Lip Print Pattern among Children Visiting Dental Out patient department.

BACKGROUND: Lip print patterns are unique in every individual. The uniqueness of lip print pattern assists in the personal identification. The objectives of the present study were to study the different lip print patterns among the children visiting Kanti Children's Hospital, and to compare the distribution of lip print patterns based on gender and race. METHODS: A cross-sectional study was conducted among 300 children visiting the Dental Outpatient Department of Kanti Children's Hospital, Kathmandu, Nepal. Convenience sampling method was used to choose the study subjects. Digital photography method was used to record the image of lips. RESULTS: The study showed 'Long vertical' (Type I) as the most frequent (41%) type of lip print pattern, whereas 'Unspecified' (Type V) was the least frequent (2.7%) type. Prevalence of 'Type I' pattern was significantly higher in males as compared to females (p=0.007) whereas prevalence of 'Type IV' pattern was significantly higher in females as compared to males (p=0.006). 'Type I' pattern was the commonest lip print pattern among both Caucasians and Mongolian, whereas 'Type V' (2%) and 'Type IV' (3.7%) were the least common lip print patterns in Caucasians and Mongolian children respectively. CONCLUSIONS: 'Long vertical' (Type I) was the most common lip print pattern among the children visiting the Dental Outpatient Department of Kanti Children's Hospital, Kathmandu, Nepal. Nevertheless, in higher or lesser numbers, all kinds of lip print patterns as described by Suzuki and Tsuchihashi were seen in the study population.

Does BRAF mutation status and related clinicopathological factors affect the recurrence rate of ameloblastoma? A systematic review, meta-analysis and metaregression.

OBJECTIVES: This review aims to analyse the recurrence rate in BRAFv600e+ and BRAFv600e- ameloblastomas and explore its association with clinicopathological variables. METHODS: A comprehensive search was conducted using databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, Google Scholar and grey literature, without any limitation on start date or language up to 20 June 2023. A random effect meta-analysis was conducted and Metaregression analyses were performed based on available clinicopathological factors. RESULTS: Fifteen studies met the criteria for meta-analysis of outcomes. There was no significant difference in overall recurrence rates between the two groups (risk difference = 0.001, p-value = 0.987). Increasing male:female ratio in the BRAFv600e+ group was associated with a lower reported recurrence, suggesting a higher recurrence rate in females. The odds of having mandibular lesion were four times higher in BRAFv600e+ cases compared to BRAFv600e- cases (confidence interval: 2.121-7.870, p < 0.001, I2 = 28.37%). CONCLUSION: Within the BRAFv600e+ group, females showed a higher reported recurrence rate. This specific clinical group may benefit from BRAFv600e mutation investigation and potential upscaled surgical treatment and additional BRAF inhibitor therapy, which needs validation in future studies.

Microbial Spectrum of Complete Denture Wearer in Old Age People of Chitwan.

BACKGROUND: Human oral cavity contains many microorganisms, the habitat of which may be changed by complete denture among edentulous people. The complete dentures favor aggregation of microorganism. The aim of this study was to identify the microorganisms present in the complete dentures of old age people of Chitwan and assess the sensitivity pattern of the microorganisms to the common antibiotics. METHODS: A descriptive cross-sectional study was conducted at Chitwan Medical College, Chitwan, Nepal among 45 old age people who have been wearing dentures above one year. The duration of the study was from 18th Nov 2021 to 12th May 2022. Swab was taken from the polished and tissue surfaces of both maxillary and mandibular dentures in the Department of Prosthodontics while the laboratory-based experiments were conducted in the Department of Microbiology. Antibiotic sensitivity was also done. The data was analyzed using Statistical Package for Social Science (SPSS) version 16.0. Descriptive statistics were used. The data was presented in form of frequency, percentage, mean and standard deviation. RESULTS: Streptococcus spp. was predominant microorganism followed by Coagulase-negative Staphylococci and Staphylococcus aureus. The highest sensitivity pattern was observed to Amikacin, Nalidixic acid and Ciprofloxacin while the most resistant antibiotics were Amoxicillin/clavulanic acid and Cefixime. Escherichia coli was sensitive to all the tested antibiotics. CONCLUSIONS: In this study, Streptococcus spp. followed by Coagulase-negative Staphylococci and Staphylococcus aureus were the most frequently identified microorganisms from the dentures of old age people. Amikacin, Nalidixic acid and Ciprofloxacin were highly sensitive among the people of old age.

