The intriguing role of IL33/ST2 axis signaling in oral diseases - A systematic review.

PURPOSE: Oral diseases act as a silent epidemic, and the pathogenetic role of interleukin-33/ suppression of tumorigenicity-2 axis (IL-33/ST2) remains unclear due to a lack of literature. This review has attempted to highlight the importance of this axis in oral diseases, which may be helpful in developing therapeutic modalities required to halt disease progression. MATERIALS AND METHODS: A thorough search was conducted using various databases. Original research articles that assessed both IL-33 and ST2 levels in oral diseases using different techniques were included in the review. The risk of bias for each study was analyzed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and Review Manager 5.4 was used to output the results. RESULTS: In the qualitative data synthesis we included 13 published articles. The most commonly used method was serum estimation, while methods with optimistic results were saliva, real-time quantitative polymerase chain reaction and immunohistochemistry. The predominant mechanism of action was nuclear factor kappa B signaling and type 2 immune response. However, salivary gland epithelial cell activation, activation of mast cells, type 1 immune response, and upregulated angiogenesis are crucial in mediating IL-33/ST2 signaling in oral diseases. CONCLUSIONS: Accumulating evidence demonstrates that the IL-33/ST2 axis is a fundamental pathogenetic mechanism of oral diseases of inflammatory, autoimmune, or neoplastic origin.

An Update on Pharmacological and Phytochemical Aspects of Costus pictus D. Don - A Promising Anti-diabetic Plant.

BACKGROUND: The genus Costus is the largest genus in the family Costaceae and encompasses about 150 known species. Among these, Costus pictus D. Don (Synonym: Costus mexicanus) is a traditional medicinal herb used to treat diabetes and other ailments. Currently, available treatment options in modern medicine have several adverse effects. Herbal medicines are gaining importance as they are cost-effective and display improved therapeutic effects with fewer side effects. Scientists have been seeking therapeutic compounds in plants, and various in vitro and in vivo studies report Costus pictus D. Don as a potential source in treating various diseases. Phytochemicals with various pharmacological properties of Costus pictus D. Don, viz. anticancer, anti-oxidant, diuretic, analgesic, and anti-microbial have been worked out and reported in the literature. OBJECTIVE: The aim of the review is to categorize and summarize the available information on phytochemicals and pharmacological properties of Costus pictus D. Don and suggest outlooks for future research. METHODS: This review combined scientific data regarding the use of Costus pictus D. Don plant for the management of diabetes and other ailments. A systematic search was performed on Costus pictus plant with anti-diabetic, anti-cancer, anti-microbial, anti-oxidant, and other pharmacological properties using several search engines such as Google Scholar, PubMed, Science Direct, SciFinder, other online journals and books for detailed analysis. RESULTS: Research data compilation and critical review of the information would be beneficial for further exploration of its pharmacological and phytochemical aspects and, consequently, new drug development. Bioactivity-guided fractionation, isolation, and purification of new chemical entities from the plant as well as pharmacological evaluation of the same will lead to the search for safe and effective novel drugs for better healthcare. CONCLUSION: This review critically summarizes the reports on natural compounds, and different extract of Costus pictus D. Don with their potent anti-diabetic activity along with other pharmacological activity. Since this review has been presented in a very interactive manner showing the geographical region of availability, parts of plant used, mechanism of action and phytoconstituents in different extracts of Costus pictus responsible for particular action, it will be of great importance to the interested readers to focus on the development of the new drug leads for the treatment of diseases.

Assessment of periodontal status in patients with oral lichen planus.

OBJECTIVE: Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus. METHOD AND MATERIALS: 108 patients comprising 54 with oral lichen planus and 54 age-matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters, ie Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, clinical attachment level, and periodontal phenotype were measured. RESULTS: On comparing the test and control groups, statistically significant differences were observed in respect to Plaque Index (P = .00), Gingival Index (P = .00), and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets was observed in the test group (P = .00). On comparison of various oral lichen planus subtypes, significant difference was observed in respect to Gingival Index (P = .00) and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets (P = .01) and greater CAL (P = .00) was observed in the erosive/atrophic subgroup compared to the reticular group. However, the differences between the reticular (a less severe form of oral lichen planus) and control group in terms of Gingival Index (P = .94), Plaque Index (P = .05), bleeding on probing (P = .17), probing pocket depth (P = .56), and clinical attachment level (P = .23) were not statistically significant. Statistically significant differences were observed in terms of Gingival Index (P = .01) and bleeding on probing (P = .00) between thin and thick periodontal phenotypes in the oral lichen planus group. Statistically significant positive correlations in periodontal parameters with increased gingival involvement and severity were observed using Spearman rank correlation coefficient. CONCLUSION: Significantly greater periodontal inflammation in the test group means there is a risk of greater attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression.

