Three-Dimensional Evaluation of Alveolar Cleft Volume and Nasomaxillary Form in Patients with Unilateral Cleft Lip and Palate.

OBJECTIVE: To evaluate the alveolar cleft volume (ACV) and to study its correlation with the nasomaxillary form in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective study. SETTING: University Academic Hospital. PATIENTS/PARTICIPANTS: 30 patients with UCLP and 30 non-cleft patients. INTERVENTIONS: Cone beam computed tomography (CBCT) scans. RESULTS: The Maxillary sinus volume (MSV) and Nasal cavity volume (NCV) were significantly reduced on the affected side in patients with UCLP (P < .001) and also in the cleft group when compared to the noncleft group (P < .01). The septal deviation measured at anterior, mid and posterior nasal spine were increased in the UCLP group significantly when compared to the non-cleft group (P < .01) and maximum deviation was seen at the mid-level. The mean ACV was found to be 0.587 + 0.396 cm3.The nasomaxillary complex was affected in UCLP patients irrespective of cleft size and a statistically significant correlation of ACV was found with septal height only (r value = -0.508). Parameters like septal height, anterior and middle maxillary width were significantly reduced (P < .01) in the cleft group when compared to the non-cleft group. CONCLUSION: The patients with UCLP showed significant differences among various parameters within the nasomaxillary complex when compared to the control group. Within the cleft group, the MSV and NCV were significantly decreased on the cleft side and also a significant negative correlation of ACV was found with septal height only.

Stress Trajectory Variations During Occlusal Loading in Human Skull with a Maxillofacial Defect: A Finite Element Analysis.

Background and Aim: Biting forces from the teeth are distributed to the facial bones and to the skull through the stress trajectories. The presence of a bony defect in either the maxilla or mandible might lead to variations in the stress distribution. The aim of this study was to evaluate the stress distribution and variations in stress trajectories from biting forces in a human skull with maxillofacial defect using a finite element (FE) model. Methodology: In this study, a cone beam computed tomography (CBCT) of an adult male patient with a maxillectomy defect consequent to surgical treatment of mucormycosis is evaluated for the stress distribution from the biting forces of the remaining posterior teeth. Finite element model without the mandible was constructed from the patient's CBCT data. Occlusal loading forces of 600 N were applied on each side of the maxillary teeth. Stress trajectories were visualised through the stress distribution pattern. Results: The results showed deviations in the normal stress distribution during occlusal loading and variations in zygomatic and pterygoid stress trajectories in the maxillofacial and skull regions in our FE model due to the bony defect. Conclusion: We conclude that a skeletal maxillofacial defect should be reconstructed to resume proper stress distribution during functional forces to maintain a healthy craniofacial skeleton.

Cephalometric evaluation of pharyngeal airway and tongue space following treatment with Herbst and AdvanSync appliances : A prospective randomized clinical trial.

OBJECTIVES: To evaluate and compare pharyngeal airway and tongue space changes after treatment with fixed functional appliances-Herbst and AdvanSync™ (Ormco, Orange, CA, USA) appliances-in skeletal class II patients in pre- and posttreatment lateral cephalograms. METHODS: For this randomized, controlled trial, 40 patients (21 male, 19 female) were divided into two groups-a Herbst group (mean age 12.6 ± 0.67 years) and an AdvanSync group (mean age 12.8 ± 0.66 years). Pre- and posttreatment (appliance therapy duration-8 months) lateral cephalograms were traced using a software program to evaluate pharyngeal airway and tongue space changes. RESULTS: Nasopharyngeal airway, velopharyngeal airway, glossopharyngeal airway, and hypopharyngeal airway increased in the Herbst group by 2.12 mm (p ≤ 0.001), 2.33 mm (p ≤ 0.001), 2.40 mm (p ≤ 0.01), and 1.57 mm (p ≤ 0.05), while in the AdvanSync group the increases were 1.89 mm (p ≤ 0.001), 1.21 mm (p ≤ 0.001), 1.18 mm (p ≤ 0.001), and 1.53 mm (p ≤ 0.001), respectively. In the Herbst group, tongue length and height increases were 2.04 mm (p ≤ 0.01) and 3.74 mm (p ≤ 0.001), while the values in the AdvanSync group were 2.41 mm (p ≤ 0.05) and 2.69 mm (p ≤ 0.001). The change of the tongue tip from the lower occlusal plane was 0.69 mm (p ≤ 0.001) in the Herbst group and 0.77 mm (p ≤ 0.001) in the AdvanSync group. The velopharyngeal airway dimension was correlated positively with that of the retroglossal oropharyngeal airway, which in-turn positively correlated with the laryngopharyngeal airway which correlated well with the distance of the tongue tip from the lower occlusal plane. CONCLUSIONS: The airway dimensions and tongue parameters increased significantly in both treatment groups in the present study. These changes were higher in the Herbst appliance than in the AdvanSync group, except for the distance of the tongue tip from the lower occlusal plane. A significant difference between the pharyngeal airways was found only for the retropalatal oropharyngeal airway.

