Oral Health Assessment in Cleft Lip & Palate Patients During Orthodontic Treatment for Maxillary Protraction: A Periodontal & Microbiological Study.

OBJECTIVE: To assess the oral health status and microbiota of subgingival plaque in patients with surgically repaired cleft lip and palate (CLP) during orthodontic treatment for maxillary protraction with two different orthodontic appliances. DESIGN: Randomized controlled trial. SETTING: Institutional. PARTICIPANTS: A total of 90 patients with surgically repaired Unilateral Cleft Lip and Palate, out of initially enrolled 120 patients, were divided into 3 groups: experimental group I, experimental group II and control group, with 30 subjects each. Patients with a history of oral prophylaxis in last 6 months or antibiotic therapy within 3 months were excluded from the study. INTERVENTIONS: Bone Anchored Maxillary Protraction was done in experimental group I, while facemask with acrylic occlusal splint was used for maxillary protraction in experimental group II and no orthodontic intervention in control group. MEAN OUTCOME MEASURES: Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), Probing Depth (PD), and microbiota of subgingival plaque (P. gingivalis, P. intermedia, Veillonella and Capnocytophaga) were compared at baseline (T0) and after 8 months (T1). RESULTS: The PI, GI, GBI and PD were observed to be significantly higher in experimental group II followed by experimental group I as compared to control group at 8 months interval (P < .001). The microbiota counts increased significantly in experimental group II and experimental group I (P < .001), as compared to control group. CONCLUSION: Maxillary protraction with facemask and bone plates was found to be a better alternative than facemask with occlusal splint, considering the overall oral health of patients with CLP.

3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial.

OBJECTIVE: Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. DESIGN: Randomised clinical trial. SETTING: Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). INTERVENTIONS: Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). MAIN OUTCOME MEASURE(S): Changes in facial and nasolabial morphology. RESULTS: Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. CONCLUSIONS: Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.

Periodontal and microbiological evaluation in cleft lip/palate patients undergoing orthodontic treatment: A cross-sectional study.

BACKGROUND: The present cross-sectional study was undertaken to evaluate the periodontal and microbiological parameters in patients with surgically repaired unilateral cleft lip and palate (UCLP) undergoing orthodontic correction in comparison to patients without any cleft or orthodontic treatment. METHODS: A total of 120 patients, out of initial 148 patients, between the age group 6 and 18 years were enrolled and divided into four groups with 30 patients each: non-cleft patients without orthodontic treatment in Group 1, non-cleft patients undergoing fixed orthodontic treatment in Group 2, patients with UCLP without any orthodontic treatment in Group 3, and patients with UCLP undergoing fixed orthodontic treatment in Group 4. Periodontal parameters including plaque index (PI), gingival index (GI), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) index, pocket probing depth (PD), and tooth mobility were measured in all the groups. The subgingival plaque samples of all the patients were subjected to microbial evaluation using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) for clinical diagnosis. RESULTS: The periodontal parameters were significantly raised in Group 4, followed by Group 3 and Group 2 in comparison to Group 1 (p < 0.01), thereby suggesting poor periodontal health in patients with UCLP undergoing orthodontic treatment. Statistically significant differences (p < 0.01) in counts of micro-organisms among the groups were observed for P. gingivalis, P. intermedia, Veillonella, and Capnocytophaga, with the highest proportions in Group 4, indicating a deteriorating oral health in these patients. CONCLUSION: Poor periodontal and microbial health in patients with UCLP undergoing orthodontic treatment indicates a need for reinforcement of oral hygiene practices among these patients.

Effect of Aligning Forces by Two Preadjusted Edgewise Techniques on a Buccally Positioned Maxillary Canine at Varying Vertical Displacements: A Finite Element Study.

