Alignment efficiency and three-dimensional assessment of root resorption after alignment with conventional and copper-nickel-titanium archwires: A randomized controlled trial.

OBJECTIVE: To compare alignment efficiency and root resorption between nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) archwires after complete alignment in mandibular anterior region. METHODS: In this two-arm parallel single-blind randomized controlled trial, forty-four patients with Class I malocclusion with mandibular anterior crowding were recruited form orthodontic clinic of All India Institute of Medical Sciences (Jodhpur, India). Patients were randomly allocated into NiTi and CuNiTi groups, with a 1:1 allocation. Alignment was performed using 0.014-in, 0.016-in, 0.018-in, 0.019x0.025-in archwire sequence in the respective groups, which terminated in 0.019 x 0.025-in stainless-steel working archwire. The primary outcome was alignment efficiency, measured on study models from baseline (T0) to the first, second, third, fourth and fifth-month (T5). Secondary outcome was root resorption, measured from CBCT scans taken at T0 and T5. Mixed-factorial ANOVA was used to compare Little's Irregularity Index (LII). For assessing the proportion of patients with complete alignment at the end of each month, Kaplan-Meier survival curve was built and time to treatment completion was compared between groups using log rank test. Paired t-test was used to assess external apical root resorption (EARR) within groups, whereas independent t-test was used to evaluate LII and EARR between the groups. RESULTS: Twenty-two patients were recruited in each group. One patient was lost to follow-up in the CuNiTi group. No statistically significant differences were observed in alignment efficiency between the groups (p>0.05). Intergroup comparison revealed that the changes in root measurement in three-dimensions were not statistically significant (p>0.05), except for mandibular right central incisor, which showed increased resorption at root apex in NiTi group (p<0.01). CONCLUSION: The two alignment archwires showed similar rate of alignment at all time points. Root resorption measurement did not differ between the NiTi and CuNiTi groups, except for the mandibular right central incisor, which showed more resorption in NiTi group.

Effects of delayed appointments in fixed orthodontic patients due to lockdown during the COVID-19 pandemic.

Objectives: To determine the frequency of orthodontic emergencies and their impact on the treatment progress caused by delayed appointments due to the lockdown during the COVID-19 pandemic. Materials and methods: Two hundred thirty-eight patients undergoing fixed orthodontic treatment participated in this cross-sectional study. A pre-structured questionnaire was divided into six parts (Part A-C comprised of orthodontic emergencies and Part D-F comprised of various adverse effects and impacts on treatment progress). Two specialist orthodontists performed clinical examinations to complete the questionnaire. The final data were expressed as frequency and percentage. Results: Maximum number of patients reported four months after lockdown. Nearly half of the patients reported debonding of at least one of the brackets. Loosening of molar bands and debonding of second molar tubes were observed in 12.6% and 18.9% of patients, respectively. Ligation method failures were reported in 41.2% of the patients. Patients fitted with transpalatal arch/lingual arch skeletal anchorage showed a failure rate of 26.1% and 10%, respectively. Almost 29% of the patient complained of discomfort due to distal wire impingement. Undesired tooth movements were seen in almost 25% of patients. Alignment, space closure, and settling of occlusion were affected in 47.6%, 17.4%, and 35.7% of patients, respectively. Conclusions: This study helps to determine various types of adverse effects that can occur due to delayed appointments. The study's outcomes suggest that clinicians should be prepared to deal with future pandemics or other causes that might lead to delayed appointments.

Interobserver and Intraobserver Reliability of Cephalometric Measurements Performed on Smartphone-Based Application and Computer-Based Imaging Software: A Comparative Study.