Finite element analysis of tie wings rotation: A new phenomenon in orthodontic bracket-archwire contact assembly during simulated torque.

In orthodontics, the torque generated forces from the rectangular archwires refine the teeth position. Literature shows only linear deformation in brackets during torqueing. The objective of this study was to evaluate a new phenomenon of tie wings rotation, an angular deformation in Stainless Steel (SS) brackets with SS and Beta-Titanium (ß-Ti) archwires at various angles of twist. Maxillary central incisor SS 0.457 mm × 0.635 mm and 0.558 mm × 0.711 mm brackets, SS and ß-Ti archwires of 0.431 mm × 0.635 mm and 0.533 mm × 0.635 mm sizes were used. Finite element analysis was performed in various bracket-archwire assemblies for simulated torque. Palatal root torque was applied and the gingival tie wings rotation was measured at selected points, from 5° to 30° angles of twist. The tie wings rotation for 30° twist with SS 0.533 mm × 0.635 mm archwire in 0.558 mm bracket ranged from 1.32° to 2.55° and with SS 0.431 mm × 0.635 mm archwire in 0.457 mm bracket from 0.71° to 1.73°. Similarly, with ß-Ti 0.533 mm × 0.635 mm archwire in 0.558 mm bracket and ß-Ti 0.431 mm × 0.635 mm archwire in 0.457 mm bracket, the tie wings rotation ranged from 0.73° to 1.38° and 0.39° to 0.93° respectively. The tie wings rotation were present in all the FE models. Higher archwire size, stiffness, and angles of twist showed increased rotation. Thus, clinicians should be aware of this tie wings rotation during torqueing as an additional factor for torque loss.

Thidiazuron, a phenyl-urea cytokinin, inhibits ergosterol synthesis and attenuates biofilm formation of Candida albicans.

Candida albicans is a common human fungal pathogen that colonizes mucosa and develops biofilm in the oral cavity that causes oral candidiasis. It has been reported that cytochrome P450 enzyme (CYP51), a vital part of the ergosterol synthesis cascade, is associated with Candida infections and its biofilm formation. Thidiazuron, a phenyl-urea cytokinin, exhibits anti-senescence and elicitor activity against fungal infection in plants. However, how Thidiazuron impacts C. albicans biofilm formation is still uncertain. Here, we aimed to investigate the effects of a Thidiazuron against the growth and biofilm formation properties of C. albicans using in silico and in vitro experimental approaches. A preliminary molecular docking study revealed potential interaction between Thidiazuron and amino acid residues of CYP51. Further in vitro antifungal susceptibility test, scanning electron microscopy (SEM) and time kill analysis revealed the anti-fungal activity of Thidiazuron in both dose and time-dependent manner. Crystal violet staining, 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) reduction assay revealed 50% inhibition in C. albicans biofilm by Thidiazuron at concentrations 11 and 19 µM respectively. Acridine orange staining assay visually confirmed the biofilm inhibitory potential of Thidiazuron. The gene expression study showed that Thidiazuron treatment down regulated the expression of genes involved in ergosterol synthesis (ERG3, ERG11, ERG25), cell adhesion (ASL3, EAP1), and hyphae development (EFG1, HWP1, SAP5) in C. albicans. Wherease, the expression of negative transcription regulator of hyphae (NRG1) was upregulated (5.7-fold) by Thidiazuron treatment. Collectively, our data suggest that Thidiazuron is a robust antifungal compound and an outstanding biofilm inhibitor, which may promise further therapeutic development due to CYP51 binding and inhibition of ergosterol formation against C. albicans.

Comparative finite element analysis of bracket deformation in tie wings and slot region during simulated torque.

INTRODUCTION: Torque in orthodontics is the activation of the archwire for the third-order movement of teeth. During this force transfer mechanism from the twisted archwire, the bracket is prone to deformation. This study aimed to compare the deformation in tie wings and the slot region of the bracket during torque using finite element analysis. METHODS: Three-dimensionally modeled 0.017 × 0.025-in and 0.019 × 0.025-in stainless steel (SS) and titanium molybdenum alloy archwires were assembled in 0.018-in and 0.022-in solid modeled SS edgewise brackets, respectively. The finite element model of the bracket-archwire combinations was developed with contact boundary conditions. The deformation between tie wings and the slot was analyzed for various angles of twist. RESULTS: For SS archwires at 30° angle of twist, the tie wings deformation in 0.018-in and 0.022-in brackets were 48.67 µm and 34.87 µm, respectively. The slot deformations of 0.018-in and 0.022-in brackets were 66.33 µm and 45.69 µm, respectively. Similarly, the amount of deformation in the bracket-titanium molybdenum alloy archwire combinations were also presented. CONCLUSIONS: The slot deformation was more than the tie wings deformation as the slot walls bear the immediate torque force. Thus, orthodontic researchers should know that the torque-relevant bracket deformation should ideally be evaluated in the slot region rather than the tie wings.