Is the Pre-Shaping of an Orbital Implant on a Patient-Specific 3D-Printed Model Advantageous Compared to Conventional Free-Hand Shaping? A Systematic Review and Meta-Analysis.

This study aimed to perform a systematic review and meta-analysis to compare pre-shaped implants on a patient-specific 3D-printed (3DP) model to manual free-hand shaping (MFS) for orbital wall reconstruction. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42021261594). A search was conducted in MEDLINE (PubMed), Embase, Cochrane Library, Clinicaltrials.gov, Google Scholar, and the grey literature. Ten articles were included, and six outcomes were analyzed. In total, 281 patients were in the 3DP group and 283 were in the MFS group. The studies had an overall high risk of bias. 3DP models resulted in a better accuracy of fit, anatomical angle reproduction, and defect area coverage. The correction of orbital volume was also superior with statistical significance. There was a higher percentage of the correction of enophthalmos and diplopia in the 3DP group. Intraoperative bleeding and hospital stay were reduced in the 3DP group. The meta-analysis of operative time showed a reduction in the average operative time by 23.58 min (95% CI: -43.98 to -3.19), which was statistically significant (t(6) = -2.8299, p = 0.0300). The 3DP models appear advantageous for an accurate orbital wall reconstruction, with fewer complications than those for conventional free-hand-shaped implants.

Advances in Tissue Engineering of the Temporomandibular Joint Disc: An Overview of Current Status and Future Directions.

Advances in tissue engineering have progressed to potentially offer a solution to temporomandibular joint disc (TMJ) disorders not amenable to conservative therapies. Conclusive treatment options for patients with end-stage disc disorders requires discectomy and reconstruction of the articular disc with various materials. Tissue engineering TMJ disc is a promising alternative to the limited and sometimes inadequate clinical options in the management of such disorders. However, tissue engineering is far from completion for the TMJ disc regeneration. This review briefly discusses the properties of native disc, the mechanism by which TMJ disorders manifest, and how a tissue engineered disc could assuage the problems inherent in the management of such disorders. Furthermore, the review addresses and provides updates to relevant themes of tissue engineering in regards to the TMJ disc, namely, the scaffolds, cells and biomarkers, hurdles in tissue engineering of the disc, and its application in translation to the clinical practice and future directions.

Perception Regarding Tooth Carving Using wax Block among the Dental Practitioners.

BACKGROUND: The various pedagogical methods applied for teaching dental anatomy to dental students includes lectures, analysis of extracted natural teeth and carving of wax blocks to accurately replicate the morphology of teeth. The thorough knowledge of dental morphology is indispensable for a successful dental practice. This study was thus aimed to assess the perceived relevance of tooth carving using wax block among the dental practitioners. METHODS: A cross-sectional study was designed with the objective of involving dental practitioners working in Kathmandu. Self-administered questionnaires were used for the data collection. The results were later analyzed for descriptive statistics using the Statistical Package for the Social Sciences (SPSS) 16 software. RESULTS: About 232 (98.3%) participants practiced tooth carving using wax block to study dental anatomy. More than 96% of the participants agreed that tooth carving exercises have helped them better understand tooth morphology and more than 85% feel that their manual dexterity was developed by these exercises. A total of 223 (94.5%) were of the opinion that tooth carving should be continued in the BDS preclinical curriculum. CONCLUSIONS: The dental wax carving is an effective pedagogical strategy to develop manual dexterity of dental students by recreating tooth morphological features using a wax block, thereby achieving the mandatory psychomotor skills.