Objective: The aim was to compare the reliability of cephalometric analysis using a smartphone-based application with conventional computer-based imaging software. Methods: Pre-treatment cephalometric radiographs of 50 subjects (26 males, 24 females; mean age, 19.2 years; ±4.2) were traced using the OneCeph® application and Dolphin imaging software®. Two independent observers identified seventeen landmarks and measured fourteen cephalometric measurements at an interval of. Interobserver and intraobserver reliability were evaluated using the intraclass correlation coefficient. Student's t-test was used to compare the means of two measurement methods for observer 1 and observer 2. Additionally, the time taken to complete the cephalometric measurements was also compared between the two methods. Results: Good (ICC 0.75-0.90) to excellent (ICC 0.90-1.00) interobserver and intraobserver reliability was observed for all hard and soft tissue measurements with both methods. No significant differences were found between the two measurement methods for both observers (p<0.05). OneCeph application took significantly more time to complete the analysis than Dolphin imaging software (p<0.001). Conclusion: Cephalometric measurements made through a smartphone-based application showed good to excellent interobserver and intraobserver reliability and are comparable with the computer-based software. Therefore, it can be recommended for clinical use. The time taken to complete the cephalometric measurements was more with a smartphone-based application (OneCeph application) compared to computer-based software (Dolphin imaging software).

Rate and anchorage loss during en-masse retraction between friction and frictionless mechanics: A randomized clinical trial.

OBJECTIVE: To compare rate and anchorage loss during en-masse retraction of anterior maxillary teeth between friction mechanics (FM) and frictionless mechanics (FLM). SETTING AND SAMPLE POPULATION: Thirty-eight patients requiring en-masse retraction of protruded anterior maxillary teeth were randomly allocated into FM and FLM groups. METHODS: En-masse retraction with sliding mechanics (FM) using an elastomeric chain was compared with continuous mushroom loop archwire mechanics (FLM). Study models and lateral cephalograms were taken before (T1) and immediately after retraction (T2). The primary outcome was the rate of en-masse retraction. Anchorage loss was the secondary outcome. Intergroup comparison was performed using an independent t test (P < .05). RESULTS: Baseline characteristics were similar between groups. Thirty-six patients completed the trial. Two patients were lost to follow-up in the FLM group. The rate of en-masse retraction did not differ significantly (P = .625) between FM (0.7 mm/mo) and FLM (0.8 mm/mo) groups. The intragroup comparison showed significant anchorage loss in FM (2.28 mm) and FLM (1.13 mm) groups; however, the intergroup comparison showed no statistically significant difference (P = .093). Maxillary first molar showed a statistically significant change in angulation between the two mechanic groups (P < .001). Vertical movement of the maxillary incisor and first molar showed no significant difference between FM and FLM groups (P = .143, P = .546, respectively). CONCLUSIONS: The rate of en-masse retraction and anchorage loss was comparable between the FM and FLM groups. Significant anchorage loss was seen with both mechanics. The result suggests that both the mechanic group require external reinforcement to prevent anchorage loss.

Alignment efficiency and three-dimensional assessment of root resorption after alignment with conventional and copper-nickel-titanium archwires: A randomized controlled trial

ABSTRACT Objective: To compare alignment efficiency and root resorption between nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) archwires after complete alignment in mandibular anterior region. Methods: In this two-arm parallel single-blind randomized controlled trial, forty-four patients with Class I malocclusion with mandibular anterior crowding were recruited form orthodontic clinic of All India Institute of Medical Sciences (Jodhpur, India). Patients were randomly allocated into NiTi and CuNiTi groups, with a 1:1 allocation. Alignment was performed using 0.014-in, 0.016-in, 0.018-in, 0.019x0.025-in archwire sequence in the respective groups, which terminated in 0.019 x 0.025-in stainless-steel working archwire. The primary outcome was alignment efficiency, measured on study models from baseline (T0) to the first, second, third, fourth and fifth-month (T5). Secondary outcome was root resorption, measured from CBCT scans taken at T0 and T5. Mixed-factorial ANOVA was used to compare Little's Irregularity Index (LII). For assessing the proportion of patients with complete alignment at the end of each month, Kaplan-Meier survival curve was built and time to treatment completion was compared between groups using log rank test. Paired t-test was used to assess external apical root resorption (EARR) within groups, whereas independent t-test was used to evaluate LII and EARR between the groups. Results: Twenty-two patients were recruited in each group. One patient was lost to follow-up in the CuNiTi group. No statistically significant differences were observed in alignment efficiency between the groups (p>0.05). Intergroup comparison revealed that the changes in root measurement in three-dimensions were not statistically significant (p>0.05), except for mandibular right central incisor, which showed increased resorption at root apex in NiTi group (p<0.01). Conclusion: The two alignment archwires showed similar rate of alignment at all time points. Root resorption measurement did not differ between the NiTi and CuNiTi groups, except for the mandibular right central incisor, which showed more resorption in NiTi group.

