Understanding and Appraising Systematic Reviews and Meta-Analysis.

Systematic reviews and meta-analysis seek to answer a pre-framed research question to lead to a valid answer through a systematic, explicit and reproducible method of locating; identifying, including and appraising appropriate trials. The results are synthesized considering the methodological rigor of included trials. While the meta-analysis quantitatively pools the results from individual included studies, the systematic review summarizes the findings as qualitative conclusions. These reviews are crux of evidence based dentistry for various stake-holders, i.e., clinicians, researchers and policy-makers. Although the meticulous methodology of systematic review and meta-analysis minimizes the elements of bias, yet the validity and reliability of their findings should be explored prior to translating their conclusions to practice. The goal of this paper is to familiarize readers with rationale, conduct and appraisal of systematic review and meta-analysis. Further, guidance is provided on tracing potential elements of bias in the review to enable readers to judge the quality of evidence generated from the review.

Phenotypes of Enamel Hypomineralization and Molar Incisor Hypomineralization in Permanent Dentition: Identification, Quantification and Proposal for Classification.

OBJECTIVES: To report the extent, pattern, clinical presentation and phenotypes of enamel hypomineralization in permanent dentition Study Design: This cross sectional observational study recruited a random sample of 1726, 12-16 year olds. Enamel hypomineralization was scored on all teeth by a calibrated examiner using the EAPD 2003 criteria. Proportions of affected subjects (prevalence) with a minimum of one hypomineralization and Molar Incisor Hypomineralization (MIH) were calculated. Proportions of following phenotypes were quantified i.e. MH (only FPM hypomineralization), M+IH (concomitantly affected FPMs and permanent incisors without affecting any other tooth in the arch), MIHO (hypomineralization affecting at least one of the canines, premolars or 2(nd) molars and simultaneously including at least one FPM), IH (only permanent incisor's hypomineralization) and NoFPM (hypomineralization affecting at least one of the canines, premolars and 2(nd) molars but not FPM; incisors can be affected concomitantly). A comparative evaluation of extent and severity of enamel hypomineralization was performed amongst various phenotypes. Statistical measures employed t-test, chi square tests and ANOVA. RESULTS: Overall prevalence of affected subjects was 13.21% (228/1726) and 9.79% (169/1726) for enamel hypomineralization and MIH respectively. A total of 4.36±3.45 teeth/subject and 6.01±5.20 surfaces/subject were found to be affected with enamel hypomineralization. Most prevalent phenotype was M+IH while the least prevalent was IH. Maximum severity i.e. number of affected surfaces and surfaces with PEB were reported for MIHO (p<0.001). CONCLUSION: Enamel hypomineralization can manifest in any tooth in five phenotypic variations in permanent dentition with varying extent and severity.

A CAMBRA Model For High Caries Risk Indian Children: A Pragmatic Comprehensive Tailored Intervention.

OBJECTIVE: To evaluate a CAMBRA based therapeutic and preventive model for high caries risk children in a pediatric dentistry clinic set-up. STUDY DESIGN: A total of 100 systemically healthy children aged 4-8 years with dmft/DMFT ≥ 5 and/or ≤ 20% magnitude of cariogram sector 'chance to avoid new cavities' were enrolled. The program comprised of following components i.e. caries risk assessment, customized preventive interventions (Motivational interviewing and counseling, oral prophylaxis, fluoride varnish, fissure sealants) and restorative procedures. The recall intervals were scheduled on the basis of caries risk i.e. every 1 month (≤ 40% chance to avoid new cavities) and 3 months (≥ 41% chance to avoid new cavities). The primary outcome measure was 'new carious lesions' at 12 months following achievement of 'termination levels' i.e. ≥ 41% magnitude of 'chance to avoid new cavities.' The secondary outcome measures were changes in cariogram parameters at termination and duration needed to achieve termination levels. RESULTS: The program showed 97% success rate as 3/100 subjects developed new carious lesions at 12 months follow up. Highly significant (p<0.001) favorable shift was achieved in cariogram parameters at termination. Termination levels were achieved in 2.71 ± 4.854 months. CONCLUSIONS: The present CAMBRA based program with customized intervention and recall schedules showed favorable results.