Objective: To evaluate the effect of continuous arch and piggyback mechanics in a straight wire appliance (SWA) for the alignment of buccal and variably vertically positioned maxillary canines. Methods: A three-dimensional finite element model with near-normal occlusion and buccal and vertically displaced maxillary canines was used. Two groups were created to simulate two commonly used SWAs techniques, continuous archwire (Group 1) and piggyback models (Group 2). Each group had three subgroups with varying vertical displacement of the canine from 2 to 6 mm from the occlusal plane. The displacement and stress distribution were noted in each group. Results: As the vertical displacement increased in Group 1, the concentration of von Mises stress increased progressively at the incisal third (0.36, 0.41 and 0.44 MPa) at 2, 4, and 6 mm, respectively, with decreased maximum occlusal movement in the vertical plane with respect to the canine. Group 2 exhibited a similar pattern but greater occlusal movement of the canine compared with Group 1. Conclusion: A vertical displacement of 4 mm is the optimal level at which continuous arch mechanics should be considered. For displacements beyond 4 mm, the piggyback wire technique is a suitable alternative.

Frequency of Electrocardiogram-Defined Cardiac Conduction Disorders in a Multi-Institutional Primary Care Cohort.

Background: Disorders affecting cardiac conduction are associated with substantial morbidity. Understanding the epidemiology and risk factors for conduction disorders may enable earlier diagnosis and preventive efforts. Objectives: The purpose of this study was to quantify contemporary frequency and risk factors for electrocardiogram (ECG)-defined cardiac conduction disorders in a large multi-institutional primary care sample. Methods: We quantified prevalence and incidence of conduction disorders among adults receiving longitudinal primary care between 2001 and 2019, each with at least one 12-lead ECG performed prior to the start of follow-up and at least one ECG during follow-up. We defined conduction disorders using curated terms extracted from ECG diagnostic statements by cardiologists. We grouped conduction disorders by inferred anatomic location of abnormal conduction. We tested associations between clinical factors and incident conduction disease using multivariable proportional hazards regression. Results: We analyzed 189,163 individuals (median age 55 years; 58% female). The overall prevalence of conduction disorders was 27% among men and 15% among women. Among 119,926 individuals (median age 55 years; 51% female), 6,802 developed an incident conduction system abnormality over a median of 10 years (Q1, Q3: 6, 15 years) of follow-up. Incident conduction disorders were more common in men (8.78 events/1,000 person-years) vs women (4.34 events/1,000 person-years, P < 0.05). In multivariable models, clinical factors including older age (HR: 1.25 per 5-year increase [95% CI: 1.24-1.26]) and myocardial infarction (HR: 1.39 [95% CI: 1.26-1.54]) were associated with incident conduction disorders. Conclusions: Cardiac conduction disorders are common in a primary care population, especially among older individuals with cardiovascular risk factors.

Noninvasive assessment of organ-specific and shared pathways in multi-organ fibrosis using T1 mapping.

Fibrotic diseases affect multiple organs and are associated with morbidity and mortality. To examine organ-specific and shared biologic mechanisms that underlie fibrosis in different organs, we developed machine learning models to quantify T1 time, a marker of interstitial fibrosis, in the liver, pancreas, heart and kidney among 43,881 UK Biobank participants who underwent magnetic resonance imaging. In phenome-wide association analyses, we demonstrate the association of increased organ-specific T1 time, reflecting increased interstitial fibrosis, with prevalent diseases across multiple organ systems. In genome-wide association analyses, we identified 27, 18, 11 and 10 independent genetic loci associated with liver, pancreas, myocardial and renal cortex T1 time, respectively. There was a modest genetic correlation between the examined organs. Several loci overlapped across the examined organs implicating genes involved in a myriad of biologic pathways including metal ion transport (SLC39A8, HFE and TMPRSS6), glucose metabolism (PCK2), blood group antigens (ABO and FUT2), immune function (BANK1 and PPP3CA), inflammation (NFKB1) and mitosis (CENPE). Finally, we found that an increasing number of organs with T1 time falling in the top quintile was associated with increased mortality in the population. Individuals with a high burden of fibrosis in ≥3 organs had a 3-fold increase in mortality compared to those with a low burden of fibrosis across all examined organs in multivariable-adjusted analysis (hazard ratio = 3.31, 95% confidence interval 1.77-6.19; P = 1.78 × 10-4). By leveraging machine learning to quantify T1 time across multiple organs at scale, we uncovered new organ-specific and shared biologic pathways underlying fibrosis that may provide therapeutic targets.

Deep learning of left atrial structure and function provides link to atrial fibrillation risk.

