Use of Optical Coherence Tomography in Dentistry.

Optical coherence tomography (OCT) is an optics-based imaging technique, which may be called an "optical biopsy." It can be used to acquire structural information about a tissue at a resolution comparable to histopathology. OCT is based on the principle of low-coherence interferometry where near-infrared (NIR) light is shown on a tissue sample and then cross-sectional images are obtained based on backscattered light and echo time delay. Two main types of OCT are characterized as time-domain OCT (TD-OCT) and Fourier-domain OCT (FD-OCT). The applications of OCT in dentistry can be broadly divided into two groups, i.e., assessment of pathologies and assessment of surfaces and interfaces. Lately, OCT has made its transition from experimental laboratories to mainstream clinical applications. Starting from the short-term training courses, clinicians working in specialities like oral pathology, oral medicine, and oral implantology may find it a useful tool for their practices. It is now clear that OCT will be considered a gold standard diagnostic tool for the detection and characterization of several conditions and lesions of the orofacial region. However, the next challenge will be to incorporate it into the undergraduate and postgraduate curriculum and train dental healthcare staff in the use of these devices.

Alveolar bone loss and root resorption in mesialized second molars in mandibular first molar extraction cases as compared to contralateral non-extraction side in young adults: A retrospective cross-sectional study.

INTRODUCTION: The alveolar bone loss (ABL) and external apical root resorption (EARR) depict the safety of mesialization of mandibular second molars into the extraction space of mandibular first molars. The aim of this study was to evaluate the ABL and EARR after closure of mandibular first molar extraction space by mesialization of second molar on extraction side (ES) as compared to the contralateral non-extraction side (NES). MATERIAL AND METHODS: A retrospective cross-sectional study was carried out using the pre and posttreatment orthodontic records of young adults with complete set of permanent dentitions treated with extraction of unilateral mandibular first molar and non-extraction treatment on the contralateral side. All patients underwent mini-implant supported mesialization of second molar on ES. The ABL and EARR of second molar on ES and contralateral NES were measured on digital orthopantomograms. The ABL and EARR of second molars on ES and contralateral NES were compared using independent sample t-test. RESULTS: A total of 36 subjects (14 males and 22 females) were included in the study. The mean treatment duration for molar mesialization was 28.75±8.05months. The mean crown and root movements of mandibular second molar on ES were 10.94±1.25mm and 9.04mm±1.14mm, as compared to 0.91±1.01mm and 0.77±0.83mm on contralateral NES, respectively. The mean ABL and EARR at mandibular second molar were found to be significantly greater on the ES than the contralateral NES (P<0.001 and<0.05, respectively). A total of seven patients (19.4%) experienced ABL≥1mm on ES as compared to none in the contralateral NES. EARR of>2mm of at least one root was found in seven patients (19.4%) in ES as compared to four (11%) in contralateral NES. CONCLUSION: There was small but statistically significant difference in the ABL and EARR of mesialized mandibular second molar at first molar ES as compared to the contralateral NES. For majority of patients this difference was small but few isolated cases experienced severe ABL and EARR.

Nature and severity of dental malocclusion in children suffering from transfusion-dependent (-thalassemia major

ABSTRACT Objective: To evaluate the prevalence and severity of malocclusion in children suffering from β-thalassemia and to assess orthodontic treatment need using Grainger's Treatment Priority Index (TPI) and index of orthodontic treatment need (IOTN)-dental health component (DHC). Methods: A cross-sectional study was conducted on 200 transfusion-dependent children diagnosed with homozygous β-thalassemia and 200 healthy school children aged 11-17 years. The TPI and IOTN-DHC data was recorded for both groups. Total TPI score for each subject was calculated and graded according to malocclusion severity estimate (MSE). Independent sample t-test was used to compare mean TPI scores, overjet and overbite between thalassemic and healthy children. Chi-square test was used to compare the frequency of IOTN-DHC grades, Angle's classification, and MSE grades between thalassemic and healthy children. Results: The most prevalent malocclusion was Class I in normal children (67.5%) and Class II in thalassemic children (59%). The mean overjet and overbite were significantly (p<0.001) greater in thalassemic children than in healthy children. Severe tooth displacements were 3.5 times greater in thalassemic children, compared to controls. A greater proportion of thalassemic children were in IOTN grades 3 and 4, compared to the controls (p<0.001). MSE grades 4 and 5 were significantly (p<0.001) more prevalent in thalassemic children, compared to the controls. Conclusion: There is a high prevalence of Angle's Class II malocclusion in thalassemic children. Majority of these children are categorized in higher grades of IOTN-DHC and TPI-MSE, showing a great severity of malocclusion and high orthodontic treatment needs.