Faces of Fibrodysplasia Ossificans Progressiva: Lessons from a Clinical Masquerader.

OBJECTIVES: To evaluate the natural history and to highlight the possible masqueraders causing diagnostic delay and iatrogenic interventions in Fibrodysplasia Ossificans Progressiva (FOP). METHODS: Patient details with suspected FOP were retrieved from the patient registry from 2012 through 2021. Clinical records, X-rays, clinical photographs, and molecular testing results were captured. Follow-up was recorded where available. RESULTS: A total of 16 patients with a clinical diagnosis of FOP were found. Twelve patients with both clinical and molecular records were included in this study. The median age of onset and diagnosis was 1.5 y and 6.5 y respectively with a median diagnostic delay of 3.5 y. The disease course was progressive in ten patients. Seven out of twelve patients were subjected to invasive procedures due to misdiagnosis, which exacerbated their disease progression. CONCLUSIONS: Clinical suspicion followed by molecular testing is straightforward for a confirmed diagnosis of FOP. It is not only diagnostic, cost-effective, and saves time but also avoids unnecessary interventions in these patients.

Evaluation of risk factors, clinico-radiographic presentations of COVID-associated mucormycosis in the maxillofacial region reporting to a tertiary care dental facility.

Purpose: To evaluate the prevalence of risk factors associated with COVID-associated mucormycosis (CAM) in the maxillofacial region with emphasis on clinical and radiological characteristics of the disease reporting to the dentists. Methods: Archival records of the patients diagnosed with rhino-cerebral mucormycosis through histopathology or culture, were screened and 266 records were included. These records were divided into three groups-previously diabetic (PD, n = 122), recently diagnosed diabetic (RD, n = 105) and non-diabetic (ND, n = 39). All the records were evaluated and compared among the three groups for the duration of presentation, history of co-existing medical conditions, the association of treatment given during COVID-19, and the clinical and radiographic presentations of the disease. Results: The results confirmed uncontrolled diabetes mellitus as the major risk factor for the disease. The prevalence of steroid administration was lower in our study in contrast to previous literature. The risk factors and treatment rendered during COVID-19 did not differ significantly among the three groups (p > 0.05). The findings indicate that the disease was milder and progressed more slowly in the ND group, both clinically and radiographically, and it had close resemblance to odontogenic infection. Conclusion: Patients with early CAM mimicked the odontogenic infection and were more likely to report in a dental setup. Hence, a multidisciplinary and holistic management approach is necessary.

Comparative histological evaluation of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome of apicomarginal defects: A randomized clinical trial.

The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects. Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections. In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm2) than PRF High clots, which had a dense structure and fewer neutrophils (253.15 ± 63.86 per mm2) (p = 0.001). Autologous platelet concentrates (APCs) promoted satisfactory periapical healing, with no significant difference between the groups. Within the limitations of the study, it seems that PRF Medium should be preferred over PRF High when the patients' quality of life is the priority.

Mucor infection associated with global COVID-19 pandemic - an institutional histopathological study

Background: Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM). Material and methods: Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion. Results: 0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases. Conclusions: The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly. (AU)

Patient-centric outcome assessment of endodontic microsurgery using periapical radiography versus cone beam computed tomography: A randomized clinical trial.