Experimental evaluation of orthodontic bracket slot deformation to simulated torque.

In orthodontic fixed appliance therapy, the archwire torque used to refine the teeth position during the treatment imparts significant forces inside the bracket slot. The objective of this study was to measure the torque relevant bracket slot deformation in Stainless Steel (SS) brackets during various degree of archwire twist. Standard edgewise brackets 0.018-inch (in.)/0.022-in. each 20 no. and 0.016 × 0.022, 0.017 × 0.025, 0.019 × 0.025, and 0.021 × 0.025 in. archwires each 10 no. were used. A novel experimental setup consisting of loading fixture and torque key mounted on a Vision Measuring System (VMS) were used to measure the brackets slot deformation. The Top Slot and Middle Slot Deformations (TSD and MSD) of the brackets for 35° angle of twist in 0.016 × 0.022 in. archwire in 0.018-in. slot, 0.019 × 0.025 in. archwire in 0.022-in. slot and for 30° angle of twist in 0.017 × 0.025 in. archwire in 0.018-in. slot and 0.021 × 0.025 in. archwire in 0.022-in. slot were measured. Results showed that the mean TSD and MSD were higher when the archwire size, the slot size and the angle of twist were greater. In the evaluated bracket-archwire combinations, the TSD were higher than MSD and the bracket slots were elastically deformed within the clinically required 35° angle of twist in the archwire. Clinicians should be aware of this torque relevant bracket slot deformation which might be a factor for torque loss and suitably incorporate archwire angle of twist.

Stress distribution and deformation in six tie wings Orthodontic bracket during simulated tipping - A finite element analysis.

BACKGROUND AND OBJECTIVES: Four tie wings brackets are widely used in orthodontics, while the Six Tie Wings Brackets (STWB) are recently emerging in fixed orthodontic appliances due to their claim for less friction and thus faster teeth movement. The aim of this work was to evaluate the stress distribution and deformation during simulated mesio-distal tipping forces in Stainless Steel (SS) six tie wings orthodontic bracket using Finite Element Analysis (FEA). METHODS: A six tie wings bracket (Synergy®, RMO, USA) dimensions were measured using the Vision system and a 3D model of the bracket was constructed. A Finite Element (FE) model was developed and mesio-distal tipping forces of 1.22 N to 1.96 N (125 to 200 gm) in increments were applied on the gingival and incisal slot walls. The stress distribution and deformation were recorded at specific points in the bracket and analyzed. RESULTS: The maximum deformation and stress distribution for the mesial and distal tipping forces of 1.96 N were recorded as 0.137 µm and 10.60 MPa respectively. The stress concentration was more at the junction of the slot wall and the slot base. For mesial tipping,the deformation was more on the disto-incisal and mesio-gingival tie wings. Similarly, for distal tipping the deformation was more on the mesio-incisal and disto-gingival tie wings. The mid-tie wings showed minimal deformation during both distal and mesial tipping. CONCLUSIONS: Our study visualized both the mesial and distal tipping forces induced stress distribution in the bracket tie wing-slot junctions. The deformation was present maximum in the mesio-incisal and disto-incisal tie wings and minimal in the mid-tie wings. Clinicians should be aware of this behavior of STWB in making decisions to alter the tipping forces in the archwire to compensate for the tie wing deformation in refining the teeth position.

Finite element analysis of torque induced orthodontic bracket slot deformation in various bracket-archwire contact assembly.