Clinical outcomes of indirect composite restorations for grossly mutilated primary molars: a clinical observation.

This study was conducted to report the clinical outcomes and the parental and child satisfaction of onlays for restoring mutilated primary molars. Twenty subjects, ages 3-8 years, with the presence of at least 1 mutilated primary molar (≥3 carious surfaces and a carious surface area ≥3/4 of the occlusal surface) were recruited. This study assessed the clinical success, gingival health, and parent/child satisfaction of 28 indirect composite onlays. The onlays showed a 100% retention rate at 12 months follow-up and a marginal integrity of 96.43%. High rates of satisfactory Alpha ratings for color stability (92.86%), surface texture (92.86%), and anatomic form (100%), coupled with significant improvements in gingival health of the restored teeth (P < 0.05), were reported. Indirect composite onlays successfully restored anatomic form and function of the grossly decayed primary molars--with shorter chairside times--while satisfying the esthetic demands of the young pediatric patients.

Bispectral Index Monitoring: validity and utility in pediatric dentistry.

Reliable and safe provision of sedation and general anesthesia is dependent on continuous vigilance of patient's sedation depth. Failure to do so may result in unintended oversedation or undersedation. It is a common practice to observe sedation depth by applying subjective sedation scales and in case of general anesthesia, practitioner is dependent on vital sign assessment. The Bispectral Index System (BIS) is a recently introduced objective, quantitative, easy to use, and free from observer bias, and clinically useful tool to assess sedation depth and it precludes the need to stimulate the patient to assess his sedation level. The present article is an attempt to orient the readers towards utility and validity of BIS for sedation and general anesthesia in pediatric dentistry. In this article, we attempt to make the readers understand the principle of BIS, its variation across sedation continuum, its validity across different age groups and for a variety of sedative drugs.

Enamel Hypomineralization: Prevalence, Defect Characteristics in Primary Dentition in a Northern Indian Region.

Background: No data is available on hypomineralization in the full complement of primary dentition. Aim: To report on the prevalence and clinical presentation of enamel hypomineralization (EH) in the primary dentition. Design: A cross-sectional observational study with a random sample of 948, 4-6-year-old schoolchildren of Gautam Buddh Nagar, Uttar Pradesh, India, was conducted after approval from the Institutional Ethics Committee. European Academy of Paediatric Dentistry (EAPD) (2003) criteria were employed to score EH in all primary teeth. A single experienced examiner conducted an entire clinical examination of the study population. Data were expressed as the prevalence, type, extent, and distribution. Further analyses were conducted to compare the prevalence and distribution of different types of lesions in affected subjects using student t-tests and analysis of variance (ANOVA). Results: An overall prevalence of 7.51% (71/948) was reported. A total of 2.75 ± 1.735 teeth/subject were reported to be affected. The most common lesion was creamy white opacity (p = 0.002), while posteruptive breakdown (PEB) was observed in 40.85% (29/71) of affected subjects. Conclusion: The prevalence of EH in primary dentition was 7.51%. Further studies mapping the prevalence as well as possible links with molar incisor hypomineralization (MIH) in other geographical locations of the world are required. How to cite this article: Mittal N, Gupta N, Goyal A. Enamel Hypomineralization: Prevalence, Defect Characteristics in Primary Dentition in a Northern Indian Region. Int J Clin Pediatr Dent 2024;17(S-1):S67-S72.

A Randomised Controlled Trial on the Effect of Hamulectomy on Hearing Outcomes in Cleft Palate Patients - A Comparative Study.