Increased left atrial volume and decreased left atrial function have long been associated with atrial fibrillation. The availability of large-scale cardiac magnetic resonance imaging data paired with genetic data provides a unique opportunity to assess the genetic contributions to left atrial structure and function, and understand their relationship with risk for atrial fibrillation. Here, we use deep learning and surface reconstruction models to measure left atrial minimum volume, maximum volume, stroke volume, and emptying fraction in 40,558 UK Biobank participants. In a genome-wide association study of 35,049 participants without pre-existing cardiovascular disease, we identify 20 common genetic loci associated with left atrial structure and function. We find that polygenic contributions to increased left atrial volume are associated with atrial fibrillation and its downstream consequences, including stroke. Through Mendelian randomization, we find evidence supporting a causal role for left atrial enlargement and dysfunction on atrial fibrillation risk.

A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial.

BACKGROUND: Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD: The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION: We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

Diode Laser versus Conventional Surgical Circumferential Supracrestal Fiberotomy in Preventing Relapse of Orthodontically Derotated Teeth: A Randomised Control Trial.

Objective: To evaluate the effectiveness of a diode laser (810 nm) for circumferential supracrestal fiberotomy compared with conventional surgical circumferential supracrestal fiberotomy in preventing rotational relapse in orthodontically treated cases. Methods: Seventy-six patients (age range from 18-25 years) with mandibular crowding ranging between 5-8 mm and rotation >10˚ (from the individualized arch form) treated non-extraction with a straight wire appliance (McLaughlin, Bennet, Trevisi; 0.022 inch) prescription were selected for the study. The patients were randomly allocated into 3 groups of 22 patients each: Group 1 (Control group-No circumferential supracrestal fiberotomy), Group 2 (Conventional circumferential supracrestal fiberotomy), and Group 3 (diode laser circumferential supracrestal fiberotomy). After leveling and alignment up to "0.019x0.025" stainless steel wire, the arch wire was removed for a period of 1 month. Impressions were made and the poured casts were scanned. The 3D models (.STL files) were evaluated for changes in the irregularity index and rotational relapse. Results: One-way ANOVA and post-hoc Tukey's test were used for data analysis. Group 1 (Control group) showed greater relapse in both irregularity index and rotation angulations in comparison with Groups 2 and 3, which was statistically significant (p<0.001). There was no statistically significant difference in irregularity index and rotational relapse between Group 2 and Group 3 (p=0.35 for irregularity index, and p=0.41 for rotational relapse). Conclusion: The control group showed significantly more relapse than both circumferential supracrestal fiberotomy groups. Both conventional and diode laser circumferential supracrestal fiberotomy decreased the relapse tendency.

A Deep Learning Model for Inferring Elevated Pulmonary Capillary Wedge Pressures From the 12-Lead Electrocardiogram.

Background: Central hemodynamic parameters are typically measured via pulmonary artery catherization-an invasive procedure that involves some risk to the patient and is not routinely available in all settings. Objectives: This study sought to develop a noninvasive method to identify elevated mean pulmonary capillary wedge pressure (mPCWP). Methods: We leveraged data from 248,955 clinical records at the Massachusetts General Hospital to develop a deep learning model that can infer when the mPCWP >15 mmHg using the 12-lead electrocardiogram (ECG). Of these data, 242,216 records were used to pre-train a model that generates useful ECG representations. The remaining 6,739 records contain encounters with direct measurements of the mPCWP. Eighty percent of these data were used for model development and testing (5,390), and the remaining records comprise a holdout set (1,349) that was used to evaluate the model. We developed an associated unreliability score that identifies when model predictions are likely to be untrustworthy. Results: The model achieves an area under the receiver operating characteristic curve (AUC) of 0.80 ± 0.02 (test set) and 0.79 ± 0.01 (holdout set). Model performance varies as a function of the unreliability, where patients with high unreliability scores correspond to a subgroup where model performance is poor: for example, patients in the holdout set with unreliability scores in the highest decile have a reduced AUC of 0.70 ± 0.06. Conclusions: The mPCWP can be inferred from the ECG, and the reliability of this inference can be measured. When invasive monitoring cannot be expeditiously performed, deep learning models may provide information that can inform clinical care.