxilar com ancoragem esquelética intrabucal (I-SAMP) tem sido considerada um tratamento efetivo para a má oclusão esquelética de Classe III. Objetivo: O presente estudo in silico avaliou, usando análise de elementos finitos, a influência de diferentes direções da força dos elásticos Classe III com ancoragem esquelética intrabucal nas mudanças no complexo craniomaxilofacial. Métodos: Um modelo de elementos finitos tridimensional (3D) dos ossos craniomaxilofaciais, incluindo as suturas circum-maxilares, foi construído, com alta semelhança biológica. Uma montagem 3D de quatro miniplacas foi projetada e fixada na maxila e na mandíbula do modelo de elementos finitos. O modelo foi aplicado com o uso de 250g/força nas miniplacas em três angulações (10°, 20° e 30°) em relação ao plano oclusal, para medir as tensões e os deslocamentos, usando o programa ANSYS. Resultados: As suturas zigomaticotemporal, zigomaticomaxilar e esfenozigomática desempenharam um papel significativo no deslocamento para anterior e na rotação anti-horária da maxila e do zigoma, independentemente da angulação na aplicação da força. Os deslocamentos e as rotações do complexo zigomático-maxilar diminuíram gradualmente com o aumento de 10° para 30° no ângulo de aplicação da força entre as miniplacas. A mandíbula apresentou deslocamento irrelevante, com rotação no sentido horário. Conclusões: Os efeitos do tratamento com I-SAMP foram corroborados, com um vislumbre dos padrões de deslocamento e das suturas envolvidas, que não existiam nos estudos com imagens 2D e 3D realizados anteriormente. A angulação dos elásticos Classe III ancorados esqueleticamente deve ser a menor possível, visto que o deslocamento do complexo zigomático-maxilar aumenta com a redução no ângulo dos elásticos.

Biomechanical effects of Skeletally anchored Class III elastics on the maxillofacial complex: a 3D finite element analysis.

BACKGROUND: Although, the outcomes and changes in the maxillofacial complex after the application of intraoral bone anchored Class III elastics, have been reported by multiple clinical studies, there was no finite element study to assess and evaluate the stress pattern and displacement on maxillomandibular complex with bimaxillary anchorage. The present study aims to evaluate the biomechanical effects on maxillomandibular complex of Skeletally anchored Class III elastics with varying angulations using the 3D finite element analysis. METHODOLOGY: Two 3-dimensional analytical models were developed using the Mimics 8.11 (Materialise: Leuven, Belgium) and ANSYS software Version 12.1 (ANSYS Inc, Canonsburg, PA, USA) from sequential computed tomography images taken from a Skeletal Class III subject. The models were meshed into 465,091 tetrahedral elements and 101,247 nodes. Intraoral mechanics for skeletally anchored maxillary protraction (I-SAMP) were applied on two models i.e. A and B (without and with maxillary expansion respectively) between miniplates on maxilla and mandible on both right and left sides with three different angulations of forces-10°, 20° and 30°). RESULTS: Although the craniomaxillary complex in both the models (A and B) displaced forward while demonstrating rotations in opposite directions, the displacements and rotations decreased gradually with the increase of the angle of load application from 10° to 30°. The mandible rotated clockwise in both the simulations, but the displacement of mandibular surface landmarks was higher in Simulation A. However, the antero-inferior displacement of the glenoid fossa was higher in Simulation B than in A. CONCLUSION: Significant displacement of maxillofacial sutures and structures was witnessed with I-SAMP with maxillary expansion and Class III elastics for correction of Skeletal Class III with maxillary retrognathism. Thus, I-SAMP with maxillary expansion is a desired protocol for treatment of maxillary retrognathism. However, the prescribed angulation of the Class III elastics should be as low as possible to maximise the desired effects.

Non-invasive methods for the assessment of biomarkers and their correlation with radiographic maturity indicators - a scoping review.