RESUMO Objetivo: Avaliar a prevalência e gravidade da má oclusão em crianças que sofrem de beta-talassemia e mensurar a necessidade de tratamento ortodôntico usando o Índice de Prioridade de Tratamento (IPT) de Grainger e o Índice de Necessidade de Tratamento Ortodôntico (Index of Orthodontic Treatment Need - IOTN) - Componente de Saúde Dental (Dental Health Component - DHC). Métodos: Um estudo transversal foi conduzido com 200 crianças com diagnóstico de beta-talassemia homozigótica dependentes de transfusão e 200 crianças saudáveis em idade escolar, entre 11 e 17 anos. Os dados do IPT e do IOTN-DHC foram documentados para ambos os grupos. A pontuação total do IPT para cada sujeito foi calculada e classificada de acordo com a Estimativa de Severidade da Má oclusão (ESM). O teste t para amostras independentes foi usado para comparar os escores médios de IPT, sobressaliência e sobremordida, entre as crianças saudáveis e as com talassemia. O teste qui-quadrado foi usado para comparar a frequência dos escores do IOTN-DHC, a classificação de Angle e os escores do ESM entre crianças com beta-talassemia e crianças saudáveis. Resultados: A má oclusão mais prevalente foi a Classe I em crianças normais (67,5%) e a Classe II em crianças com beta-talassemia (59%). Os valores médios de sobressaliência e a sobremordida foram significativamente (p< 0,001) maiores em crianças com beta-talassemia do que em crianças saudáveis. Os deslocamentos dentários graves foram 3,5 vezes maiores em crianças com beta-talassemia em comparação com os controles. Uma proporção maior de crianças com beta-talassemia estava nos escores 3 e 4 do IOTN em comparação com os controles (p <0,001). Os escores 4 e 5 de ESM foram significativamente (p< 0,001) mais prevalentes em crianças com beta-talassemia em comparação com os controles. Conclusão: Há uma alta prevalência de má oclusão de Classe II de Angle em crianças com beta-talassemia. A maioria dessas crianças é categorizada em escores superiores de IOTN-DHC e IPT-ESM, mostrando uma grande gravidade de má oclusão e alta necessidade de tratamento ortodôntico.

Management of an adolescent with complete bilateral cleft lip and palate using fan-shaped expander and secondary alveolar bone graft: A case report.

Treatment approach for bilateral cleft lip and palate (BLCLP) patients varies according to their presenting age. This case report describes the successful orthodontic treatment in an adolescent with BLCLP who was classified in Grade 3 according to Bauru BLCLP yardstick. The patient was diagnosed with skeletal Class III malocclusion, severe crowding, anterior and bilateral posterior crossbites and bilateral maxillary anterior alveolar defects. A combined orthodontic and surgical approach comprising of fan-shaped expander, secondary alveolar bone graft followed by comprehensive orthodontic treatment was utilized. The treatment resulted in a greatly improved facial aesthetics and stomatognathic function, which contributed to psychological well being of the patient.

Current trends in craniofacial distraction: A literature review.

The techniques and procedures involved in craniofacial distraction are constantly evolving. The understanding of histological and biochemical response at the distraction site is now improved. The cascade of events in distraction osteogenesis (DO) differs significantly from the typical fracture healing, and a better knowledge about these events has helped us identify suitable candidates for DO, make appropriate modifications to the distraction protocols and minimize the risk of complications. Recent advances in the manufacturing techniques have also facilitated the availability of distractors of various shapes and designs, which are now changing the way different craniofacial defects are being treated. Small but rigid intraoral distractors now enable easy placement, are well tolerated by patients and allow for a long consolidation period. The introduction of newer approaches toward treatment, together with the simultaneous management of different craniofacial defects at multiple osteotomy sites and enhanced surgical accuracy with the help of digital imaging, have made treatment outcomes more predictable.

Nature and severity of dental malocclusion in children suffering from transfusion-dependent (-thalassemia major.