Is manual reduction adequate for intraoperative control of occlusion during fixation of mandibular fractures? A systematic review and meta-analysis.

The aim of this systematic review was to find out if manual intraoperative control of occlusion is adequate for the reduction of mandibular fractures in comparison with intermaxillary fixation (IMF). We searched PubMed, Embase, the Cochrane Library and Clinical Trials Registry, and the references of included trials. Our primary outcomes of interest were the reduction of fracture anatomically and radiographically, occlusal disturbances, and the incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operating time and infective complications. Of the 257 studies retrieved (manual reduction = 136, IMF = 121), four were included. The studies had an unclear risk of bias. Nevertheless, the overall effect was statistically significant and in favour of manual reduction, with a lower number of adverse events in the manual reduction group (n = 43) than in the IMF group (n = 78), odds ratio 0.42 (95% CI 0.27 to 0.64). An absolute reduction in adverse events was seen in occlusion disturbances (120 fewer/1000), revision procedures (164 fewer/1000), and infective complications (178 fewer/1000). The evidence to support manual reduction over IMF for the intraoperative control of fracture fragments and occlusion was derived from few studies with an unclear risk of bias, and the quality was low. The results were not different when condylar fractures were present. The overall certainty of evidence was moderate. Clinicians should select the appropriate technique based on the injury pattern, and the treating surgeon's experience and available resources.

How effective is 5-Fluorouracil as an adjuvant in the management of odontogenic keratocyst? A systematic review and meta-analysis.

Odontogenic keratocyst (OKC) is known for its benign but aggressive clinical behaviour, and presents a challenge in its management due to high recurrence rate following surgical intervention. The sourcing of Carnoy's solution, the widely used adjunct in OKC treatment, has lately become difficult especially after its banning by the United States Food and Drugs Agency (FDA). This has generated interest in exploring alternative chemical agents such as 5-Fluorouracil (5-FU) and Modified Carnoy's solution (MCS). We conducted a systematic review and meta-analysis to assess the effectiveness of 5-FU as an adjunct following surgical intervention of OKC. A protocol was registered in PROSPERO prior to the literature search. All studies reporting the use of 5-FU in OKC treatment were included in the initial search of multiple literature databases. Of the 148 initially identified articles, three met the criteria for the final appraisal. The relevant data were extracted and a meta-analysis was undertaken in relation to recurrence rate and nerve paraesthesia. There were no recurrence observed in cases treated with 5-FU (n=56), and the incidence of nerve paraesthesia was 20% (none permanent). This systematic review has revealed early encouraging results for 5-FU as an adjunct, however a caution is recommended due to overall low quality of evidence related to individual studies. We present the cumulative evidence on the effectiveness of 5-FU in OKC treatment with discussion on its mechanism of action, safety profile, application protocol, and the implications for clinical practice.

Transport distraction osteogenesis compared with autogenous grafts for ramus-condyle unit reconstruction in temporomandibular joint ankylosis: a systematic review and meta-analysis.

This systematic review was planned to assess the clinical outcomes of transport distraction osteogenesis (TDO) compared with autogenous grafts for reconstruction of the ramus condyle unit (RCU). We searched Medline, Embase, Cochrane Library, Clinicaltrial.gov, and the references of included trials. The primary outcome was maximal incisal opening (MIO). Of the 148 studies retrieved, five were included (TDO = 49, autogenous grafts =123). The mean difference in MIO between TDO and autogenous graft RCU reconstruction, based on the random-effects model was 1.28 mm (95% CI 0.167 to 2.403) in favour of TDO. Re-ankyosis was observed in four cases in the costochondral graft group and none in the TDO group. Reconstruction of the RCU using TDO is comparable to autogenous grafts after the release of TMJ ankylosis, though the evidence is weak considering the small number of trials, high risk of bias, and absence of long-term results.

