Biomarkers in Body Fluids as Indicators of Skeletal Maturity: A Systematic Review and Meta-analysis.

OBJECTIVES: This review aimed to critically appraise the evidence for biomarkers in blood serum, gingival crevicular fluid (GCF), saliva, and urine in comparison with standard radiographic indices for skeletal maturation assessment. MATERIALS AND METHODS: A thorough literature search in multiple databases was conducted for biomarkers in body fluids for skeletal maturation assessed with cervical vertebrae in lateral cephalograms or on hand-wrist radiographs. Different combinations including free text, MeSH terms, and Boolean operators were used. Two researchers used strict inclusion and exclusion criteria to screen title, abstract, and full text, and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 instrument for risk of bias assessment of individual studies. Meta-analysis was performed on eligible studies using RevMan 5 software. RESULTS: A total of 344 articles were screened, of which 33 met the inclusion criteria and quality assessment. The skeletal maturity indicators included insulin-like growth factors (IGF-1), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), dehydroepiandrosterone sulfate (DHEAS), vitamin D binding protein (DBP), parathormone-related protein (PTHrP), osteocalcin, metalloproteins, and serotransferrin (TF) along with different metabolites. At puberty, a significant rise was seen in IGF-1, DBP, ALP, osteocalcin, TF, and BALP. However, the serum DHEAS and PTHrP increased from pre-pubertal to post-pubertal stages. Due to the data heterogeneity, a meta-analysis could be performed on seven studies in total on IGF-1 in serum and blood. Of these, five were included for data in males and six in females, and four studies on IGF-1 in serum and blood. A significant difference in IGF-1 levels was seen between stages of peak pubertal growth spurt (CS3 and CS4) and decelerating pubertal growth (CS5) compared with growth initiation stage (CS2). CONCLUSIONS: Pubertal growth spurts were correlated with peak serum IGF-1 and BALP in both sexes individually. Peak ALP levels in GCF were correlated with the pubertal spurt in a combined sample of males and females. Standard biofluid collection protocols and homogeneity in sampling and methodology are strongly recommended for future research.

Assessment of Skeletal Maturation in Nonsyndromic Cleft and Non-cleft Children-A Comparative Study.

The study aims to determine the difference in the skeletal maturation of unilateral cleft lip and palate (UCLP) and non-cleft children. This study also attempts to determine sexual dimorphism in attaining skeletal maturation between UCLP and non-cleft children. This was a retrospective, cross-sectional study. The total sample consisted of the lateral cephalogram of 131 UCLP (62 female and 71 male) children and 500 (274 female and 226 male) non-cleft children. The reviewer used the Baccetti method (2005) to review all the cephalograms for the cervical vertebrae maturation (CVM) stages. T -test was used to compare the mean chronological age and skeletal maturation of cleft and non-cleft children at each CVM stage. There was no significant difference in the mean chronological age and skeletal maturation status of UCLP and non-cleft children. There was no significant difference in skeletal maturation based on sex. The intraobserver assessment showed 80% and 85% kappa agreement, signifying absolute agreement. The correlation coefficient between chronological age and CVMIs was 0.86 ( P <0.001) in cleft children and 0.76 ( P <0.001) in non-cleft children, which was highly significant. The study indicates no significant difference in the skeletal maturation of UCLP and non-cleft children and no sex-related difference.

A pattern of microbiological colonization of orthodontic miniscrew implants.

INTRODUCTION: Current orthodontic literature reveals a lack of studies on bacterial colonization of orthodontic miniscrew implants (MSI) and their role in the stability of MSI. This study aimed to determine the pattern of microbiological colonization of miniscrew implants in 2 major age groups, to compare it with the microbial flora of gingival sulci in the same group of patients and to compare microbial flora in successful and failed miniscrews. METHODS: The study involved 102 MSI placed in 32 orthodontic subjects in 2 age groups: (1) aged ≤14 years and (2) aged >14 years. Gingival and peri-mini implant crevicular fluid samples were collected using sterile paper points (International Organization for Standardization no. 35) >3 months and processed by conventional microbiologic culture and biochemical techniques. A microbiologist characterized and identified the bacteria, and the results were subjected to statistical analysis. RESULTS: Initial colonization was reported within 24 hours, with Streptococci being the dominant colonizer. The relative proportion of anaerobic bacteria over aerobic bacteria increased over time in peri-mini implant crevicular fluid. Group 1 had greater Citrobacter (P = 0.036) and Parvimonas micra (P = 0.016) colonizing MSI than group 2. Failed MSI showed a significantly higher presence of Parvimonas micra (P = 0.008) in group 1 and Staphylococci (P = 0.008), Enterococci (P = 0.011), and Parvimonas micra (P <0.001) in group 2. CONCLUSIONS: Microbial colonization around MSI is established within 24 hours. Compared to gingival crevicular fluid, peri-mini implant crevicular fluid is colonized by a higher proportion of Staphylococci, facultative enteric commensals and anaerobic cocci. The failed miniscrews showed a higher proportion of Staphylococci, Enterobacter, and Parvimonas micra, suggesting their possible role in the stability of MSI. The bacterial profile of MSI varies with age.