Introduction: Cleft palate, a common congenital craniofacial defect, requires surgical repair and many surgical approaches have been employed for the same to reduce the risk of post-operative complications and improve outcomes. In order to achieve tension free closure, fracture of pterygoid hamulus has been advised. However, the effect of this manoeuvre on auditory functions remains debatable. The study was designed to evaluate the effect of hamulectomy on auditory function during the post-operative period after palatoplasty. Materials and Methods: The present study enrolled 100 participants aged 10 months-2 years with isolated cleft palate defect. They were randomly divided into two groups: palatoplasty with hamulectomy (n = 50) and palatoplasty without hamulectomy (n = 50). Hearing outcomes were evaluated using objective measures (otoscopy, tympanometry, and otoacoustic emission [OAE] tests) at 1-month and 6-month post-operative follow-up visits. The Chi-square test was used to analyse the data and significance level was kept at P ≤ 0.05. Results: The findings of otoscopy, tympanometry and OAE tests were statistically similar between the two study groups (P > 0.05; Chi-square test) at both one month and six months follow-up visits. Another noteworthy observation was improvement in auditory function during follow-up period indicating recovery of middle ear function following palatoplasty. Discussion: The addition of hamulectomy to the palatoplasty treatment may improve the hearing outcomes for cleft palate patients and can be adopted to achieve tension free closure.

Elucidating the Anticancer Mechanisms of Cinnamoyl Sulfonamide Hydroxamate: Insights From DNA Content Analysis and Gene Expression Profiling in Squamous Cell Carcinoma.

BACKGROUND: Oral cancer is a major public health concern worldwide, with oral squamous cell carcinoma (OSCC) being one of its most common subtypes. Despite advances in diagnosis and management of this disease, there remains a need to develop new therapeutic approaches for better outcomes. OBJECTIVE: This study aimed to investigate the molecular mechanisms through which cinnamoyl sulfonamide hydroxamate derivatives exert their anticancer effects on OSCC. MATERIALS AND METHODS: The derivatives were synthesized via multi-step processes and then characterized at the molecular level. Flow cytometry assay for DNA content and cell cycle distribution, anisidine/toluidine double staining for apoptosis detection, as well as reverse transcription polymerase chain reaction (RT-PCR) gene expression analysis, were performed on OSCC cell lines exposed to cinnamoyl sulfonamide hydroxamate derivatives. RESULTS: Flow cytometry unveiled remarkable changes in the distribution of cells throughout the OSCC cell line upon treatment with cinnamoyl sulfonamide hydroxamate derivatives. Consequently, it led to a noticeable decrease in cells at the G0/G1 phase, together with an increase at the S phase, thereby indicating a retardation at various points of the cycle. In addition, apoptotic morphological alterations have been observed by anisidine/toluidine double staining after some treatments with the compounds. RT-PCR analysis showed a marked increase in p21 gene expression levels, further supporting the compounds' ability to induce cell cycle arrest and apoptosis. CONCLUSION: The research highlighted the potential of cinnamoyl sulfonamide hydroxamate derivatives as candidates for oral cancer, particularly OSCC treatment, shedding light on their operation at the molecular level and paving the way for the development of targeted therapies that could aid in the cure of oral cancer.

Evaluation of effect of single vector mandibular distraction for correction of postankylotic mandibular hypoplasia requiring multiplanar correction: A prospective case series.

Introduction: Uniplanar devices have been criticized for being insufficient to correct complex mandibular deformities and associated problems of open bite and cross bite. The use of oblique vector to correct complex multiplanar deformities using uniplanar mandibular distraction devices is the uniqueness of the present case series. Aim and Objective: The aim of the present case series is to describe the successful use of uniplanar mandibular distraction devices for the correction of complex multiplanar deformities. Material and Method: The technique of callous molding was employed to overcome any open bite. A total of 40 mandibular distractors in 20 patients (mean age 13 ± 2.67 years) were placed on the mandible for correction of the facial deformity associated with the lower jaw(mandible) in vertical, horizontal and/or sagittal plane, secondary to temporomandibular joint ankylosis. The distraction was done before and after the gap arthroplasty in 15 and 5 patients, respectively. A latency period of 3-5 days was applied, and distraction was performed at a rate of 1 mm/day with the rhythm of 0.5 mm twice daily. Results: The significant lengthening was observed in both mandibular height (Ar Go) (50.40 ± 1.52 mm from 38.80 ± 4.38mm, P = 0.006) as well as in mandibular corpus length (Go Pg) (79.40 ± 2.28 from 58.80 ± 4.09, P = 0.001). Statistically significant changes in mandibular dimensions, facial proportions, and soft tissue profile were seen, which was assessed with the help of COGS analysis done on lateral cephalogram taken preoperatively and postoperatively. Conclusion: With intelligent vector planning and callus molding multiplanar complex deformities can be corrected by using semiburieduniplanar devices.