RESUMO Objetivo: Comparar os fios de níquel-titânio (NiTi) e de cobre-níquel-titânio (CuNiTi) quanto à eficiência do alinhamento e quantidade de reabsorção radicular, após alinhamento completo dos dentes da região anterior inferior. Métodos: Neste estudo clínico randomizado, cego, paralelo, de dois braços, quarenta e quatro pacientes com má oclusão Classe I e apinhamento anterior inferior foram recrutados na clínica ortodôntica do All India Institute of Medical Sciences (Jodhpur, India). Os pacientes foram alocados aleatoriamente nos grupos NiTi e CuNiTi, na proporção de 1:1. O alinhamento foi realizado usando a sequência de fios 0,014", 0,016", 0,018" e 0,019" x 0,025" nos respectivos grupos, finalizando com o arco de trabalho 0,019" x 0,025" de aço inoxidável. O desfecho primário foi a eficiência do alinhamento, medida nos modelos de estudo nos tempos inicial (T0) e após um, dois, três, quatro e cinco meses (T5). O desfecho secundário foi a reabsorção radicular, medida a partir de tomografias computadorizadas realizadas em T0 e T5. ANOVA fatorial mista foi utilizada para comparar o Índice de Irregularidade de Little (IIL). Para avaliar a proporção de pacientes com alinhamento completo ao fim de cada mês, foi construída uma curva de sobrevida pelo método de Kaplan-Meier, e o tempo até o fim do tratamento foi comparado entre os grupos por meio do teste log-rank. Um teste t pareado foi utilizado para avaliar a reabsorção radicular apical externa (RRAE) dentro dos grupos, enquanto um teste t independente foi utilizado para avaliar o IIL e a RRAE entre os grupos. Resultados: Vinte e dois pacientes foram recrutados em cada grupo. Um paciente perdeu o acompanhamento no grupo CuNiTi. Não foram observadas diferenças estatisticamente significativas entre os grupos quanto à eficiência do alinhamento (p>0,05). A comparação intergrupos revelou que as alterações na RRAE medida em três dimensões não foram estatisticamente significativas (p>0,05), exceto para o incisivo central inferior direito, que apresentou aumento da RRAE no grupo NiTi (p<0,01). Conclusão: Os dois tipos de fios de alinhamento apresentaram taxa de alinhamento semelhante em todos os momentos. A medida da reabsorção radicular não diferiu entre o grupo NiTi e CuNiTi, exceto para o incisivo central inferior direito, que apresentou maior reabsorção no grupo NiTi.

Caries experience scores revisited for caries risk assessment using cariogram model - A cross-sectional study.

Context: The widely accepted caries risk assessment tools such as the Cariogram model needs modifications in the scoring of different factors for reliable results. Aims: The study was aimed to report the caries experience in 3-60 years of the Rajasthan population and to apply the newly derived average decayed exfoliated filled teeth/Decayed Missing Filled Teeth (deft/DMFT) scores in the Cariogram model to assess the caries risk. Settings and Design: The cross-sectional study was planned in the Department of Dentistry and a total of 500 participants were equally divided into five groups (3-6, 7-12, 13-30, 31-44, and 45-60 years) were included. Methods and Material: All participants were examined for caries detection using deft/DMFT, ICDAS, and CAST indices according to the predefined protocol. A single examiner evaluated the participants in a dental operatory and data was recorded. Statistical Analysis Used: One-Way ANOVA and Tukey's Post-Hoc tests were used to evaluate the significant difference between the groups of each caries index. Results: A statistically significant difference was observed between the mean deft/DMFT and CAST scores of 3-6, 7-12, and 13-30 age groups with the 45-60 years age group. Caries prevalence was highest (83%) in 31-44 and 45-60 year age groups and lowest (51%) in the 3-6 year age group. Conclusions: Caries experience scores increase as the age increases and the highest scores were observed in 31-44 and 45-60 year age groups and the lowest were observed in the 3-6 year age group. The average ICDAS and CAST scores were higher when compared to the deft/DMFT index.

The clinical efficacy of minocycline mouth rinse on recurrent aphthous stomatitis-A randomized controlled trial.