AIM: This study aimed to evaluate whether utilizing additional cone beam computed tomography (CBCT) imaging has any effect on quality of life and healing outcome following periapical surgery compared with periapical radiographs (PR). METHODOLOGY: The study was registered in ClinicalTrials.gov (NCT04333940). In this parallel group randomized controlled trial, 52 patients (88 teeth) with persistent apical periodontitis and periapical radiographic evidence of periapical lesion were randomly assigned to either PR or CBCT group. The primary predictor was the type of the imaging method (PR only or with additional CBCT). The primary outcome was patient's quality of life during the first week after periapical surgery and the secondary outcomes were duration of surgery and healing outcome at 12-month follow-up. Participants of both groups received periapical surgery based on the pre-surgical plan provided by the radiographic imaging methods. Quality of life (QoL) was assessed using Modified Shugars questionnaire. Radiographic analysis for healing was conducted using Molven's criteria and modified PENN 3D criteria. The categorical data between groups were analysed using the Chi-square test, whilst intragroup comparisons were analysed using the McNemar test. The average scores for each component of QoL (oral functions, general functions, pain, swelling and other symptoms), combined QoL scores (overall average of values of 13 variables) and analgesic usage on each day were calculated and analysed. RESULTS: At 12 months of follow-up, fifty patients were evaluated. Participants in PR group reported significantly more swelling on first three days compared with CBCT group. The analgesic use was higher in the PR group on 2nd and 3rd day (Mann-Whitney U test with Bonferroni correction; p < .007). A significant difference in the limitation of general functions was observed at the second day (p < .07) with the higher values in the PR group. The combined QoL score between the two groups was found to be non-significant. However, none of the patients experienced intraoperative complications or neurovascular exposure. The mean surgical time was lesser in the CBCT group (p < .05). Radiographic healing revealed a success rate of 96.2% for the PR group and 95.8% for the CBCT group with no significant difference between the groups. CONCLUSION: Participants in the CBCT group experienced substantially less early postoperative swelling and limitation in general functions, in comparison with the PR group. However, preoperative CBCT had no effect on other QoL parameters and intraoperative complications in medium-risk patients. Furthermore, CBCT did not exhibit any added advantage over periapical radiography in terms of assessing healing outcome following endodontic microsurgery. CBCT offered surgically relevant anatomic information for pre-surgical planning and ensured the treatment rendition with a significantly reduced operative time.

Peripheral Ossifying Fibroma Veiling a Nasopalatine Duct Cyst: An Unusual Concurrence.

We hereby report an unusual case which presented as a routinely encountered reactive lesion on the palate, whilst the radiological examination revealed a radiolucent cystic lesion underneath. After the investigations from radiography to histopathology, it was finally diagnosed as a peripheral ossifying fibroma coexisting with a nasopalatine duct cyst.

Low Grade Intraductal Carcinoma of Palate: An Extremely Rare Entity with Review of Literature.

Low-grade intraductal carcinoma (LG-IDC) is the new World Health Organization designation for tumors previously called "low-grade cribriform cystadenocarcinoma" and "low-grade salivary duct carcinoma". LG-IDC is a rare low grade malignant salivary gland neoplasm. A 56-year old woman presented with a painless swelling on the right posterior part of palate of 2 months duration. Radiographic examination revealed heterogenously enhancing soft tissue mass on right side of palate. A provisional diagnosis of pleomorphic adenoma was executed and local excision was done. The tumor had a typical feature of intraductal growth pattern composed of low grade ductal epithelial cells with cribriform and micropapillary patterns forming true "Roman bridges". Immunohistochemically myoepithelial cells displayed p63 around all tumor islands. The case was diagnosed as LG-IDC. LG-IDC is an extremely rare entity and awareness of this entity is important to avoid erroneous diagnosis and inappropriate treatment.

Comparative Efficacy of Platelet-Rich Plasma and Dry Needling for Management of Trigger Points in Masseter Muscle in Myofascial Pain Syndrome Patients: A Randomized Controlled Trial.

AIMS: To compare the efficacy of platelet-rich plasma (PRP) injection vs dry needling (DN) for management of trigger points in the masseter muscle in myofascial pain syndrome (MPS) patients. METHODS: This randomized controlled trial included 30 clinically confirmed cases of myofascial trigger points (MTrPs) in the masseter muscle who were randomly and equally (1:1) assigned to the test (PRP) and control (DN) groups. Both groups were evaluated for pain (visual analog scale [VAS]), range of functional movements, need for pain medication, patient satisfaction (Likert scale), and sleep (VAS) at baseline and 2-week, 1-month, and 3-month follow-ups. VAS pain and Likert score were also obtained at 6-month intervals. RESULTS: The use of PRP solution in MTrPs in MPS patients had a better effect on pain and patient satisfaction compared to DN. CONCLUSION: PRP appears to be a more effective treatment modality compared to DN in the management of MTrPs in MPS patients.

Evaluation of relationship between odontogenic infections and maxillary sinus changes: A Cone Beam Computed Tomography-based study.