BACKGROUND: Detection of skeletal maturity is vital in orthodontic treatment timing and planning. Traditional methods include hand-wrist radiography and cervical vertebral maturation index (CVMI). Though the radiographic methods are well established and routinely used to assess skeletal maturation, they carry the drawback of subjective perception and low reproducibility. With evolving concepts, skeletal maturation has been assessed quantitatively through biomarkers obtained from saliva, gingival crevicular fluid (GCF), and urine. The scoping review aims to explore the various biomarkers assessed through non-invasive methods and their correlation with radiographic skeletal maturity. METHODOLOGY: The literature search was carried out on MEDLINE via Pubmed, Cochrane Library (Cochrane database of systematic reviews), Cochrane central register of controlled trials (CENTRAL), Google Scholar, Semantic Scholar, ScienceDirect, and Opengrey.eu for articles up to and including November 2020. Pertinent articles were selected based on inclusion and exclusion criteria. The results were tabulated based on the type of sample collected, the biomarker assessed, method of sample collection, and the radiographic method used. RESULTS: The literature search resulted in 12 relevant articles. Among all the studies, 10 studies showed that the concentration of biomarkers increases during the pubertal growth peak. On the contrary, 2 articles showed no significant difference between the levels of biomarkers and pubertal growth peak. CONCLUSION: It can be concluded that the level of biomarkers increases during the pubertal growth spurt and can provide a quantitative way of assessing skeletal maturity.

Effect of fixed functional appliances on pharyngeal airway dimensions in Skeletal Class II individuals - A scoping review.

BACKGROUND: Skeletal Class II malocclusion due to a retrognathic mandible produces a backwardly positioned tongue and soft palate, emanating compromised upper airway dimensions and breathing difficulties. AIMS: The present review aims to explore and concise the findings of the existing studies assessing the effects of fixed functional appliances on pharyngeal airway dimensions by advancing the mandible. DESIGN: A literature search was carried out on MEDLINE/PubMed, Cochrane Library, Science direct, Semantic Scholar and Google Scholar databases for studies up to December 2020, resulting in 1037 studies. Specified inclusion/exclusion criteria guided the selection of 18 relevant articles. The sample size, type of the appliance, method of assessment and outcomes of these articles were assessed in detail and tabulated. RESULTS: Out of 18 studies included, 12 were retrospective longitudinal and the remaining were clinical trials. Majority of the studies (72%) reported a positive influence of the fixed functional appliances on the dimensions of the oropharyngeal and hypopharyngeal airways with minimal effects on nasopharyngeal airway. CONCLUSION: Thus, it can be concluded that fixed functional appliances have a beneficial effect on the middle and lower pharyngeal airway dimensions by advancing the mandible.

Closure of large alveolar defect by maxillary alveolar distraction using a vector-controlled distractor appliance in cleft patients: A pilot study.

OBJECTIVE: To assess the treatment outcome of custom made maxillary transport distractor appliance for closure of large alveolar clefts. METHOD: A pilot study was conducted on 12 large alveolar cleft defects present in 11 non-syndromic cleft lip and palate patients (1 bilateral and 10 unilateral) in the age group of 16-25 years. All the subjects underwent pre-surgical orthodontics followed by alveolar distraction using custom-made distractor appliance. Study models, lateral cephalogram, panoramic radiograph and cone beam computed tomograms were obtained pre-surgically (T0) and after distractor removal (T1). The reduction in the width and volume of the alveolar cleft defect and change in the mesiodistal axial inclination of the teeth in transport segment following distraction were recorded. P value â€‹< â€‹0.05 was considered statistically significant. RESULTS: Significant reduction in cleft width (9.18 â€‹mm), volume (89.82 â€‹mm3) and the change in the mesiodistal axial inclination of the teeth in the transport segment (3.05°) (P â€‹< â€‹0.05) were observed. SNA (1.75°), ANB (1.58°), maxillary length (1.58 â€‹mm), upper incisor inclination (3°) and distal movement of anchorage teeth (0.95 â€‹mm) also showed significant change (P â€‹< â€‹0.05). CONCLUSION: The custom-made tooth borne distraction appliance successfully closed the large alveolar cleft defect with minimal or no inadvertent effects on the oral tissues.