Mean Attitude Score Regarding Dental Floss among Dentists in a District of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Oral health is an inherent part of the overall individual's general health. Good oral hygiene practices are widely considered essential in maintaining good oral health and flossing has long been considered an indispensable part of an effective oral hygiene routine. This study aimed to find out the mean attitude score regarding dental floss among dentists. METHODS: A descriptive cross-sectional study was conducted among 142 dentists practicing in a district of Nepal from February 2020 to April 2020. Convenience sampling was performed to reach the sample size of 142. Data was collected through both self-administered and online questionnaires sent through google forms after ethical approval from the Institutional Review Committee (Reference number: IRC/076/077-131). Data analysis was done by using Statistical Package for Social Sciences version 20.0 software. Point estimate at 95% confidence interval was calculated along with mean, standard deviation, frequency, and proportion. RESULTS: The mean attitude score regarding dental floss among dentists was 53.77±4.01 (53.11-54.42 at 95% Confidence Interval). Positive attitude was observed in the majority of dentists 120 (84.5%). Twenty-two (15.5%) were found to have a neutral attitude and none of them possessed a negative attitude towards dental floss similar to other studies. CONCLUSIONS: Based on results of this study, the mean attitude score regarding dental floss among dentists in our study is similar to the findings of other studies. The majority of dentists were found to have a positive attitude towards dental floss.

Mean Fluoride Concentration in Drinking Water Sources of a Municipality: A Descriptive Cross-sectional Study.

Introduction: Fluoride is essential for the growth and development of teeth and bone. Excess or less fluoride consumption can have harmful effects on our bodies. Fluoride level of 0.5-1.5 mg/l is said to be optimized according to the World Health Organization. The level of fluoride varies among the different geographical regions and water sources. It is essential to find out the fluoride content of various water sources used for drinking purposes. The aim of this study was to find the mean concentration of fluoride in drinking water sources of a municipality. Methods: A descriptive cross-sectional study was conducted in a Municipality. The study was conducted from 1 December 2021 to 30 December 2021 after receiving ethical approval from the Ethical Review Board (Reference number: 1134). Water samples were collected and the fluoride content was estimated using 2-parasulfophenylazo-1,8-dihydroxy-3,6-napthalene-disulfonate colorimetric method. The data collected from the laboratory were calculated and presented in the form of a table. Point estimate and 95% Confidence Interval were calculated. Results: The mean value of fluoride content in 160 collected water samples was 0.369±0.275 mg/l (0.33-0.41, 95% Confidence Interval). Among the different wards, the fluoride content was 0.708±0.27 mg/l in ward number 12 followed by a fluoride content of 0.57±0.19 mg/l in ward number 5. Conclusions: In this study, the mean fluoride levels were lower when compared with similar studies conducted in similar settings. The levels were lower than that recommended by the World Health Organization. The various controlled methods of fluoridation have to be quickly initiated. Other means of fluoride consumption, like the use of fluoridated toothpaste, has to be recommended. Keywords: dental caries; drinking water; fluoride.

Morphology of Maxillary Labial Frenum in Chepang Community of Chitwan.

BACKGROUND: Labial frenum is a fold of mucous membrane whose function is to attach lips and cheek to the alveolar mucosa, gingiva and underlying periosteum. The maxillary labial frenum has lot of variation in shape, size location. This study was aimed to assess the variation of maxillary labial frenum in the indigenous Chepang community of Nepal. METHODS: A descriptive cross-sectional study was conducted among the Chepang community at Madi municipality in Chitwan, Nepal. The clinical examination was done by distending the upper lip upward for viewing. The obtained data was classified according to Mirko and Sewerin classification. Data was entered into Statistical Package for the Social Sciences version 16 and descriptive statistics was performed. RESULTS: All the Chepang participants 102 (100 %) had mucosal type of maxillary frenum. Among the variations normal frenum was mostly present 74 (72.5%). This type was mostly present in male participants 44 (43.1%). Apart from this frenum with nodules and appendix was also observed. CONCLUSIONS: The mucosal type of frenal attachment was prevalent in Chepang Community and normal frenum was the most common type of frenal morphology.

Management of Traumatic Liver Injury in a Tertiary Care Hospital in Nepal.