OBJECTIVE: To evaluate the prevalence and severity of malocclusion in children suffering from ß-thalassemia and to assess orthodontic treatment need using Grainger's Treatment Priority Index (TPI) and index of orthodontic treatment need (IOTN)-dental health component (DHC). METHODS: A cross-sectional study was conducted on 200 transfusion-dependent children diagnosed with homozygous ß-thalassemia and 200 healthy school children aged 11-17 years. The TPI and IOTN-DHC data was recorded for both groups. Total TPI score for each subject was calculated and graded according to malocclusion severity estimate (MSE). Independent sample t-test was used to compare mean TPI scores, overjet and overbite between thalassemic and healthy children. Chi-square test was used to compare the frequency of IOTN-DHC grades, Angle's classification, and MSE grades between thalassemic and healthy children. RESULTS: The most prevalent malocclusion was Class I in normal children (67.5%) and Class II in thalassemic children (59%). The mean overjet and overbite were significantly (p<0.001) greater in thalassemic children than in healthy children. Severe tooth displacements were 3.5 times greater in thalassemic children, compared to controls. A greater proportion of thalassemic children were in IOTN grades 3 and 4, compared to the controls (p<0.001). MSE grades 4 and 5 were significantly (p<0.001) more prevalent in thalassemic children, compared to the controls. CONCLUSION: There is a high prevalence of Angle's Class II malocclusion in thalassemic children. Majority of these children are categorized in higher grades of IOTN-DHC and TPI-MSE, showing a great severity of malocclusion and high orthodontic treatment needs.

The maxillary incisor display at rest: analysis of the underlying components

ABSTRACT Introduction: Maxillary incisal display is one of the most important attributes of smile esthetics. Objective: The aim of this study was to determine the relationship between maxillary incisal display at rest (MIDR) and various soft tissue, hard tissue and dental components. Methods: A cross-sectional study was conducted on 150 subjects (75 males, 75 females) aged 18-30 years. The MIDR was recorded from the pretreatment orthodontic records. The following parameters were assessed on lateral cephalograms: ANB angle, mandibular plane angle, palatal plane angle, lower anterior and total anterior facial heights, upper incisor inclination, upper anterior dentoalveolar height, and upper lip length, thickness and protrusion. The relationship between MIDR and various skeletal, dental and soft tissue components was assessed using linear regression analyses. Results: The mean MIDR was significantly greater in females than males (p = 0.011). A significant positive correlation was found between MIDR and ANB angle, mandibular plane angle and lower anterior facial height. A significant negative correlation was found between MIDR and upper lip length and thickness. Linear regression analysis showed that upper lip length was the strongest predictor of MIDR, explaining 29.7% of variance in MIDR. A multiple linear regression model based on mandibular plane angle, lower anterior facial height, upper lip length and upper lip thickness explained about 63.4% of variance in MIDR. Conclusions: Incisal display at rest was generally greater in females than males. Multiple factors play a role in determining MIDR, nevertheless upper lip length was found to be the strongest predictor of variations in MIDR.

RESUMO Introdução: a exposição dos incisivos superiores é um dos fatores mais importantes na estética do sorriso. Objetivo: o objetivo desse estudo foi determinar a relação entre a exposição dos incisivos superiores em repouso (EISR) e diferentes componentes em tecidos moles, tecidos duros e dentários. Métodos: um estudo transversal foi conduzido com 150 pacientes (75 homens, 75 mulheres), com idades entre 18 e 30 anos. A EISR foi obtida nos registros pré-tratamento ortodôntico. Os seguintes parâmetros foram analisados nas radiografias laterais: ângulo ANB; ângulo do plano mandibular; ângulo do plano palatino; altura facial anterior inferior; altura facial anterior total; inclinação dos incisivos superiores; altura dentoalveolar anterior superior; comprimento, espessura e protrusão do lábio superior. A relação entre a EISR e os diferentes componentes esqueléticos, dentários e em tecidos moles foi analisada por meio de uma análise de regressão linear. Resultados: a EISR média foi significativamente maior nas mulheres do que nos homens (p= 0,011). Foi encontrada correlação positiva significativa entre a EISR e: o ângulo ANB, ângulo do plano mandibular e a altura facial anterior inferior. Uma correlação negativa significativa foi encontrada entre a EISR e o comprimento e a espessura do lábio superior. A análise de regressão linear mostrou que o comprimento do lábio superior foi o maior preditor da EISR, explicando 29,7% das variações na exposição dos incisivos superiores em repouso. Um modelo de regressão linear múltipla baseado no ângulo do plano mandibular, na altura facial anterior inferior, comprimento do lábio superior e espessura do lábio superior explicou cerca de 63,4% das variações na EISR. Conclusões: a exposição dos incisivos em repouso foi, de um modo geral, maior nas mulheres do que nos homens. Múltiplos fatores exercem influência na quantidade da exposição dos incisivos superiores em repouso; porém, o comprimento do lábio superior foi identificado como o maior preditor das variações na EISR.