Accuracy of freehand versus guided immediate implant placement: A randomized controlled trial.

PURPOSE: This randomized controlled trial (RCT) aimed to compare the accuracy of immediate implant placement with freehand and static guided surgery. METHODS: An RCT was conducted on 61 subjects who received a total of 80 dental implants. The enrolled patients were randomly allocated to two groups: freehand surgery (control group, n = 40 implants) and static guided surgery with R2Gate® (Megagen, Gyeongbuk, South Korea, test group, n = 40 implants). Crestal and apical deviations in both mesiodistal and buccolingual dimensions, as well as depth and angular deviations, were calculated by comparing the three-dimensional (3D) position of the implant in the planning software with the final implant position, revealed by an intraoral scan of the fixture after placement. The Mann-Whitney test was used for comparative assessment. RESULTS: In the freehand group (control), crestal deviations of 1.13 ± 0.89 mm and 1.00 ± 0.76 mm were found in the mesiodistal and buccolingual directions, respectively, versus 0.34 ± 0.26 mm (p<0.001) and 0.37 ± 0.24 mm (p = 0.03) in the static guided surgery group (test). Apical deviation was also higher in the freehand group (control) than in the static guided surgery group (test) in the mesiodistal (4.04 ± 1.90 mm vs. 0.97 ± 0.55 mm, p = 0.04) and buccolingual directions (3.46 ± 1.82 mm vs. 0.94 ± 0.67 mm, p = 0.02). Freehand surgery had greater angular deviation (6.09° ± 3.23) compared to guided surgery (0.83° ± 0.53, p = 0.02). However, depth deviation was similar in the freehand surgery group (2.24 ± 1.58 mm) and static guided surgery group (0.66 ± 0.43, p = 0.09). CONCLUSIONS: Immediate implant placement with static guided surgery demonstrated better accuracy than freehand surgery. STATEMENT OF CLINICAL RELEVANCE: Guided implant surgery showed fewer deviations compared to freehand surgery in fresh extraction sockets; therefore, the use of static guides should be given preference over the freehand modality.

Assessment of Therapeutic Bio-Activity of Cinnamoyl Sulfonamide Hydroxamate in Squamous Cell Carcinoma.

Background Cancer is the second most common cause of death. Oral squamous cell carcinoma (OSCC) represents the most frequent of all oral neoplasms. Many treatment modalities such as chemotherapy, radiotherapy, surgery, and immunotherapy are emerging but still, the patients' quality of life is questionable. Despite the advances in therapeutic approaches, the percentages of morbidity and mortality of OSCC have not improved significantly during the last 30 years. Treatment using natural products can act as a potent anti-cancer agent with reduced adverse effects. Cinnamic acid derivatives exhibit anti-cancer potential through histone deacetylase inhibitor (HDAC) enzyme inhibition. Methodology In an experimental study design, cinnamoyl hydroxamate derivatives were prepared. The structure was confirmed using ultraviolet-visible spectroscopy (UV-Vis), nuclear magnetic resonance (NMR), infrared spectroscopy, and mass spectrophotometry. An in-vitro antioxidant assay using nitric oxide scavenging and reducing power assay was done and an in-vitro cytotoxic (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) (MTT) assay and viability assay were carried out using tryphan blue dye. Results Statistical analysis was performed using SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp). Cinnamoyl hydroxamate derivatives were obtained and named as compounds 3a (E)-N-Hydroxy-3-(4-(N-(phenyl bromo) sulfamoyl) phenyl) acrylamide-) and 3b ((E)-N-Hydroxy-3-(4-(N-(phenyl nitro) sulfamoyl) phenyl) acrylamide). In the nitric oxide scavenging assay, compound 3a showed good antioxidant activity than 3b. Reducing power assay was higher in 3a compared to 3b. Cell viability using tryphan blue exhibited a concentration decrease in % cell viability with an increase in the concentration of human oral cavity squamous cell carcinoma cell line (OECM 1), a unique head and neck squamous carcinoma cell line (UM SCC 6) & human oral squamous cell carcinoma forming metastatic foci (HSC 3) cell lines. Conclusion The results of the present study revealed that the study compounds play a vital role in the up-regulation of apoptotic pathways and regulation of terminal differentiation pathways. The compounds showed good anti-oxidant and anti-cancer activities in lesser concentrations, hence they can be used as a therapeutic agent for oral squamous cell carcinoma.