BACKGROUND: The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment modalities and outcome in patients with liver injuries only and associated injuries outside the liver. METHODS: This was a retrospective study in patients with liver injuries admitted from 1st March 2014 to 31st January 2019 at Chitwan Medical College and Hospital, Nepal. The patients were divided into two groups. Group A consisted of isolated liver injury and Group B liver injury with associated injury of other organs. Data were analysed by using descriptive statistics and Mann-Whitney U test. RESULTS: A total of 61 patients were admitted with liver injury. There were 18 (29.5 %) patients with liver injury alone (group A) and 43 (70.5 %)liver injury associated with other organs (group B). Low grade liver injuries were 48 (78.7 %) and high grade 13 (21.3 %). The operative management was done for one liver injury with biliary peritonitis in group A. In group B, 16 patients required laparotomy and operative management for associated abdomen injuries. CONCLUSIONS: Non-operative treatment modality in hemodynamically stable patients with isolated liver injuries was safe and effective.

Prevalence of Temporomandibular Joint Disorders and its Association with Para Functional Habits in the Patients Attending Tertiary Care Hospital.

BACKGROUND: Temporo-mandibular disorders is a collective term used to describe problems involving muscles of mastication and temporomandibular joint. The study aimed to evaluate the prevalence of temporo-mandibular disorders and its association with parafunctional habits in patients visiting department of dentistry, Patan Academy of Health Sciences. METHODS: A cross-sectional study was carried out among 213 patients coming to Patan Academy of Health Sciences. A screening questionnaire recommended by American Association of Orofacial Pain was used to determine the signs and symptoms of temporo-mandibular disorders. RESULTS: The prevalence of temporomandibular disorders was 31.9 %. The three most common parafunctional habits were chewing gums (32.4 %), mouth breathing (19.7 %) and biting of objects (14.6 %) respectively. Statistically significant association was found between nail biting, grinding of teeth, biting of lips and objects and mouth breathing with signs and symptoms of temporomandibular disorders (p<0.05). Among the signs and symptoms of temporomandibular disorders, getting headaches, neck pain or toothaches often was the most frequent signs of temporomandibular disorders (n=105, 49.3 %). Feeling of recent change in bite was the second most frequent sign reported by 82 participants (38.5 %). CONCLUSIONS: The parafunctional habits between nail biting, grinding of teeth, biting of lips and objects and mouth breathing have statistically significant association with signs and symptoms of temporomandibular disorders.

Establishment of tooth blood supply and innervation is developmentally regulated and takes place through differential patterning processes.

Teeth are richly supported by blood vessels and peripheral nerves. The aim of this study was to describe in detail the developmental time-course and localization of blood vessels during early tooth formation and to compare that to innervation, as well as to address the putative role of vascular endothelial growth factor (VEGF), which is an essential regulator of vasculature development, in this process. The localization of blood vessels and neurites was compared using double immunofluorescence staining on sections at consecutive stages of the embryonic (E) and postnatal (PN) mandibular first molar tooth germ (E11-PN7). Cellular mRNA expression domains of VEGF and its signaling receptor VEGFR2 were studied using sectional radioactive in situ hybridization. Expression of VEGF mRNA and the encoded protein were studied by RT-PCR and western blot analysis, respectively, in the cap and early bell stage tooth germs, respectively. VEGFR2 was immunolocalized on tooth tissue sections. Smooth muscle cells were investigated by anti-alpha smooth muscle actin (αSMA) antibodies. VEGF showed developmentally regulated epithelial and mesenchymal mRNA expression domains including the enamel knot signaling centers that correlated with the growth and navigation of the blood vessels expressing Vegfr2 and VEGFR2 to the dental papilla and enamel organ. Developing blood vessels were present in the jaw mesenchyme including the presumptive dental mesenchyme before the appearance of the epithelial dental placode and dental neurites. Similarly, formation of a blood vessel plexus around the bud stage tooth germ and ingrowth of vessels into dental papilla at E14 preceded ingrowth of neurites. Subsequently, pioneer blood vessels in the dental papilla started to receive smooth muscle coverage at the early embryonic bell stage. Establishment and patterning of the blood vessels and nerves during tooth formation are developmentally regulated, stepwise processes that likely involve differential patterning mechanisms. Development of tooth vascular supply is proposed to be regulated by local, tooth-specific regulation by epithelial-mesenchymal tissue interactions and involving tooth target expressed VEGF signaling. Further investigations on tooth vascular development by local VEGF signaling, as well as how tooth innervation and development of blood vessels are integrated with advancing tooth organ formation by local signaling mechanisms, are warranted.