Introduction: Recurrent aphthous stomatitis (RAS) is one of the most common ulcerative diseases affecting the general population. The present study aimed to evaluate the clinical efficiency of 0.5% minocycline mouth rinse prescribed along with the topical anesthetic gel and vitamin supplement over the topical anesthetic gel and vitamin supplement prescribed alone for treating RAS. Materials and Methods: A total of 60 participants were randomly divided into two groups-experimental group: 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel; and control group: vitamin supplement and topical anesthetic gel alone. The pain symptoms were evaluated using the VAS scores at baseline and first follow-up visits. The data were analyzed using Student's t test. Results: A significant reduction in the pain scores was observed in participants using the 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel on the first follow-up visit (P = < 0.001). Conclusion: The 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel had shown more reduction in the pain symptoms when compared to topical anesthetic gel and vitamin supplement prescribed alone for the treatment of RAS.

Efficacy and Safety of Concentrated Growth Factors and Platelet- Rich Fibrin on Stability and Bone Regeneration in Patients with Immediate Dental Implants: A Randomized Controlled Trial.

PURPOSE: Immediate dental implants revolutionized the field of implant dentistry with significant advantages over conventional implants. The lack of adequate bone in the extraction socket raises the question of the appropriate timing of implant loading. Platelet concentrates have been used widely to accelerate bone regeneration in the maxillofacial region. This study evaluates the effect of platelet concentrates on bone healing and implant stability in the maxillary and mandibular molar regions. Bone regeneration is regulated by several growth factors, particularly vascular endothelial growth factor (VEGF) and transforming growth factor-ß1 (TGF-ß1); therefore, quantification of these factors in platelet concentrates and its correlation with bone healing has been assessed in this study. MATERIALS AND METHODS: The primary aim of this randomized clinical trial was to compare the stability of immediate dental implants in the maxillary and mandibular molar regions treated with platelet-rich fibrin (PRF) versus concentrated growth factors (CGF) using resonance frequency analysis (RFA). The secondary objectives were to evaluate the bone regenerate around implants with the use of PRF and CGF and to quantify growth factors VEGF and TGF-ß1 in the prepared CGF and PRF and their correlation with bone healing, if any. A total of 36 patients were randomized into three groups (12 each): control, PRF, and CGF. In all patients, immediate implants were placed either with or without platelet concentrate (PRF or CGF). Implant stability was measured using RFA immediately postoperatively and at 4, 8, and 12 or 16 weeks (12 weeks for mandible and 16 weeks for maxilla) postoperatively. Radiodensity and the bone gap (horizontal/vertical) were measured on intraoral periapical radiographs immediately postoperatively and at 8 weeks and 12 or 16 weeks postoperatively. RESULTS: On comparing the implant stability quotient (ISQ), radiodensity/grayscale (GS), and horizontal and vertical bone gap (HG and VG), there was no significant difference noted between the three groups at any point in time. On ISQ analysis at 8 weeks, the control group showed a significant improvement (P = .04), whereas at 12 or 16 weeks, significant improvement was seen in PRF (P = .03) and CGF groups (P = .02). In GS assessment, only the control group showed significant improvement at 12 or 16 weeks (P = .009). In horizontal and vertical bone gap analysis all three groups showed significant improvement at 8 weeks (control [P < .001], PRF [P = .001], CGF [P = .01]) as well as 12 or 16 weeks (control [P < .001], PRF [P < .001], CGF [P = .006]). The enzyme-linked immunosorbent assay (ELISA) quantification of VEGF and TGF-ß1 showed significant concentration of VEGF in PRF as compared to the plasma, while concentration of TGF-ß1 was found to be comparable in both groups. CONCLUSION: The application of platelet concentrates seems to enhance stability of implants, but intergroup results were nonsignificant at all time points. There was no statistically significant difference between the three groups when comparing quality (radiodensity/grayscale) and quantity (horizontal and vertical gap reduction) of bone regenerate. Studies with larger sample sizes are required to make conclusive assertions regarding efficacy of platelet concentrates in dental implants.

Effectiveness of zirconia crowns compared with stainless steel crowns in primary posterior teeth rehabilitation: A systematic review and meta-analysis.