Autogenous grafts for reconstruction arthroplasty in temporomandibular joint ankylosis: a systematic review and meta-analysis.

Autogenous methods for reconstruction arthroplasty (RA) for the surgical management of the temporomandibular joint (TMJ) have been extensively reported. The present review was aimed to systematically review and pool data on clinical outcomes of autogenous grafts for RA in subjects with TMJ ankylosis. Major electronic databases and prominent subject-specific journals were searched up to December 2020. Randomised controlled trials (RCT), cohort studies, and retrospective studies reporting outcomes of autogenous grafts for RA in TMJ ankylosis were included. A total of 35 studies with 700 subjects was included. The most commonly employed grafts were costochondral grafts (CCG) and coronoid process grafts. Postoperative change in maximum incisor opening (MIO) was comparable amongst all grafts and was in the clinically acceptable range (27.21-31.38 mm). The recurrence rate was comparable for all grafts and was ≈ 8% except for coronoid grafts, where the recurrence rate was 2.98%. Growth assessment for CCG revealed that 55.89%, 30.89%, and 13.24% of subjects depicted optimal growth, overgrowth, and undergrowth, respectively. Within the limitations of the present review, the recurrence rate for all grafts was comparable except for coronoid graft, which depicted least recurrence rate and resultant postoperative change in MIO was in the clinically acceptable range.

To evaluate the effect and longevity of Botulinum toxin type A (Botox®) in the management of gummy smile - A longitudinal study upto 4 years follow-up.

AIM: the current study was aimed (1) To study the effect of Botulinum toxin (BT) A on gummy smile (2) To determine the efficacy, predictability & longevity of the effect of Botox® in the management of gummy smile and lastly (3)To identify the treatment groups for Botox® as a single modality for the non-surgical treatment of gummy smile. MATERIAL AND METHOD: only patients who were willing to get the treatment done with Botox® injection were enrolled in the study, irrespective for the need for the surgery. Thus, total of 32 patients were divided into two groups, group 1, having a gummy smile with less than 5 â€‹mm who were treated with 3 units of Botox® and group II, having gummy smile of more than 5 â€‹mm who were treated with 5 units of Botox® and each group underwent 2 cycles of injection 7 months apart given at the Yonsei's point and were followed for a period of 14 months. RESULTS: the procedure was tolerated well by the patients; none developed any allergic reaction or antibodies related to BT. In the less that 5 â€‹mm and more than 5 â€‹mm of gingival show group the results remain excellent till 3 months after which gummy smile gradually reaches to the baseline levels. Significant changes start to reappear by the 5th month. CONCLUSION: Authors recommend use of BT for the treatment of gummy smile as the technique is safe, economical and easy to use. Though not long lasting, it may motivate patients to go for surgical procedure, mainly who have gummy smile of more than 5 â€‹mm because of maxillary vertical excess.

Outcomes of surgical management of TMJ ankylosis: A systematic review and meta-analysis.

