A Comparative Analysis of Sector Classification and the Impacted Canine Grading System by Kumar and Daigavane in Patients With Unilateral Cleft Lip and Palate Utilizing Orthopantomogram (OPG) as a Diagnostic Tool.

Introduction Non-syndromic oral clefts, affecting one in 700 newborns in India, are the most prevalent craniofacial anomalies, with genetic or environmental causes impacting various life aspects. Studies indicate higher dental disturbances, particularly impacted canines, in cleft lip and palate (CLP) patients compared to non-cleft individuals. Impacted canines, trapped by hard tissues, require early diagnosis to prevent orthodontic issues. The widely used Ericson and Kurol method employs orthopantomograms (OPGs) to classify canine impaction in typical children. However, diagnosing canines in CLP patients is challenging due to palate defects and post-grafting complications. This study aims to compare the utility of the Kumar and Daigavane (KD) grading system and the sector classification to determine the best method for diagnosing impacted canine eruption paths. Method This cross-sectional comparative observational study was conducted at Sharad Pawar Dental College's Department of Orthodontics and Dentofacial Orthopaedics. The sample size, calculated using a significance level of 5% and a prevalence of 1%, required a minimum of 16 participants aged 9-11 years with non-syndromic clefts and impacted canines. Patients with systemic diseases or over 12 years of age were excluded. The sectoral and KD classification systems collected and evaluated OPGs from qualifying cleft patients. Sector classification considered the angle between the occlusal plane or canine tip and the adjacent tooth's long axis, while KD's classification considered the Frankfort horizontal plane, occlusal plane, vertical height from the occlusal plane, canine apex root position, and canine exposure to the cleft defect. Results The study found an 81.25% agreement between the KD grading system and the sector classification, with a Cohen's kappa value of 0.586, indicating a moderate agreement. The KD system showed 81.82% sensitivity and 80.00% specificity, with positive and negative predictive values of 90.00% and 66.67%, respectively. The receiver operating characteristic (ROC) curve analysis revealed the KD system's superior performance in identifying impacted and non-impacted canines compared to the sector classification. Conclusion The KD grading system demonstrated higher efficacy than the sector classification for evaluating the impacted canines in children with unilateral cleft lip and palate (UCLP). The KD system's high sensitivity and specificity make it a valuable tool for predicting canine eruption paths and addressing anatomical challenges in cleft conditions. This study highlights the need for accurate diagnostic tools tailored to cleft patients and contributes to advancing orthodontic treatment outcomes through improved classification systems.

Addressing Missing Permanent Premolars With Retained Deciduous Teeth: Orthodontic Solutions and Outcomes.

This case report presents an orthodontic treatment approach involving retained deciduous teeth. The patient presented with a Class I malocclusion and buccal crossbite. Despite the presence of retained deciduous teeth, a non-extraction treatment plan was devised to address the malocclusion and achieve optimal dental alignment. The treatment protocol included the use of fixed appliances and quad helix to facilitate the alignment of permanent dentition. The progress of treatment was closely monitored through regular follow-up appointments and adjustments to the treatment plan as necessary. Upon completion of treatment, the patient achieved a harmonious occlusion, improved dental alignment, and a pleasing aesthetic outcome. This case report highlights the successful management of a challenging orthodontic case through a non-extraction approach with retained deciduous teeth, emphasizing the importance of individualized treatment planning and careful consideration of each patient's unique dental anatomy.

The Future of Orthodontics: Deep Learning Technologies.