BACKGROUND: The authors' aim was to evaluate the clinical and radiographic effectiveness of zirconia crowns (ZCs) compared with stainless steel crowns (SSCs) in the rehabilitation of primary posterior teeth. TYPES OF STUDIES REVIEWED: Using predefined combinations of different search terms, the authors searched the standard electronic bibliographic databases-MEDLINE, Embase, Google Scholar, The Cochrane Library, The Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature-and the Trip medical database for randomized controlled trials in which the investigators evaluated the clinical and radiographic effectiveness of ZCs and SSCs. Version 2 of the Cochrane risk of bias tool for randomized trials was used for quality appraisal of the included clinical trials. Random-effects model and Mantel-Haenszel test were used for the statistical analysis of estimated effect sizes. The overall quality of evidence was assessed using GRADEpro GDT software (McMaster University and Evidence Prime). RESULTS: A total of 6 studies were included from the initial 641 results. The overall risk of bias had "low" concerns in 3 studies and "some" concerns in the remaining 3 studies. From the pooled data of the meta-analysis, the authors observed 63 clinical failure events in 497 primary teeth rehabilitated with ZCs or SSCs. Rehabilitation of primary teeth with ZCs may result in fewer clinical failures (risk ratio, 0.48; 95% CI, 0.15 to 1.52; P = .21; I2 = 62%) and probably better gingival health (mean difference, -0.32; 95% CI, -0.42 to -0.23; P < .001; I2 = 0%) than SSCs. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Primary posterior teeth rehabilitated with ZCs may have less risk of experiencing clinical failure and probably better gingival health after 12 months than SSCs. Considering the quality of available literature, no recommendations could be made regarding the effectiveness of ZCs compared with that of SSCs in the rehabilitation of primary posterior teeth. Pediatric dentists should select ZCs or SSCs according to the clinical situation for successful primary teeth rehabilitation. A protocol was registered with the International Prospective Register of Systematic Reviews (CRD42020194363).

Methylmethacrylate Inter-Facetal and Inter-Vertebral Body Spacers for Cranio-Vertebral Junction and Various Spine Surgeries: Technical Note.

STUDY DESIGN: Prospective. PURPOSE: Over past one and half decade, ready-to-use magnetic resonance imaging (MRI) compatible spinal implants have changed the clinical practice and economics of spinal surgery. These are beyond reach of majority of population of developing countries like India due to financial reasons and also availability in remote areas. There is a growing need for a MRI compatible cost-effective spinal implant of proven quality. The authors used bone cement spacers for the said purpose for various level spine surgeries. OVERVIEW OF LITERATURE: Methylmethacrylate, known as bone cement, was used extensively for spinal surgeries from craniovertebral junction to sacrum for augmentation and replacement of various spinal elements. Its biochemical and biomechanical properties were tested for safe clinical use and was a favored material for spinal surgeons. MATERIALS AND METHODS: The authors made molds for making bone cement spacers for various spine levels with the help of silicone material. RESULTS: Sixteen patients (12 males, 4 females with an average age of 31 years) of various spine level surgeries were done where bone cement spacers were used. It included patients of basilar invagination (n = 9), dorsal Pott's disease (n = 1), lumbar (n = 2), and lumbo-sacral spondylolisthesis (n = 1). Spacers could be used without any difficulties and postoperative day 1- and 3-months follow-up computed tomography scan of the patients revealed no change in the dimensions of the spacer and fusion at 3 months of operated levels. CONCLUSION: The authors feel that bone cement spacers may be an effective and low-cost alternative to the existing costly alternatives.

BCG vaccination impact on mortality and recovery rates in COVID-19: A meta-analysis.