BACKGROUND: Temporomandibular joint (TMJ) ankylosis can be surgically managed by a number of approaches. This systematic review compared the clinical outcomes among various treatment options, i.e., gap arthroplasty (GA), interpositional gap arthroplasty (IGA), reconstruction arthroplasty (RA) and distraction osteogenesis (DO). METHODS: PubMed, Ovid, Embase, Web of Science, Scopus and Cochrane central register of controlled trials were searched till April 2018. Randomized controlled trials, cohort studies and retrospective studies in subjects with acquired TMJ ankylosis reporting re-ankylosis with a follow-up period of ≥12 months were included. RESULTS: Twenty-six studies with 1197 subjects were included. The higher recurrence rate was observed with GA compared to both IGA and RA (p < 0.05). Comparable results were obtained with IGA, RA and DO (p > 0.05). Among interpositional materials, alloplastic materials showed higher recurrence rate compared to autogenous materials (p < 0.05). However, for reconstruction, both autogenous grafts and alloplastic prosthetic implants gave similar results (p > 0.05). The highest improvements in MMO (maximum mouth opening) resulted with IGA but the differences regarding post-operative changes in MMO were clinically similar in all other groups. CONCLUSION: IGA with autogenous material and reconstruction using either autogenous grafts or total joint replacement by alloplastic prosthetic implants provide similar clinical outcomes for TMJ ankylosis management.

Methods of Intracanal Reinforcement in Primary Anterior Teeth-Assessing the Outcomes through a Systematic Literature Review.

AIM: To assess how the various methods of intracanal reinforcement (short root canal posts) performed in their clinical and radiographic outcomes for restoring grossly broken down primary anterior teeth after pulpectomy for 1 year or longer follow-up period. MATERIALS AND METHODS: Literature search of electronic databases (Sept 2013) and various journals (1980-Sept 2013) using medical subject headings and free text terms was conducted. For inclusion in quality assessment, prespecified inclusion criteria were applied. Quality assessment was performed by using 'The Cochrane collaboration's tool for assessing risk of bias'. RESULTS: Seven relevant papers were selected for full text evaluation. After applying the inclusion criteria, only two trials could be considered for quality assessment. Both of these were classified as having high risk of bias. CONCLUSION: The evidence to support any method of intracanal reinforcement for restoring grossly broken down anterior teeth is presently lacking. Further trials with well-defined methodology are needed. How to cite this article: Mittal N, Bhatia HP, Haider K. Methods of Intracanal Reinforcement in Primary Anterior Teeth- Assessing the Outcomes through a Systematic Literature Review. Int J Clin Pediatr Dent 2015;8(1):48-54.

Restoring the smile: Inexpensive biologic restorations.

Extensive breakdown of primary teeth to the cervical level and their loss in very young children is not uncommon. Owing to increasing concerns over self-appearance, due considerations to esthetic aspects in addition to restoring function are necessary aspects of rehabilitation of mutilated teeth to help children grow into a psychologically balanced personality. The present article describes rehabilitation of grossly decayed teeth with biologic restorations such as dentine posts, dentine post and core and biologic shell crown. This treatment modality provided a cost-effective esthetic solution.

Acceptability and Efficacy of Commercial Oral Preparation of Midazolam for brief Painful Procedure: A Randomized Double Blind Clinical Trial.

AIM: To compare the acceptability and efficacy of orally administered commercially available midazolam syrup and injection midazolam mixed in honey for performing venepuncture. MATERIALS AND METHODS: This double blind randomized controlled trial enrolled 40 anxious and healthy 2 to 6 years olds. All subjects received either syrup midazolam or injection midazolam mixed in honey (0.5 mg/kg) per orally, prior to venepuncture as per their group assignment. Primary outcome measures in this trial was acceptability of midazolam. Secondary outcome measures included sedation depth, success of venepuncture, observer and parental satisfaction and parental perception of child's pain. RESULTS: Although the acceptability of syrup midazolam (95%) was higher than injection midazolam (80%), there was no significant difference among two groups with respect to any primary or secondary outcome (p > 0.05). CONCLUSION: Syrup midazolam can serve as a suitable alternative to injection midazolam; thus, eliminating the procedural steps of mixing injection midazolam with any vehicle. How to cite this article: Srivastava B, Mittal N, Mittal P. Acceptability and Efficacy of Commercial Oral Preparation of Midazolam for brief Painful Procedure: A Randomized Double Blind Clinical Trial. Int J Clin Pediatr Dent 2014;7(3):153-156.