Deep learning has emerged as a revolutionary technical advancement in modern orthodontics, offering novel methods for diagnosis, treatment planning, and outcome prediction. Over the past 25 years, the field of dentistry has widely adopted information technology (IT), resulting in several benefits, including decreased expenses, increased efficiency, decreased need for human expertise, and reduced errors. The transition from preset rules to learning from real-world examples, particularly machine learning (ML) and artificial intelligence (AI), has greatly benefited the organization, analysis, and storage of medical data. Deep learning, a type of AI, enables robots to mimic human neural networks, allowing them to learn and make decisions independently without the need for explicit programming. Its ability to automate cephalometric analysis and enhance diagnosis through 3D imaging has revolutionized orthodontic operations. Deep learning models have the potential to significantly improve treatment outcomes and reduce human errors by accurately identifying anatomical characteristics on radiographs, thereby expediting analytical processes. Additionally, the use of 3D imaging technologies such as cone-beam computed tomography (CBCT) can facilitate precise treatment planning, allowing for comprehensive examinations of craniofacial architecture, tooth movements, and airway dimensions. In today's era of personalized medicine, deep learning's ability to customize treatments for individual patients has propelled the field of orthodontics forward tremendously. However, it is essential to address issues related to data privacy, model interpretability, and ethical considerations before orthodontic practices can use deep learning in an ethical and responsible manner. Modern orthodontics is evolving, thanks to the ability of deep learning to deliver more accurate, effective, and personalized orthodontic treatments, improving patient care as technology develops.

The Co-occurrence of Cleft and Clubfoot: A Case Report on a Rare Medical Condition.

Cleft lip and palate (CLP) are complex deformities in craniofacial development that can range from isolated to syndromic presentations. This case presentation emphasizes the identification and early management of syndromic associations in patients with CLP. The report presents a unique case of a one-month-old female patient with complete unilateral CLP and clubfoot. The patient was comprehensively assessed, and a treatment plan was formulated. Presurgical nasoalveolar molding was done for the initial alignment of cartilages and alveolar bone. The treatment modalities for clubfoot are presented in the discussion. The following presentation emphasizes the characteristics of syndromic CLP and the importance of multidisciplinary therapy toward optimum patient care. This report underlines the role of coordinated efforts in managing the multifaceted needs of patients with complex congenital conditions to improve their overall well-being and quality of life.

From an Open Bite to a Harmonious Smile: Orthodontic Intervention With Bluegrass Appliance and Tongue Thrust Resolution.

The tongue-thrusting habit significantly contributes to the development of the anterior open bite (AOB), particularly when an infantile swallowing pattern persists into the later stages of childhood and adolescence. This habit results in the protrusion of the anterior teeth. Treatment typically involves addressing the underlying causes, incorporating retraining exercises, and utilizing mechanical appliances to control tongue positioning. However, commonly used devices such as palatal cribs or spurs may present challenges, including speech impediments, chewing difficulties, and the potential for unintended injuries. This paper presents a case report detailing the treatment of a patient with an AOB, dental protrusion, and spacing. The treatment approach included the application of a fixed tongue trainer, in the form of a modified bluegrass appliance. Subsequent fixed orthodontic therapy was employed to rectify proclined teeth within the dental arch.

In the Shadows of Rarity: A Case Report of Syndromic Cleft Lip and Palate!

Deviations from normal craniofacial development can result in a range of abnormalities, including cleft lip and/or palate, either as standalone conditions or as components of syndromes with varying clinical characteristics. The ability to distinguish between isolated incidents and syndromes with clefts as one component is integral to achieving accurate diagnosis and therapy. The following case presentation highlights the importance of comprehensive screening and differential diagnosis in identifying syndromic connections in patients with cleft lip and palate. In this specific case, the patient presented with polydactyly, camptodactyly, and pelvic area abnormalities, indicating a possible syndromic connection with cleft lip and/or palate.

Clinical Insights Into Addressing Constricted Maxillary Arch in Angle's Class II Malocclusion: A Case Report.

The transverse dimension, often overlooked in orthodontics, plays a crucial role in malocclusions, affecting not only occlusion in that dimension but also sagittal and vertical dimensions. Posterior crossbites, indicative of transverse maxillary issues, are commonly addressed through palatal expansion. This case report explores the clinical insights into addressing a constricted maxillary arch in Angle's Class II malocclusion using a nickel-titanium (NiTi) expander. The NiTi expander provides constant and optimal expansion forces by incorporating a temperature-activated NiTi alloy. A 16-year-old male with irregularly placed teeth, high palatal vault, and posterior crossbite underwent treatment involving NiTi expander usage for maxillary expansion. The case presentation details the patient's journey, starting with upper arch bonding and expansion, then lower arch bonding, and concluding with complete leveling and alignment without extractions. The presented case demonstrates successful correction of a constricted maxillary arch, specifically in the canine and molar regions, utilizing the NiTi expander. The observed increase in intermolar width aligns with previous studies, showcasing the effectiveness of slow maxillary expansion. This article contributes valuable clinical insights into addressing transverse maxillary issues, emphasizing the importance of careful consideration in choosing the appropriate expansion method for optimal results.