COVID-19 is a pandemic caused by SARS-CoV-2 virus which is a very worrisome public health emergency. In this study, we compared the mortality rate and recovery rate in countries with and without BCG vaccination policy. The data of mortality of COVID-19 was extracted from worldometer (https://www.worldometers.info/coronavirus/) on 26th July 2020. The data of countries where BCG vaccination is being done for all individuals is taken from BCG world atlas (http://www.bcgatlas.org/index.php), updated in 2017. BCG vaccination policy recommended countries are intervention group versus countries without BCG vaccination policies which are regarded as control group. Pooled analysis of countries with and without BCG vaccination policy revealed mortality rate of 1.31% (95%CI - 1.31% to 1.32%; I2 = 100%, p<0.01) and 3.25% (95%CI - 3.23% to 3.26%; I2 = 100%, p<0.01), respectively. The recovery rates in two country groups were found to be 72.60% (95%CI - 72.57% to 72.63%) and 55.94% (95%CI - 55.90% to 55.98%), respectively. 52 individuals need to be BCG vaccinated to prevent one death (NNT = 52). In BCG vaccination program countries, there is statistically and clinically significant less mortality (p<0.001) as compared to countries without BCG policy. Our findings corroborate the hypothesis that BCG vaccination may provide protection from COVID-19. High quality evidence from randomised controlled trials are required to establish causality between BCG vaccination and protection from severe COVID-19.

Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis.

OBJECTIVES: Evaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19. DATA SOURCES: Electronic search for eligible articles of PubMed, Cochrane Central and clinicaltrials.gov was performed on 20 September 2020. PARTICIPANTS AND STUDY ELIGIBILITY CRITERIA: Only randomised controlled trials (RCTs) evaluating efficacy of remdesivir in COVID-19 were included for meta-analysis. INTERVENTIONS: Remdesivir was compared with standard of care. PRIMARY AND SECONDARY OUTCOMES: Primary outcome was mortality and secondary outcomes were time to clinical improvement and safety outcomes like serious adverse events, respiratory failure. STUDY APPRAISAL AND SYNTHESIS METHODS: Data synthesis was done with Cochrane review manager 5 (RevMan) V.5.3. Cochrane risk of bias V.2.0 tool was used for methodological quality assessment. The GRADE pro GDT was applied for overall quality of evidence. RESULTS: 52 RCTs were screened and 4 studies were included in analysis, with total of 7324 patients. No mortality benefit was observed with remdesivir versus control group (OR=0.92 (95% CI 0.79 to 1.07), p=0.30, moderate quality evidence). Significantly higher rates of clinical improvement (OR=1.52 (95% CI 1.24 to 1.87), p<0.0001, low quality) and faster time to clinical improvement (HR=1.28 (95% CI 1.12 to 1.46), p=0.0002, very low quality) was observed with remdesivir versus control group. Significant decrease was found in the risk of serious adverse events (RR=0.75 (95% CI 0.62 to 0.90), p=0.0003, low quality); however, no difference was found in the risk of respiratory failure (RR=0.85 (95% CI 0.41 to 1.77), p=0.67, very low quality evidence) with remdesivir. CONCLUSIONS: As per the evidence from current review, remdesivir has shown no mortality benefit (moderate quality evidence) in the treatment of COVID-19. From a cost-benefit perspective, it is our personal opinion that it should not be recommended for use, especially in low and lower middle income countries. TRIAL REGISTRATION NUMBER: PROSPERO registration number: CRD42020189517.

Clinical Post-operative Bleeding During Minor Oral Surgical Procedure and In Vitro Platelet Aggregation in Patients on Aspirin Therapy: Are they Coherent?

AIM: The risk of excessive bleeding prompts physicians to discontinue aspirin in patients on low-dose, long-term therapy which in turn puts them at the risk from adverse cardiovascular and thrombotic events. Effect of low-dose aspirin therapy on platelet function was assessed using platelet aggregation method. The aim was to correlate the laboratory platelet function with cutaneous and clinical oral bleeding time (BT). MATERIALS AND METHODS: One hundred one patients were enrolled in this prospective trial and were allocated into two groups. Interventional or test group consisted of patients who were on aspirin therapy (75 mg/100 mg) for primary or secondary prevention of angina, myocardial infarction and stroke. Minor oral surgical procedure was performed in this group without discontinuing aspirin therapy. Control group consisted of healthy patients (under no medication) undergoing minor oral surgical procedure. Cutaneous and clinical oral BT were recorded in both the groups. Venous blood sample was drawn, and percentage platelet aggregation function was analysed using adenosine diphosphate (ADP) and arachidonic acid (AA) reagents. The percentage of platelet aggregation was then correlated with cutaneous and clinical oral BT. RESULTS: A significant decrease in percentage platelet aggregation using ADP (aspirin-74.7 21.39; control-89.2 13.70) and AA (aspirin-47.6 23.11; control-82.3 20.17) was observed. However, there were no significant difference in mean cutaneous BT (aspirin-1.5 0.65 min; control-1.6 0.71 min) and clinical oral BT (aspirin-5.0 2.48 min; control-4.8 2.60 min) in aspirin and control groups. CONCLUSION: Majority of the minor oral surgical procedures can be carried out safely without discontinuing aspirin in patients on low-dose long-term therapy. This is possible because despite significant platelet aggregation evident in laboratory evaluation there is lack of its clinical corroboration owing to aspirin resistance. CLINICAL TRIAL REGISTRATION: CTRI/2018/02/012055.

