Effects of RME on Hearing in UCLP Patients: A Pilot Study.

OBJECTIVE: To assess the changes in hearing after rapid maxillary expansion (RME) and at the end of 6 months retention period in complete unilateral cleft lip and palate (UCLP) patients using pure tone audiometry and tympanometry test. DESIGN: Prospective pilot study. SETTING: Tertiary health care teaching hospital in New Delhi. PATIENTS: This study was conducted on 6 UCLP patients in the age range of 6-14 years with normal ear anatomy. All 6 patients had undergone primary repair of cleft lip and palate and required no more than 5 mm expansion in the intermolar region. INTERVENTION: RME was done using a Hyrax expander with daily activation of one-quarter turn per day for a period of 15-20 days (0.25 mm per day). MAIN OUTCOME MEASURE: Audiometry and tympanometry readings at the baseline as compared to the post expansion and at the end of 6 months retention period. RESULTS: There were no significant changes in the hearing levels on the audiometry test after RME on the cleft side (p-value -0.51) and the noncleft side ear (p-value -0.26). No significant changes were observed in the middle ear volume on the tympanometry test after RME on the cleft side (p-value -0.09) and the noncleft side ear (p-value -0.28). CONCLUSION: There was no improvement or deterioration in the hearing levels after RME and at the end of 6 months retention period in UCLP patients as evaluated using pure tone audiometry and tympanometry test. Hence RME may be undertaken in UCLP patients safely in terms of hearing is concerned.

The First Hybrid International Educational Comprehensive Cleft Care Workshop.

OBJECTIVE: Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. DESIGN: Cross-sectional survey-based evaluation. SETTING: International comprehensive cleft care workshop. PARTICIPANTS: Total of 489 participants. INTERVENTIONS: Three-day simulation-based hybrid comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. RESULTS: The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). CONCLUSION: Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Next Generation Sequencing and Cytogenetic Based Evaluation of Indian Pierre Robin Sequence Families Reveals CNV Regions of Modest Effect and a Novel LOXL3 Mutation.

BACKGROUND: Pierre Robin Sequence (PRS) affects approximately 1 per 8500 to 14000 new-borns worldwide. Although the clinical entity is well defined, the pathogenesis of PRS is debated. The present study aims to understand the contribution of genomic imbalances and genetic variants in patients clinically diagnosed of PRS. METHODOLOGY: A total of 7 independent patients with nonsyndromic PRS thoroughly evaluated by a medical geneticist at a tertiary care hospital, were included in the study. Blood samples were collected from these patients and their family members. Array CGH was performed on all 7 patients and their respective family members for detection of underlying cytogenetic defects. Whole exome sequencing (WES) was performed for 5 families to capture single nucleotide variants or small indels. RESULTS: Cytogenetic analyses did not detect any previously reported gross chromosomal aberrations for PRS in the patient cohort. However, copy number variations (CNVs) of size <1 Mb were detected in patients which may have implications in PRS. The present study provided evidence for the occurrence of de novo deletions at 7p14.1 locus in PRS patients: further validating the candidate loci susceptibility in oral clefts. WES data identified LOXL3 as candidate gene, carrying novel deleterious variant, which is suggestive of the role of point mutations in the pathogenesis of PRS. CONCLUSION: The present study offered considerable insight into the contribution of cytogenetic defects and novel point mutation in the etiology of nonsyndromic PRS. Studies comprising large number of cases are required to fully elucidate the genetic mechanisms underlying the PRS phenotype.

Factors Affecting High Caries Risk in Children With and Without Cleft Lip and/or Palate: A Cross-Sectional Study.

OBJECTIVE: The aim of the study was to analyze the caries protective factors, salivary parameters, and microbial counts in high caries risk children with cleft lip and/or palate (CL/P). DESIGN: This was a cross-sectional study. SETTING: This study was conducted in a tertiary health care teaching hospital in New Delhi, India. PARTICIPANTS: The study was conducted in 40 children, 20 with CL/P and 20 without aged between 5 and 12 years. METHODS: Children with 2 or more caries lesions in both groups were included in this study. Demographic details, dental caries of affected teeth (World Health Organization criteria for Decayed Missing Filled Teeth [WHO-DMFT] and International Caries Detection and Assessment System [ICDAS II]), caries protective factors, salivary parameters, and microbial counts were recorded by one calibrated investigator. MAIN OUTCOME MEASURES: Caries protective factors, salivary parameters, and microbial profile. RESULTS: The Chi-square (χ2) test and Pearson correlation were used for statistical analysis. All the children participating in the study brushed their teeth only once in a day and consumed sweets more than twice a day. None of the children had ever received fluoride varnish. Resting saliva had a low buffering capacity in 80% of children with CL/P and 95% of children without CL/P. Microbial assessment of stimulated saliva showed that with the increases in the numbers (DMFT scores ≥4) and severity (ICDAS codes from 1-2 to 5-6) of caries lesions, both Streptococci and Lactobacilli counts were ≥105 colony-forming units/mL of saliva in the both groups. CONCLUSIONS: Children with CL/P showed limited access to caries protective measures and low buffering capacity in resting saliva, along with elevated levels of salivary Streptococci and Lactobacilli in stimulated saliva.