From Twin Blocks to Quad Blocks: A Two-Phase Approach to Class II Correction.

Twin Block, a functional orthodontic appliance, has a major impact on the dentoalveolar structures with limited skeletal effects. In specific clinical scenarios, particularly in growing patients such as class II division 1 where the mandible is retropositioned, these appliances can effectively address the malocclusions. Patient compliance plays a crucial role in the success of these appliances, which also streamline subsequent phases of fixed appliance treatment. In the current case report, a Twin Block appliance followed by a Quad Block was given to a 12-year-old boy to refine the occlusion. The design and treatment outcomes of the appliance are discussed in this case study.

Dewey's Modification for Angle's Class I Malocclusion: Revisited.

Introduction Classification is a crucial communication tool between dental school professors and students, between practitioners, and between practitioners and insurance companies or government bureaucracies. The management of patients is significantly impacted by classification. Once a patient has been categorized, the practitioner will frequently use treatment strategies corresponding to that classification. The classification used by orthodontists most frequently is Dewey's version of Angle's categorization. To date, the shortcomings of Dewey's modification were not mentioned in the literature. Various other malocclusions are still not included in this classification system that was modified by Dewey.  Aim The aim of this study was to re-evaluate and re-establish Dewey's modification for class I malocclusion for the various other types of malocclusions that are not included in the classification system. Material and method An observational study was carried out on a total of 600 patients in the Department of Orthodontics. The study duration was eight months. The photographic method was used for the evaluation of the malocclusion. Photographs were taken and clinical evaluation was done of the selected cases. The type of malocclusion was observed and recorded. Result The results showed that other types of malocclusions other than that of Dewey's modification are observed in the population. A total of 4% of the population was affected with single tooth crossbite and 5% were affected in more than one tooth. A total of 1% of the population was affected with single-tooth scissor bites, and in 2%, more than one tooth was involved. In 9% of the population, single-tooth rotations were present, whereas in 6%, more than one tooth was involved. A total of 35% of the population showed other types of malocclusions. Conclusion To conclude, various other malocclusions are present in the population suggesting a lacuna in Dewey's modification. Hence, there was a need to revisit.

Harmonizing Dentofacial Balance: A Comprehensive Exploration of Class 1 Malocclusion Resolution With Impacted Maxillary Central Incisor Management.

Permanent maxillary central incisor impaction is generally a rare phenomenon. Because the anterior teeth have a huge impact on a patient's facial aesthetics, missing anterior teeth are of major concern to patients who seek orthodontic treatment. However, correcting this type of malocclusion poses a challenge to the orthodontist. This case report of a 16-year-old male patient with an impacted maxillary right central incisor takes us through a series of events that are necessary to treat this type of malocclusion. The presenting case also had an impacted supernumerary tooth which was the primary cause for permanent tooth impaction. A combined treatment approach is usually needed to manage this type of case involving both the orthodontist and the surgeon.

An Oral Odyssey: Navigating the Complexity of Impacted Parapremolars and Paramolars in the Oral Landscape!

Supernumerary molars are an uncommon anomaly that can occur in the maxillofacial complex, referring to the presence of additional teeth in the dental arch. This condition is often associated with several rare disorders such as Gardner's syndrome, Cleidocranial dysplasia, Ehler-Danlos syndrome, and Down syndrome However, it is seldom observed in non-syndromic associations. They occur more frequently in the maxilla than in the mandible. This research represents a unique case study that explores unerupted paramolar and parapremolar follicles coexisting in both the maxillary and mandibular arches of a 17-year-old male patient. The discovery of these follicles was fortuitous, as the patient exhibited no symptoms during the initial orthopantomogram scan. Despite the absence of noticeable symptoms, vigilant monitoring and observation were employed over time. Subsequently, a substantial shift in the approach to management occurred with the integration of surgical and orthodontic methodologies, guided eruption strategies, and a collaborative, multidisciplinary effort.