BACKGROUND AND OBJECTIVES: Orthodontic fixed appliance therapy involves alignment of teeth through the bracket and archwires. The archwire twist (torque) imparts significant forces inside the bracket slot in refining the teeth position at the end of treatment. The objective of this in- silico study was to evaluate the torque induced bracket slot deformation in the commonly used 0.018 inch (") and 0.022" conventional Stainless Steel (SS) brackets with clinically relevant archwires during various angles of twist. METHODS: SS maxillary central incisor brackets of 0.018" width × 0.022" depth (0.457 mm × 0.558 mm) and 0.022" width × 0.028" depth (0.558 mm × 0.711 mm) were used. The SS archwires of 0.016" width × 0.022" depth (0.406 mm × 0.558 mm), 0.017" width × 0.025" depth (0.431 mm × 0.635 mm), 0.019" width × 0.025" depth (0.482 mm × 0.635 mm) and 0.021" width × 0.025" depth (0.533 mm × 0.635 mm) were engaged in the respective bracket slots. The assembled bracket-archwire Finite Element (FE) models were constructed. The archwire torque, the top, middle and bottom slot deformations (TSD, MSD, BSD) were obtained for the bracket-archwire combinations for various angles of archwire twist using FE Analysis (FEA). RESULTS: The torque, TSD, MSD and BSD for 30o twist of 0.016" × 0.022" archwire in 0.018" slot were 28.13 Nmm, 35.71 µm, 21.51 µm and 15.67 µm respectively, and for 0.017" × 0.025" archwire were 50.18 Nmm, 54.52 µm, 32.47 µm and 19.11 µm respectively. Similarly for 0.019" × 0.025" archwire in 0.022" slot and 0.021" × 0.025" archwire in 0.022" slot they were 38.82 Nmm, 50.78 µm, 31.47 µm and 16.82 µm, and 60.22 Nmm, 65.22 µm, 36.44 µm and 22.68 µm respectively. CONCLUSIONS: The slot deformation was present in both 0.018" and 0.022" brackets which increased as the angle of twist increased. The TSD were higher than the MSD and BSD in all the bracket-archwire combinations. We conclude that there is only elastic deformation of bracket slots upto 30o angle of twist and clinicians could maintain within this torque limits to avoid plastic deformation leading to improper teeth position.

Gustatory Dysfunction as an Early Symptom in COVID-19 Screening.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from Wuhan, China in December 2019 leads to the present coronavirus disease 2019 (COVID-19) pandemic. The various symptoms identified for COVID-19 are fever, dry cough, sore throat, dyspnea, fatigue, myalgia, and headache. Olfactory and gustatory dysfunctions are emerging as a new symptom more in the European patients. Taste disturbances are common in various oral and systemic diseases. Varying severity and onset of taste disturbances are reported in COVID-19 positive patients in this pandemic. But a sudden onset of taste disturbances without an established and recognized cause should raise suspicion of COVID-19. This article will analyze the various studies focusing on taste disturbances as a reliable early symptom for COVID-19 screening.

Saliva as a Potential Diagnostic Specimen for COVID-19 Testing.

The current outbreak of the highly contagious, animal origin SARS-CoV-2 virus causes the disease COVID-19. The disease is globally pandemic and as per World Health Organization (WHO) has spread to 235 countries. There is global lockdown for containment of the virus transmission. Testing of symptomatic patients, healthcare workers and suspected individuals and mass screening is vital. WHO recommends nasopharyngeal (NP) and oropharyngeal (OP) swab for the quantitative assessment of SARS-CoV-2 RNA level through real-time reverse transcription polymerase chain reaction (rRT-PCR). The virus is shown to be consistently present in saliva and rRTPCR of saliva specimens and have advantages over NP and OP swabs such as self-collection of saliva, avoidance of healthcare workers for specimen collection, cost-effectiveness, etc. This article explores the current literature and suggests saliva as an emerging potential diagnostic specimen for COVID-19 testing.

Analysis of Clinical Significance of the Pterygospinous and Pterygoalar Bars.

Presence of ossified structures at the skull base near the sphenoid bone in the infra temporal fossa are clinically significant. We studied the incidence of pterygospinous bar (PSB) and pterygoalar bar (PAB) in 140 dried human skulls. The incidence of pterygospinous bar was 22% and pterygoalar bar was 11%. An unusual large pterygspinous foramen was present in one of the skulls on the left side. Clinical significance of these bars are reviewed.

Inhibitory potential of EGCG on Streptococcus mutans biofilm: A new approach to prevent Cariogenesis.

Dental caries is a common cause for tooth loss and Streptococcus mutans is identified as the etiologic pathogen. This study evaluates the inhibitory potential of Epigallocatechin gallate (EGCG) on S.mutans glucansucrase enzyme and its biofilm. Glucansucrase binding and the inhibitory potential of EGCG was validated using AutoDock tool and enzyme inhibitory assay. Biofilm inhibitory potential was also confirmed using Scanning Electron Microscopic (SEM) analysis in human tooth samples. Molecular docking revealed that EGCG interacted with GLU 515 and TRP 517 amino acids and binds to glucansucrase. SEM analysis revealed inhibition of S.mutans biofilm by various concentrations of EGCG on surfaces of tooth samples. Bioinformatics and biological assays confirmed that EGCG potentially binds to the S. mutans glucansucrase and inhibits its enzymatic activity. Enzymatic inhibition of glucansucrase attenuated biofilm formation potential of S. mutans on tooth surface. Thus, we conclude that EGCG inhibitory potential of S. mutans biofilm on the tooth surface is a novel approach in prevention of dental caries.