A Pristine Approach for the Prominent Premaxilla in Bilateral Cleft Lip and Palate (BCLP) Cases.

OBJECTIVE: The neonate premaxilla in bilateral cleft lip and palate is often protruding and displaced laterally. Surgeons prefer the premaxilla to be repositioned and centralized to allow a tension-free primary lip repair. This report describes the fabrication of a premaxillary bonnet appliance with silicone material and its successful use in 2 cases of bilateral cleft lip and palate (BCLP). PATIENTS, PARTICIPANTS: Two male BCLP patients of ages 34 days and 10 days, respectively. INTERVENTIONS: Nonsurgical repositioning of the premaxillary segment using silicone cup-bonnet appliance. RESULTS: The duration of active treatment by silicone appliance was 36 days in case 1 and 75 days in case 2. The retention period was 2 months and 3 months, respectively. The appliance made of room temperature vulcanizing (RTV) silicone is flexible and softer in comparison to the rigid conventional acrylic appliance and is therefore almost atraumatic. A gentler appliance resulted in enhanced compliance and acceptance by the neonates. There was a noticeable change in the position of the discernible asymmetric premaxilla. Analysis of frontal facial photographs revealed an angular change in the position of the premaxilla (C) by 12° in case 1 and 6° in case 2 in reference to the midfacial plane. CONCLUSION: This silicone appliance provides enhanced compliance and improved retention compared to acrylic appliance since it is a more gentle, flexible, and less traumatic alternative to a rigid acrylic appliance. Further, the RTV silicone appliance can be 3-dimensionally printed for better accuracy following intraoral scanning and thus eliminating the need for impression making in cleft newborns.

Report from a symposium on accelerating policy-driven action against excessive sugar consumption for the prevention of early childhood caries and noncommunicable diseases.

Dental diseases and other noncommunicable diseases (NCDs) share common risks. Omnipresent and easily available sugars are a contributing risk factor for overweight, obesity, and diabetes. In addition, sugar consumption is known to cause dental caries in early childhood (early childhood caries) and in adults. It has been noticed that the prevalence of NCDs is increasing each year, leading to 70% of deaths. A symposium of diverse academicians was convened to identify the gaps in evidence, policy, and advocacy for action on sugars, emphasizing on its detrimental effects on oral health. Existence of policies on sugars, experiences of other countries, feasibility in India, and the role of public health dentists, public, and stakeholders were discussed. Policy priorities in India and advocacy to strengthen action against inappropriate sugar intake could help address the growing burden of sugar-related NCDs. Recommendations to this end were put forth by the panel of experts.

Quantitative Evaluation of Pentraxin-3 in Peri-Miniscrew Implant Crevicular Fluid in Patients Undergoing Orthodontic Treatment: A Prospective Study.

OBJECTIVE: To assess the levels of Pentraxin-3 (PTX3) in peri-miniscrew implant crevicular fluid (PMICF) before and after orthodontic force application Material and Methods: This study included 40 miniscrew implants (MSI) sites in 11 orthodontic patients with high arch discrepancy requiring first premolar extraction using maximum anchorage mechanics for the retraction of anterior teeth. After alignment, the en-masse anterior retraction was carried out using the MSI-supported direct anchorage method. PMICF was collected from the crevice of MSI using Periopaper strips 1.2µl (Oraflow Inc. USA) after one hour, 24 hours, and three weeks of MSI insertion and after one hour, 24 hours, seven days, three weeks, and six weeks of the force application. Samples were quantitatively analyzed for PTX3 levels through enzyme-linked immunosorbent assay (ELISA). RESULTS: The trend in the change of PTX3 levels was evaluated using the Wilcoxon signed-rank test. The mean concentration of PTX3 immediately after MSI insertion was 1.19 ng/ml, significantly higher than after 3 weeks after MSI insertion (0.72 ng/ml), which may correspond to the baseline. After loading, the mean PTX3 concentration increased significantly with the peak at 24 hrs (1.28 ng/ml), followed by a gradual decline till the completion of the study (0.5 ng/ml). CONCLUSION: After MSI insertion, a rise in PTX3 levels in PMICF suggests an underlying inflammatory process. The slow decline in PTX3 level and return to the baseline after loading suggests an adaptive bone response to the stimulus.

Muscle response during treatment of Class II Division 1 malocclusion with Forsus Fatigue Resistant Device.