Mean Bone Density in Interadicular Areas of Maxilla among Patients Visiting Dental Unit of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: A close relationship occurs between the type of bone density and the success of orthodontic mini-implant. The aim of this study was to find out the mean bone density in interradicular areas of the maxilla among patients visiting dental unit of a tertiary care centre. Methods: A descriptive cross-sectional study was performed at the Department of Orthodontics and Dentofacial Orthopedics at a tertiary care centre from 15 January 2022 to 28 June 2022 after taking ethical approval from the Institutional Review Committee (Reference number: UCMS/IRC/175/21). Data was collected from scan reports obtained with a computed tomography scanner. Bone density was measured at 6 mm height from the alveolar crest. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 70 patients, mean bone density at interradicular areas of maxilla was 992.31±204.20 HU (944.46-1040.13, 95% Confidence Interval). Between central and lateral incisor 50 (71.44%) had D2 type of bone density. Conclusions: The mean bone density in inter radicular areas of the maxilla among patients visiting the dental outpatient department was similar to other studies done in similar settings. Keywords: bone density; prevalence; prostheses and implants.

Perceptions of academic deans regarding interprofessional education and its implementation in dental colleges in India: results of a national survey.

This national survey was conducted to assess perceptions and status of implementation of interprofessional education in dental colleges in India. An online link to the questionnaire survey was sent to Deans and Academic Deans of those dental colleges having more than one health profession institute on the same campus. The response rate was 47%. Dental colleges' primary collaborative partner was a medical faculty (46%), with the majority of IPE experiences occurring in post-graduation (58%). Lectures (54%), case-based discussions (64%) were reported to be predominant teaching-learning methods, while written exams (40%), small group participation, and group projects (30%) were predominant assessment methods of IPE experiences. Seventy-six percent responded that there are no faculty development initiatives for IPE while 20% responded that IPE is at planning/developmental stage and 38% responded that IPE is not considered presently. Faculty resistance (32%), academic calendars, and schedule (34%) were pointed out to be the most common barriers to implementing IPE. The findings revealed that although the concept and importance of IPE were well perceived by Academic Deans throughout dental colleges in India, and although dental colleges' co-existed with other faculties on same campus, IPE was not systematically implemented with minimal formal interprofessional education involving dental students.

Nasal Cartilage Molding in a Case of Unilateral Cleft Lip and Alveolus (Type D): A Case Report.

Nasal cartilage is asymmetric in individuals with cleft lips and has a depressed nasal dome and medial and lateral crus of the nose on the affected cleft side which can be corrected before cheiloplasty by taking advantage of circulating maternal estrogen. This case report presents pre-surgical nasal cartilage molding in a patient with unilateral cleft lip and alveolus using the Sawangi Pre-surgical Nasal Cartilage Molder appliance. The appliance is made from 0.8 mm stainless-steel round wire and has three components, namely, a rectangular frame, a force-generating component, and a swan-shaped wire framework with a soft liner for nasal asymmetry correction.

A Clinical Odyssey Involving Cleidocranial Dysplasia: Report of a Rare Case.

Cleidocranial dysplasia (CCD) is a rare genetic disorder that causes cranial and skeletal abnormalities. This case report presents a comprehensive analysis of a rare instance of CCD, highlighting its clinical manifestations through an orthodontic lens shedding light on the challenges and complexities associated with managing this uncommon condition. The patient, an 18-year-old female, presented with a variety of symptoms, including delayed eruption of permanent teeth, abnormal facial features, and prominent cranial abnormalities. Multiple teeth in both the arches were missing including over-retention of primary teeth. Features of cleidocranial dysplasia were evident in her facial appearance. Treatment of CCD requires a multifaceted approach, often involving orthodontic interventions, dental extractions, and corrective surgeries to address cranial deformities and other skeletal anomalies. The report emphasizes the importance of multidisciplinary collaboration in diagnosing and managing such cases, shedding light on the distinctive features of CCD and their implications for orthodontic treatment on what kind of best treatment can be given to these patients. This case serves as a reminder of the importance of raising awareness about rare genetic disorders like CCD, as early diagnosis and intervention can significantly improve the patient's quality of life. Furthermore, it underscores the significance of a collaborative and holistic healthcare approach in managing such complex conditions. It emphasizes the need for continued research, awareness, and support for individuals affected by such conditions.