Introduction: Odontogenic infections affects the maxillary sinus mucosa. Cone Beam Computed Tomography (CBCT) is helpful in diagnosis of maxillary sinusitis of odontogenic origin. This cross-sectional study was planned with the aim to assess maxillary sinus changes associated with odontogenic infection by evaluating CBCT images. Material and methods: In cross-sectional analytical study, total 213 patients (404 sinuses) were evaluated on CBCT after thorough clinical examination of the individuals and taking into consideration the history of rhino or allergic rhinitis. Based upon CBCT images and clinical examination, patients were divided into, study group (odontogenic infection) and control group (no associated odontogenic infection). Effect of the size of periapical lesion, spatial relationship of lesion to the sinus floor and periodontal bone loss on maxillary sinus changes were evaluated. Results: Mucosal changes found in 200 sinuses (49.5%), mucosal thickening being the most prevalent and more commonly associated with odontogenic infections (p = 0.004). A significantly increased risk of mucosal thickening was observed with severe periodontal bone loss (p = 0.008). Size and spatial relationship of lesion to the maxillary sinus had no impact on the prevalence of mucosal thickening (p = 0.6, p = 0.4 respectively). Periodontal bone loss was 2.2 more likely to be associated with mucosal thickening than periapical or combined lesion. Conclusions: Most prevalent sinus change was mucosal thickening. Periodontal bone loss was significantly associated with mucosal thickening. CBCT is an appropriate method for sinus evaluation.

Immunohistochemical correlation of mast cells and angiogenesis in oral lichen planus.

OBJECTIVE: The study was conceived with an aim to correlate mast cell expression and angiogenesis in oral lichen planus (OLP) and inflamed oral mucosa. DESIGN: An observational study was performed on fifty tissue blocks of OLP and inflamed oral mucosa which were stained immunohistochemically using mast cell tryptase, CD34 and CD105. The data was analysed using Mann Whitney U-test and Spearman's rank correlation coefficient test (p < 0.05). RESULTS: OLP showed significantly higher mast cell density for total and degranulated mast cells and higher microvessel density (CD105) compared to inflamed oral mucosa (p = 0.006, 0.000). Microvessel density, total and mean vascular area (CD34) were higher in inflamed oral mucosa with a non significant difference (p = 0.985, 0.977, 0.720). Mild negative association was observed between mast cells and angiogenesis in OLP (p = 0.879). A significant positive correlation was seen between degranulated mast cells and microvessel density (CD34) in inflamed oral mucosa (p = 0.009). CONCLUSION: Mast cells execute different roles in OLP depending upon stage of the disease. We found that although degranulation of mast cells is not the predominant pathway for angiogenesis in OLP, yet is one of the important precursor phenomena in inflamed tissues.

Evaluation of amniotic membrane in the healing of apicomarginal defects using 2D and 3D imaging modalities: a randomized controlled trial.

OBJECTIVE: The study aimed to evaluate healing in apicomarginal defects with amniotic membrane (AM) using 2D periapical radiography and 3D cone beam computed tomography imaging. METHOD AND MATERIALS: Thirty-four patients with symptomatic apical periodontitis and apicomarginal communication were allocated to either the AM or control group. Clinical and radiographic assessment was performed at baseline and at 12 months using Molven criteria, modified Penn 3D criteria, and RAC and B indices at resected plane, apical area, cortical plate, and combined apicocortical area, respectively. RESULTS: There was no significant difference in the healing outcome in 2D imaging (93.3% control and 86.7% AM) and 3D imaging (80.0% control and 53.3% AM) between the groups. With RAC scoring, a greater percentage of unhealed cases was observed in cortical plate. Radiographic buccal bone formation in the 3D imaging was evident only in six cases. However, both the groups depicted significantly greater percentage reduction in the size of the lesion in 2D than the 3D analysis (AM group 91.69 ± 15.99 2D, 76.06 ± 47.62 3D, P = .020) and (control group 92.06 ± 14.36 2D, 85.12 ± 18.55 3D, P = .005). CONCLUSION: No significant difference in healing was observed between the AM and the control groups with the use of both periapical radiography and CBCT imaging. Despite good clinical healing and radiographic apical bone fill, buccal bone formation was not evident in 3D imaging in most of the cases.

Are Low Serum Vitamin D Levels a Risk Factor for Advent of COVID-19 Associated Rhinocerebral Mucormycosis: A Preliminary Case Control Study.