Unisystem Langerhans cell histiocytosis in maxillofacial region in pediatrics: comprehensive and systematic review.

BACKGROUND: The study aimed to identify, enlist, and analyze cases of unisystem LCH in the maxillofacial pediatric population to understand the clinical presentation and encourage the consideration of this rare disease in the differential diagnosis. Langerhans cell histiocytosis (LCH) is an aggressive benign condition affecting mainly the pediatric population. It can be easily masked as periodontal disease in the maxillofacial region. Early diagnosis and a systemic evaluation are of utmost importance. METHODOLOGY: We are presenting a complete review of literature in the pediatric population according to PRISMA guidelines for clinicopathologic, histopathological, immunohistochemistry, and treatment for unisystem LCH. The risk of bias assessment across studies was done using a Case series appraisal checklist by Guo et al. 53 RESULTS: Forty-nine articles (152 cases) were selected which met our inclusion and exclusion criteria to be included in our review. Most of the patients fall in 6-12 years of age with the involvement of the mandibular body region in 40.79% cases. This disease mainly presents as erythematous gingiva, pain, swelling, and mobile teeth. Management can range from minimal intervention to chemotherapy and surgery. CONCLUSION AND PRACTICAL IMPLICATIONS: Although this is a rare condition, it should be considered especially in the pediatric population with periodontitis type lesions and floating teeth and comprehensive management should be followed. Early diagnosis of the disease is very important.

The prevalence of traumatic dental injuries in primary teeth: A systematic review and meta-analysis.

BACKGROUND/AIMS: The varied prevalence of traumatic dental injuries (TDI) in primary teeth around the globe raises a serious knowledge gap in the available literature. The aim of this study was to evaluate the prevalence of TDI in primary teeth and also to evaluate the different factors associated with TDI in primary teeth. MATERIALS AND METHODS: Comprehensive searches were performed in PubMed, Embase, Google Scholar, and The Cochrane Central Register of Controlled Trials with predefined search criteria. The primary outcome was the prevalence of TDI in primary teeth, and the secondary outcomes were the factors associated with TDI in primary teeth. Qualitative analysis was done using the Newcastle-Ottawa scale adapted for cross-sectional studies. The random-effect model was used for meta-analysis, and meta-regression analysis was done to evaluate the heterogeneity between the included studies. Meta-analysis was done using the "meta" package of "R" language. The overall quality of evidence was assessed using GRADEpro GDT software. RESULTS: A total of 24 cross-sectional studies met the inclusion criteria representing 4876 TDIs in 22 839 children aged between 0 and 6 years old. The overall prevalence of TDI in primary teeth was 24.2% (95% CI: 18.24-31.43, P = 0, I2  = 99%). Falls contributed the highest number of TDI - 59.3% (95% CI: 41.05-76.40, P < .01, I2  = 98%) - in primary teeth. The most common type of tooth fracture in primary teeth was an enamel fracture (61.9%), and prevalence of TDI in children with incompetent lip closure was 49.4%. CONCLUSION: The prevalence of TDI in cross-sectional studies of primary teeth was 24.2% with very low quality of evidence. Falls contributed the highest number of TDI in primary teeth, accounting for 59.3%. Children with incompetent lip closure have the highest prevalence (49.4%) of TDI in primary teeth.

The incidence of nickel-titanium endodontic hand file fractures: A 7-year retrospective study in a tertiary care hospital.