Expanding Horizons: A Case Report of Cleft Expansion in the Mixed Dentition Stage.

A nine-year-old boy with a cleft lip and palate had midface retrusion as a result of maxillary complex growth inhibition. He sought treatment for total crossbite with a Class III skeletal pattern. The maxillary expansion widened the maxilla to improve the sagittal and transverse skeletal relationship. In skeletal Class III patients with a repaired cleft lip and palate, maxillary expansion and protraction usually provide effective improvement. The individual growth of the maxilla and mandible is crucial to the success of the orthopedic procedure.

Midline Diastema Closure Using an M Spring in a Young Adult: A Case Report.

The malocclusion known as maxillary midline diastema frequently occurs. For the management of diastema, a variety of therapy approaches are recommended. This article gives a case report of a female patient, age 24, who underwent treatment for a 4-mm maxillary midline diastema following the extraction of an additional tooth between her upper central incisors. The orthodontic treatment index was minimal (grade 2). The maxillary central incisors were fitted with bonded McLaughlin-Bennett-Trevisi (MBT) 0.018" brackets. A rectangular archwire was used after the circular archwire to ligate and activate the M spring. The diastema was successfully closed after a total of four months of treatment. This approach is effective and efficient and uses minimal inventory. This shortens the length of the orthodontic treatment and conserves valuable chairside time.

Kumar and Daigavane's Impacted Maxillary Canine Grading System: A New Classification System For Treatment of Cleft Lip and Palate.

Introduction  Maxillary canines are the most commonly impacted teeth, second only to third molars. Cleft lip and palate patients have a higher chance of impacted canines due to defects in bone formation and the soft tissue enclosing it. Various authors have used two-dimensional radiographs and developed grading systems to streamline treatment modalities to deal with the impacted canines. Material and Methods A study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics. Children aged nine to 12 were selected for this evaluation based on both clinical and radiographic examination. Four different parameters were set to evaluate the impacted canine location. which was based on angulation, vertical height, root apex location, and defect area involved. Result Based on these evaluations, a classification was developed by the present authors, and later the cases were assessed as per the new system that we named Kumar and Daigavane's (KD) Impacted Maxillary Canine Grading System which we developed to give us more clarity for treatment and prognosis for treatment of cleft lip and palate. Conclusion A three-dimensional evaluation is also advised for a better understanding of the impacted canines. Many of the shortcomings of the two-dimensional assessment can be diminished. This new grading system will improve cleft diagnosis and prognosis in patients with cleft lips and/or palates.

Review of Various Clinical Assessment Indices and Orthodontic Management for Temporomandibular Joint Disorders.

The term "temporomandibular disorders" (TMDs) refers to a variety of problems involving the muscles of the masticatory system and the jaw. The most common symptoms of TMD are pain in the face, headaches, clicking or popping in the joints, and difficulties with jaw function. The severity of TMD can be measured with a number of different scales, including the Helkimo, Craniomandibular Index (CMI), Mandibular Functional Impairment Questionnaire (MFIQ), Fonseca scale and Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) scales. The former focuses on the patient's chief complaint, while the latter takes into account secondary symptoms such as limited mobility, impaired temporomandibular joint (TMJ) function, muscle pain, and discomfort during mandibular motion. According to the severity of the issue, the results can be used to categorise the situation. To effectively treat TMD, one must first determine their index score and then formulate a treatment strategy based on that score.

Prosthodontic rehabilitation of a patient with bilateral auricular deformity

Maxillofacial prosthodontics is an art and science which provides life like appearance to the person with facial deformity. Maxillofacial prosthetic rehabilitation for acquired defects has become more complex and sophisticated with advancement in techniques and materials. This case report describes the clinical and laboratory procedure for fabricating an auricular prosthesis for a patient with trauma related bilateral auricular deformity. Ear prosthesis was fabricated in two parts taking retention from external auditory canal.