The maxillary incisor display at rest: analysis of the underlying components.

INTRODUCTION: Maxillary incisal display is one of the most important attributes of smile esthetics. OBJECTIVE: The aim of this study was to determine the relationship between maxillary incisal display at rest (MIDR) and various soft tissue, hard tissue and dental components. METHODS: A cross-sectional study was conducted on 150 subjects (75 males, 75 females) aged 18-30 years. The MIDR was recorded from the pretreatment orthodontic records. The following parameters were assessed on lateral cephalograms: ANB angle, mandibular plane angle, palatal plane angle, lower anterior and total anterior facial heights, upper incisor inclination, upper anterior dentoalveolar height, and upper lip length, thickness and protrusion. The relationship between MIDR and various skeletal, dental and soft tissue components was assessed using linear regression analyses. RESULTS: The mean MIDR was significantly greater in females than males (p = 0.011). A significant positive correlation was found between MIDR and ANB angle, mandibular plane angle and lower anterior facial height. A significant negative correlation was found between MIDR and upper lip length and thickness. Linear regression analysis showed that upper lip length was the strongest predictor of MIDR, explaining 29.7% of variance in MIDR. A multiple linear regression model based on mandibular plane angle, lower anterior facial height, upper lip length and upper lip thickness explained about 63.4% of variance in MIDR. CONCLUSIONS: Incisal display at rest was generally greater in females than males. Multiple factors play a role in determining MIDR, nevertheless upper lip length was found to be the strongest predictor of variations in MIDR.

The duration of pubertal growth peak among three skeletal classes.

INTRODUCTION:: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. OBJECTIVE:: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. METHODS:: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. RESULTS:: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). CONCLUSIONS:: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

The duration of pubertal growth peak among three skeletal classes

ABSTRACT Introduction: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. Objective: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. Methods: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. Results: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). Conclusions: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

RESUMO Introdução: o pico de crescimento puberal está intimamente relacionado a um rápido aumento no comprimento da mandíbula e propicia uma larga gama de abordagens terapêuticas. Objetivos: o objetivo do presente estudo foi determinar e comparar as idades médias ao começo do pico de crescimento puberal, bem como sua duração, nas três diferentes classes esqueléticas. Métodos: esse estudo retrospectivo transversal foi conduzido usando radiografias celafométricas laterais de 230 indivíduos com potencial de crescimento (110 homens, 120 mulheres). Os indivíduos foram categorizados em 3 classes (Classe I = 81, Classe II = 82, Classe III = 67), conforme a relação sagital presente entre a maxila e a mandíbula. O estágio de maturação cervical foi registrado por meio do método de Baccetti. As idades médias em EMVC3 e EMVC4, bem como o intervalo de idade EMVC3-EMVC4 foram comparados entre meninos e meninas e entre as três classes esqueléticas. Resultados: o pico de crescimento puberal ocorreu, em média, quatro meses mais cedo nas meninas do que nos meninos (p = 0,050). A duração média do pico de crescimento puberal foi de 11 meses nos indivíduos Classe I, 7 meses nos indivíduos Classe II e de 17 meses nos indivíduos Classe III. As diferenças interclasses foram altamente significativas (d de Cohen > 0,08). Porém, não foram identificadas diferenças significativas quanto à época de início do pico de crescimento puberal entre as três classes esqueléticas (p = 0,126 nos garotos, p = 0,262 nas garotas). Conclusões: as meninas entram no pico de crescimento puberal, em média, quatro meses antes dos meninos. Além disso, a duração do pico de crescimento puberal é, em média, quatro meses menor em indivíduos Classe II e seis meses maior nos indivíduos Classe III, em comparação aos indivíduos Classe I.

FACIAL SOFT TISSUE ANALYSIS AMONG VARIOUS VERTICAL FACIAL PATTERNS.