AIM: The present retrospective cross-sectional study aims to evaluate the incidence and factors associated with nickel-titanium hand file fractures in root canal-treated teeth in a tertiary care hospital of western India. METHODOLOGY: The diagnostic records of intraoral periapical (IOPA) radiographs were analyzed to check for file fractures in the root canal-treated teeth. As a part of standardized departmental protocol, Hand ProTaper Universal file system (Dentsply, India) was used for chemomechanical preparation for root canal treatment. The file fractures were analyzed with reference to age group, type of teeth, curvature of the canal, site of file fracture in the canal, length of file fracture, level of file fracture, distance of the file fracture from the apex, and obturation status of the file-fractured tooth. Chi-square test was applied to assess the significance difference between the tested groups. RESULTS: A total of 19,810 IOPA X-rays were screened and 2728 root canal-treated teeth were found and of these 2728 cases, 109 file-fractured teeth were observed. CONCLUSION: The total incidence of file fractures was 3.9/100 root canal-treated cases, and mandibular molars with severely curved canals (>25°) had shown the maximum incidence of file fractures.

Evaluation of Stress Pattern Caused by Mini-Implant in Mandibular Alveolar Bone with Different Angulations and Retraction Forces: A Three-Dimensional Finite Element Study.

OBJECTIVE: The objective of the study was to evaluate the stress pattern in cortical and cancellous bones, periodontal ligament, and in the implant itself when a mini-implant (MI) is inserted in the inter-radicular space between mandibular first molar and second premolar at various angulations and different retraction forces. METHODS: Finite element study was conducted with MI insertion at 30°, 45°, 60°, 75°, and 90° angulations in the mandibular posterior region (between second premolar and first molar). At these angulations, horizontal forces of 150, 200, and 250 g were applied to the middle of the MI head. von Mises stress values were then evaluated using the ANSYS software. RESULTS: Highest von Mises stress values were detected in the MI itself, followed by cortical bone, cancellous bone, and periodontal ligament. The von Mises stress values in cortical bone were highest at 30° angulation and lowest at 90° angulation. In the cancellous bone, the stress value was found to be maximum at 90°. The von Mises stress values in the MI were lowest at 90°. In all four structures, as the load increased from 150 to 250 g, the von Mises stress values increased. CONCLUSION: The von Mises stress values in the cortical bone, MI, and periodontal ligament were found to be lowest at 90°. Placement of the MI at 90° appears to be an ideal angulation when applied with a horizontal load. Force range used is within clinically recommended levels; however, the increase in load causes an increase in the stress values.

Critical analysis of methodological quality of systematic reviews and meta-analysis of antibiotics in third molar surgeries using AMSTAR 2.

The clinicians usually prescribe antibiotics to reduce post-operative complications during third molar surgeries. However, in the absence of clear conclusions regarding the use of antibiotics in third molar surgeries, present systematic review was planned to assess the quality of systematic reviews evaluating the efficiency of antibiotics in reducing post-operative complications. The literature search was done in Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, EMBASE, and Google scholar. Systematic reviews published in English during the period from January 1990 to December 2019 were included. The maxillary and mandibular third molars indicated for extraction either because of infection, orthodontic or prophylactic reasons were included. From 526 screened studies, thirteen reviews were qualified for qualitative analysis. The qualities of the included reviews were evaluated using the AMSTAR 2 tool. The included reviews were also evaluated based on the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. One high quality, eight moderate quality, three low quality, and one critically low-quality reviews were observed in the present review. No statistically significant difference was observed between the included reviews based upon the analysis of the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. Considering the observations form the high and moderate-quality reviews, the present systematic review concludes that antibiotics effectively aid in reducing the post-operative complications and frequency of observation of dry socket.

Simple and novel technique for fabrication of prosthetic vaginal dilators.

Vaginal agenesis is one of the major congenital anomalies affecting women. Postoperative prosthetic vaginal dilators are indicated in patients treated surgically for vaginal agenesis. Although different dental materials such as acrylics and silicone-coated materials are used, addition silicones alone have never been used for the fabrication of prosthetic vaginal dilators. Addition silicone materials have advantages, such as high elastic recovery, high tear and tensile strengths, which aid in the definitive use of vaginal dilators. Vaginal dilators fabricated using addition silicone materials act as an efficient prosthesis in terms of function and ease of use in surgically treated vaginal agenesis patients.