To determine whether low serum vitamin D level is a risk factor for development of Rhinocerebral mucormycosis in COVID-19 afflicted patients. A case control study was conducted in a tertiary care hospital utilizing the archived records of COVID-19 afflicted Rhinocerebral mucormycosis cases and age and gender matched controls. The mean value (± standard deviation) of vitamin D level in patients with Mucormycosis was 19.65 ± 13.07 ng/ml and in control subjects it was 27.88 ± 18.04 ng/ml.There was a significant difference between groups (p = 0.02). Thus, low Vitamin D level may be implicated as a risk factor for the advent of mucormycosis in a COVID-19 afflicted patient and therefore Vitamin D supplements may be provided to such patients to achieve normal serum levels.

Association of COVID-19 with Rhino-Cerebral Mucormycosis: An Observational Study.

Mucormycosis is becoming more common in patients infected with or recovering from COVID-19 under the current situation. However, there is a scarcity of research on a specific group of COVID-19 individuals who are predisposed to mucormycosis. As a result, a retrospective observational study was undertaken to assess the possible connection of mucormycosis with COVID-19. The goal was also to investigate the link between diabetes mellitus, mucormycosis and COVID-19. The occurrence and severity of the disease among the case records were assessed using signs and symptoms, investigations conducted during COVID-19, and serological test results. Patients were classified as previously known diabetics, recently diagnosed diabetics, or non-diabetics based on their history of pre-existing DM and HBA1c levels at the time of reporting for mucormycosis. The findings show that mild COVID-19-infected patients and non-diabetic patients have a high incidence of COVID-19-associated mucormycosis (CAM). As a result, all clinicians participating in the care of COVID-infected patients must be aware of the significant risk of secondary mucormycosis in the post-recovery phase, even in those with mild or moderate symptoms.

Effect of orthodontic treatment on periodontal health of periodontally compromised patients.

OBJECTIVES: To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients. MATERIALS AND METHODS: This was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2. RESULTS: Intragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group. CONCLUSIONS: Orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.

Primary Oral Histoplasmosis in Immunocompetent Host: Case Series with Review of Literature.

Histoplasmosis, a systemic mycosis caused by Histoplasma capsulatum manifests clinically in immunocompromised subjects as acute or chronic pulmonary infection or as a progressive disseminated disease. In oral region it clinically presents as multiple, granular and painful ulcers or verrucous growth. It is rare to find primary oral lesion of histoplasmosis in immunocompetent patient free from systemic disease. In presence of any unusual oral lesion possibility of Histoplasmosis should be considered and prompt diagnosis be attained with exclusion of false negative results as non-specific manifestation of disease may lead to gruesome misdiagnosis of lesion and inadequate treatment. In the present paper two cases of oral histoplasmosis in immunocompetent host have been discussed along with updated review of literature.

Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study.

Introduction: No study has been conducted to explore soft and hard tissue changes brought by functional appliances within the temporomandibular joint (TMJ) after correction of class II division 2 (div 2) malocclusion. Hence, we planned this study to evaluate the mandibular condyle disk-fossa relationship before and after prefunctional and twin block therapy using a magnetic resonance imaging (MRI) scan. Methodology: This prospective observational study was conducted among 14 males treated with prefunctional appliances for 3-6 months, followed by 6-9 months of fixed mechanotherapy. MRI scan was evaluated for changes in the TMJ at baseline after completion of prefunctional phase and after completion of functional appliance therapy. Results: At pretreatment, there was a flat contour on the posterosuperior surface of the condyles and a notch-like projection on its anterior surface. After functional appliance therapy, slight convexity appeared on the posterosuperior surface of the condyle and the prominence of the notch was reduced. There was a statistically significant anterior shift of condyles both after prefunctional and twin block treatment. The meniscus on both sides had significantly shifted posteriorly over three stages with respect to the posterior condylar (PC) plane and Frankfort horizontal (FH) plane. The superior joint space had significantly increased with significant linear glenoid fossa displacement between pre and posttreatment stages. Conclusion: Prefunctional orthodontics induced favorable changes in TMJ soft and hard tissues of patients, but they were not sufficient to place the soft and hard tissues in their normal positions. A functional appliance phase is needed to place the TMJ in their respective normal positions. How to cite this article: Patel B, Kukreja MK, Gupta A, et al. Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study. Int J Clin Pediatr Dent 2022;15(5):479-488.