PURPOSE: To evaluate the muscle response in order to determine the mechanism of neuromuscular adaptations with Forsus Fatigue Resistant Device which has greater elasticity and flexibility; allows greater range of movement of mandible; is available in prefabricated assembly of springs, tubes and rods and is a simple, effective and reliable corrective appliance that benefits not only growing patients but also malocclusions that previously required extractions, headgears and surgery. METHOD: Bilateral EMG activity from anterior temporalis and masseter muscles was monitored longitudinally on 10 young growing females with Class II Division 1 malocclusion to determine changes in postural, swallowing, and maximal voluntary clenching over an observation period of 6 months. RESULTS: There was a significant decrease in the muscle activity at one month after Forsus Fatigue Resistant Device insertion during swallowing of saliva and maximal voluntary clenching which gradually returned to pre treatment levels at the end of six months. CONCLUSION: This study suggests that Forsus Fatigue Resistant Device should be given for at least six months to allow for adequate neuromuscular adaptations to occur for long-term stability of the result.

Saliva and COVID 19: Current dental perspective.

Oral health care providers are at a higher risk of being infected by novel coronavirus due to close proximity to patient's face and exposure to saliva while working on the patient. Thus, there is an urgent need to interpret the available literature in order to establish safe practices for dental professionals as well as limit the spread of infection through saliva. The study intends to provide up-to-date, compiled evidence-based information related to saliva and its association with COVID-19. It further provides suggestions for safe practices in dentistry in current pandemic times. Oral symptoms may be strongly suggestive of early diagnosis and disease progression in COVID-19 patients. Viral loads in saliva are reported higher than standard nasopharyngeal swabs in few studies, majorly in the 1st week of symptom onset. Besides, salivary diagnostics has many additional advantages of being noninvasive, comfortable to the patients with the possibility of point-of-care testing for diagnosing COVID-19. High-efficiency particulate arrestor filter, rubber dam application and high-volume evacuator can reduce spatter and droplets/aerosol production. Povidone-iodine-based mouthwash maybe mouthwash of choice before any dental examination or procedures due to its ability to decrease severe acute respiratory syndrome- coronavirus 2 viral loads in the mouth. Salivary diagnostics related to COVID-19 should be integral part of dental teaching programs. There is a tremendous scope to study saliva in health and diseases.

Metallothionein levels in gingival crevicular fluid, saliva, and serum of smokers and non-smokers with chronic periodontitis.

BACKGROUND: Metallothionein (MT), a cysteine rich protein is involved as a radical scavenger in several pathological conditions associated with oxidative stress; however, its role in periodontal disease still remains elusive. The aim of this cross-sectional study is to determine the serum, saliva and gingival crevicular fluid (GCF) levels of MT in smokers (S) and non-smokers (NS) with chronic periodontitis (CP), and compare them with those of periodontally healthy (PH) individuals. METHODS: A total of 85 participants were enrolled: 45 patients with CP (23 S [CP+S] and 22 NS [CP+NS]) and 40 PH individuals (20 S [PH+S] and 20 NS [PH+NS]). In all the study participants, clinical periodontal parameters (plaque index, gingival index, sulcus bleeding index, probing depth, and clinical attachment level) were recorded and samples of serum, saliva and GCF were collected. Enzyme-linked immunosorbent assay was used to determine the levels of MT in the samples. RESULTS: All periodontal clinical parameters were significantly higher in the CP groups as compared to PH groups (P < 0.05). MT levels in CP+S group were significantly raised in comparison to other three groups. There was no statistically significant difference in MT levels among CP+NS and PH+S groups (P > 0.05); however, relatively higher levels were observed in GCF and saliva in CP+NS group. When all the study groups were observed together, MT levels were positively correlated with clinical parameters. CONCLUSIONS: Results of present study suggest that smoking and CP can induce the synthesis of MT owing to increased oxidative stress and heavy metals intoxication. Further longitudinal studies with large sample size and an interventional arm are needed to substantiate the role of MT as a potential biomarker in periodontitis.

Stress distribution in the temporomandibular joint after mandibular protraction: a 3-dimensional finite element method study. Part 1.

INTRODUCTION: This study was designed to evaluate patterns of stress generation in the temporomandibular joint after mandibular protraction, by using a 3-dimensional finite element method. The results of the initial investigation are reported here in Part 1. The effects of varying the construction bite are reported in Part 2. METHODS: A 3-dimensional computer-aided design model was developed from the magnetic resonance images of a growing boy (age, 12 years), by using I-DEAS NX (version 11.0, Siemens PLM Software, Plano, Tex). The model simulated mandibular protraction, with 5 mm of sagittal advancement and 4 mm of vertical opening. Stress distributions on the condylar neck, the glenoid fossa, and the articular disc in the anteroposterior and mediolateral directions were assessed. RESULTS: Tensile stresses were located on the posterosuperior aspects and compressive stresses on the anterior and anterosuperior aspects of the condylar head. Tensile stresses were found in the posterior region of the glenoid fossa near the attachment of the posterior connective tissues. CONCLUSIONS: These results suggest that, on mandibular protraction, the mandibular condyle experiences tensile stresses in the posterosuperior aspect that might help explain condylar growth in this direction. Similarly, on the glenoid fossa, tensile stresses are created in the region of posterior connective tissues; this might be correlated with the increased cellular activity in this region. Further study with variable vertical heights of the construction bites is needed.