BACKGROUND: The emergence of soft tissue paradigm in orthodontics has made various soft tissue parameters an integral part of the orthodontic problem list. The purpose of this study was to determine and compare various facial soft tissue parameters on lateral cephalograms among patients with short, average and long facial patterns. METHODS: A cross-sectional study was conducted on the lateral cephalograms of 180 adult subjects divided into three equal groups, i.e., short, average and long face according to the vertical facial pattern. Incisal display at rest, nose height, upper and lower lip lengths, degree of lip procumbency and the nasolabial angle were measured for each individual. The gender differences for these soft tissue parameters were determined using Mann-Whitney U test while the comparison among different facial patterns was performed using Kruskal-Wallis test. RESULTS: Significant differences in the incisal display at rest, total nasal height, lip procumbency, the nasolabial angle and the upper and lower lip lengths were found among the three vertical facial patterns. A significant positive correlation of nose and lip dimensions was found with the underlying skeletal pattern. Similarly, the incisal display at rest, upper and lower lip procumbency and the nasolabial angle were significantly correlated with the lower anterior facial height. CONCLUSION: Short facial pattern is associated with minimal incisal display, recumbent upper and lower lips and acute nasolabial angle while the long facial pattern is associated with excessive incisal display, procumbent upper and lower lips and obtuse nasolabial angle.

Facial soft tissue thickness among various vertical facial patterns in adult Pakistani subjects.

Facial reconstruction techniques are used to obtain an approximation of an individual's appearance thus helping identification of unidentified decedents from their dried skeletal remains. Many of these techniques rely on the sets of average facial soft tissue thickness (FST) values at different anatomical landmarks provided by the previous studies. FST is influenced by the age, sex, ethnicity and the body mass index of the individual. Recent literature has shown that the anthropological variations of the skull may also affect FST at certain points. This study was designed to evaluate the effect of such variations in vertical skull morphology on FST as around one third of different population groups have either a long or short facial pattern as compared to the average facial pattern. Moreover, this study also provides a FST database for the adult Pakistani subjects that may have potential implications in the facial reconstruction of the local subjects. A retrospective analysis of 276 lateral cephalograms of adult subjects having normal sagittal facial pattern was performed. Subjects were categorized into three vertical facial patterns (long face=95, average face=102, short face=79) according to the vertical dimensions of the skull and the FST was measured at 11 midline points. To compare the FST between males and females Mann-Whitney U test was used. Kruskal-Wallis test was applied to compare FST among three vertical facial patterns. The results of our study revealed significant differences in FST at nine landmarks between males and females. These sex-based differences were more pronounced in the long and short facial patterns as compared to the average facial pattern. FST at stomion, pogonion, gnathion and menton was significantly greater in the short facial pattern as compared to the long facial pattern in both the sexes. The results of the present study highlight the importance of anthropological analysis of the skull and taking the vertical skeletal dimension into consideration while performing facial reconstruction.

Facial Soft Tissue Thickness Among Three Skeletal Classes in Adult Pakistani Subjects.

Different facial reconstruction methods rely on the average facial soft tissue thickness values provided in previous studies. Facial soft tissue thickness is influenced by the age, sex, and ethnicity of the individual. The aim of the present study was to determine facial soft tissue thickness of adult Pakistani subjects with different facial morphology. A total of 166 subjects were categorized into three skeletal classes (based on convex, straight, or concave facial profile) employing the classification system used in orthodontics. Facial soft tissue thickness was determined at ten midline points on lateral cephalograms. Significant differences in facial soft tissue thickness were present at glabella, labrale superius, stomion, and labiomentale in males and at labrale superius, labrale inferius, labiomentale, and pogonion in females among different skeletal classes. The current study suggests that the skull morphology-related variations in facial soft tissue thickness should be considered during facial reconstruction to achieve accurate results.

Current trends in undergraduate medical and dental research: a picture from Pakistan.

BACKGROUND: Initiatives taken over the last few years have led us to the day when most of the medical and dental institutions in the developed countries have established a strong research culture at undergraduate level but the situation is quite the contrary in Pakistan. This study was carried out to investigate the current trends in undergraduate medical and dental research and to highlight the research barriers. METHODS: A cross-sectional study was conducted at six medical and dental colleges of Rawalpindi and Islamabad. A structured questionnaire was used to collect data from 300 students. Results were recorded as percentages. Findings of current survey were compared with those of already reported in literature using chi-square test. RESULTS: Out of 300 students, 206 (68.7%) students had already participated in research as principal researcher, co-researcher or as a research volunteer. Internet was most effective method of publicity of research opportunities reported by 74% of students. Only 36.7% students reported the presence of student research office at their institute. Accessibility to medical and dental journals and availability of research funds were reported by 77.2% and 13.4% of students, respectively. Lack of funding and academic overload were two main research barriers reported by 92.6% and 91.9% of students, respectively. CONCLUSION: The fraction of medical and dental students who are confident that they can plan, conduct and write a research study has increased over last four years. There is an improvement in the availability of research promoting activities but the number of research barriers is still high.