Nasal Parameters, Nostrils Shapes and Philtral Column Shape: A Morphometric Analysis in Nepalese Medical Undergraduate Students.

BACKGROUND: The nose is a pyramidal shaped structure situated in the midline of midface being attached to the facial skeleton. The shape, size and spatial location of the nose-philtrum-upper lip complex are important from aesthetic point of view. Hence, to study the nasal parameters, shape of nostril and philtrum among the undergraduate students remained as the main aim of this study. METHODS: This was a cross-sectional study enrolling 250 students of age 18-25 years. Nasal height, nasal width was measured and the shape of the nostrils and philtrum was recorded separately for each participant. RESULTS: Out of 250 participants 113 were males and 137 were females. The mean nasal index of male was 75.36 while that of female was 71.72 suggesting that both genders had mesorrhine nasal type. The rectangular shaped nostrils and triangular type of philtrum was the most common types found in the study Conclusions: The study concluded that, the nasal index was mesorrhine type, the nostril was rectangular and the philtrum column was triangular in this study population.

Fibrodysplasia Ossificans Progressiva: A Case Report.

Fibrodysplasia ossificans progressiva is a genetic disorder of the connective tissue differentiation characterized by congenital malformation of the big toes and progressive heterotopic ossification in the extra skeletal tissues like tendons, ligaments, fascia and skeletal muscles leading to permanent disability. The prevalence is one in two million people. During childhood, it may be asymptomatic but in later life, progressive stiffness of major joints renders movement of the individual impossible. Currently, there is no effective treatment for this debilitating disease. Here, we present a case of 27 year old male with clinical and radiological features of fibrodysplasia ossificans progressiva.

Developmentally regulated expression of intracellular Fgf11-13, hormone-like Fgf15 and canonical Fgf16, -17 and -20 mRNAs in the developing mouse molar tooth.

OBJECTIVE: To investigate and compare the cellular expression of non-secreted Fgf11-14 and secreted Fgf15-18 and -20 mRNAs during tooth formation. MATERIALS AND METHODS: mRNA expression was analyzed from the morphological initiation of the mouse mandibular first molar development to the onset of crown calcification using sectional in situ hybridization. RESULTS: This study found distinct, differentially regulated expression patterns for the Fgf11-13, -15-17 and -20, in particular in the epithelial-mesenchymal interface, whereas Fgf14 and 18 mRNAs were not detected. Fgf11, -15, -16, -17 and -20 were seen in the epithelium, whereas Fgf12 and -13 signals were restricted to the mesenchymal tissue component of the tooth. Fgf11 was observed in the putative epithelial signaling areas, the tertiary enamel knots and enamel free areas of the calcifying crown. Fgf15, Fgf17 and -20 were transiently colocalized in the thickened dental epithelium at E11.5. Later Fgf15 and -20 were exclusively expressed in the epithelial enamel knot signaling centers. In contrast, Fgf13 was present in the dental mesenchyme including odontoblasts cell lineage, whereas Fgf12 appeared transiently in the preodontoblasts. CONCLUSIONS: The expression of the Fgf11-13, -15, -17 and -20 in the epithelial signaling centers and/or epithelial-mesenchymal interfaces at key stages of the tooth formation suggest important functions in odontogenesis. Future analyses of the transgenic mice will help elucidate in vivo functions of the studied Fgfs during odontogenesis and whether any of the functions of the tooth expressed epithelial and mesenchymal Fgfs of different sub-families are redundant.