Stress distribution in the temporomandibular joint after mandibular protraction: a 3-dimensional finite element study. Part 2.

INTRODUCTION: Patterns of stress generation in the temporomandibular joint (TMJ) after mandibular protraction with a construction bite of 5 mm advancement and 4 mm opening were investigated by using a 3-dimensional finite element method; the results were reported in Part 1. In Part 2, the effects of varying the construction bite are reported. METHODS: A 3-dimensional computer-aided design model was developed from the magnetic resonance images of a growing boy (age, 12 years), by using I-DEAS NX (version 11.0, Siemens PLM Software, Plano, Tex). Sagittal advancement was 5 mm, as in Part 1; however, the vertical openings of the construction bite were changed from 4 mm to 2 and 6 mm. The stresses thus obtained were compared for differences in magnitude and pattern. RESULTS: Tensile stresses migrated more posteriorly on the condylar head with increased bite height. The locations of the tensile stresses in the glenoid fossa were similar in all simulations. The TMJ as a whole showed increased loading with the increasing vertical openings. CONCLUSIONS: This study indicates that increasing the construction bite height might give more favorable stress patterns in the TMJ, thereby improving the condylar response to functional appliances. The findings of this preliminary study need to be investigated in an animal model and in humans before deriving clinical implications.

Effectiveness of an integrated perinatal oral health assessment and promotion program on the knowledge in Indian pregnant women.

BACKGROUND: Oral health during pregnancy plays a crucial role in the overall health and well-being of pregnant women. Evidence shows that most young children acquire cariogenic organisms from their mothers. Poor maternal knowledge about oral diseases combined with inappropriate feeding can lead to severe caries among young children. The aim of study was to assess the oral health status of pregnant women and to evaluate the gain in their knowledge after educational session in an antenatal setting. MATERIALS AND METHODS: It is a pre- and post-intervention study carried out on the pregnant women (n = 198) attending an antenatal clinic in a tertiary care hospital. A specially designed semi-structured 14-point questionnaire was used to assess the pre- and post-knowledge and attitude to the oral health. Each participant was educated for self and infant oral care with the help of a specially prepared colored printed booklet. Kruskal-Wallis test was used to explore the associations between the age, education and socioeconomic class and knowledge; Wilcoxon signed-rank test was used to compare pre- and post-knowledge score. RESULTS: Median preoral health knowledge-attitude score was found to be 4 (0-8) and was found to be associated with the level of education (P = 0.014) and socioeconomic class (0.019). There was a significant improvement in the median postknowledge score to 7 (2-10) (P < 0.001) following oral health educational session in all categories. CONCLUSIONS: An integrated preventive oral health checkup and educational program to pregnant women can benefit the dental health of the women and children. Prenatal care workers can be involved to disseminate the oral health awareness to pregnant women during antenatal visits.

Bio-functionalization of grade V titanium alloy with type I human collagen for enhancing and promoting human periodontal fibroblast cell adhesion - an in-vitro study.

Surface modification of medical grade V titanium alloy (Ti-6Al-4V) with biomolecules is an important and vital step for tailoring it for various biomedical applications. Present study investigates theinfluence of type I human collagen (T1HC) bio-conjugation through a three stage process. Polished grade V titanium alloy discs were functionalizedwith free OH group by means of controlled heat and alkali treatment followed by coating of 3-aminopropyltriethoxy (APTES) silane couplingagent. T1HC were bio-conjugated through 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide hydrochloride N-hydroxysuccinimide (EDCNHS)coupling reaction. At each stage, grade V titanium alloy surfaces were characterized by atomic force microscopy (AFM), scanning electronmicroscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and Xrayphotoelectron spectroscopy (XPS). FTIR and XPS studies confirms thecovalent attachment of APTES with titanium alloy surface while terminalamine groups of APTES remained free for further attachment of T1HCthrough covalent bond. Aqueous stability of bio-conjugated titanium discsat various pH and time intervals (i.e. at pH of 5.5, 6.8 and 8.0 at timeinterval of 27 and 48h) confirmed the stability of T1HC bioconjugated collagen on titanium surface. Further human periodontalfibroblast cell line (HPdlF) culture revealed enhanced adhesion on theT1HC bio-conjugated surface compared to the polystyrene and polishedgrade V titanium alloy surfaces.