MRI-based cephalometrics: a scoping review of current insights and future perspectives.

OBJECTIVE: This review aims to explore the current status of magnetic resonance imaging (MRI) as a cephalometric tool, summarize the equipment design and methods, and propose recommendations for future research. METHODS: A systematic search was conducted in electronic databases, including PubMed, Ovid MEDLINE, Scopus, Embase, Web of Science, EBSCOhost, LILACS, and Cochrane Library, using broad search terms. The articles published in any language till June 2022 were considered. Cephalometric studies conducted using the MRI dataset on human participants, phantom or cadaver were included. Two independent reviewers assessed the final eligible articles using the quality assessment score (QAS). RESULTS: Nine studies were included in the final assessment. Studies used various methods, including 1.5 T or 3 T MRI systems and 3D or 2D MRI datasets. Among the imaging sequences, T1-weighted, T2-weighted and black bone MR images were used for cephalometric analysis. In addition, the reference standards varied among studies, such as traditional 2D cephalogram, cone-beam CT and phantom measurements. The mean QAS of all the included studies was 79% (± 14.4%). The main limitation of most studies was the small sample size and the heterogeneity of the methods, statistical tools used, and metric outcomes assessed. CONCLUSIONS: Despite the heterogeneity and lack of metrological evidence on the effectiveness of MRI-based cephalometric analysis, the preliminary results demonstrated by in vivo and in vitro studies are encouraging. However, future studies exploring MRI sequences specific to cephalometric diagnosis are required for wider adoption of this technique in routine orthodontic practice.

A Rare Case of Cleft Palate Associated With Tongue Hamartoma: A Case Report and Systematic Review.

INTRODUCTION: Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and cleft palate formation. An encounter with a case of cleft palate due to dorsal tongue hamartoma prompted us to perform this systematic review. OBJECTIVE: To review the clinical profile and management approach for a case with cleft palate and tongue hamartoma. DESIGN: A systematic literature search was conducted using keywords related to cleft palate and tongue hamartoma in PubMed, Scopus, MEDLINE, and Scielo databases through December 2021, with no time or language restrictions. PATIENTS, PARTICIPANTS: Studies reporting patients with cleft palate and tongue hamartoma were included. MAIN OUTCOME MEASURE(S): Information related to clinical profile, diagnostic tests, histopathology, management, and outcomes were extracted.Fourteen relevant publications were identified with 16 cases reported so far. Among them, thirteen patients were females (81.25%), and 3 were males (18.75%). The age of presentation varied from birth to 19 years. Oral-facial-digital syndrome (type II) was the most commonly associated syndrome.Congenital tongue hamartoma with cleft palate is a rare presentation, which can present as an isolated entity or part of a syndrome. Genetic evaluation is warranted, particularly for multiple hamartomatous lesions. The preferred treatment is immediate excision of hamartoma while following a standard timeline for palatoplasty.

A quantitative analysis of macrophage-colony-stimulating factor in peri-miniscrew implant crevicular fluid before and after orthodontic loading.

OBJECTIVES: To analyze macrophage-colony-stimulating factor (M-CSF), a bone remodeling biomarker in the peri-miniscrew implant crevicular fluid (PMICF) after insertion and orthodontic loading. MATERIALS AND METHODS: This prospective study included 40 miniscrew implant (MSI) sites in 10 subjects undergoing fixed orthodontic mechanotherapy utilizing miniscrew anchorage. After dental alignment, miniscrews were inserted between the second premolar and first molar roots. After 21 days of insertion, MSIs were direct loaded with closed-coil springs (200 g force) for en masse retraction of anterior teeth. PMICF was collected with Periopaper™ strips from the gingival crevice around MSIs at six time points (T1-T6: 1 hour, 1 day, 21 days postinsertion, and 7, 21, and 42 days postloading). PMICF was quantified for M-CSF by enzyme-linked immunosorbent assay. Paired comparison of mean M-CSF concentrations before and after loading stages (T1-T6) was made using the Wilcoxon signed-rank test. RESULTS: The mean M-CSF concentration showed a significant peak at T3 (21 days postinsertion; 12.646 pg/mL; T1 vs T3: P < .0001). After orthodontic loading of miniscrews, M-CSF levels increased to 13.570 pg/mL at T4 (7 days after loading; T1 vs T4: P < .001) and maintained at a plateau to T5 (21 days postloading; 11.994 pg/mL). However, the difference between preloading and postloading was not statistically significant (T3 vs T4). CONCLUSIONS: The maximum M-CSF activity around MSIs was observed at around 3 weeks of miniscrew insertion, suggesting underlying bone remodeling after surgical injury. However, orthodontic force on MSIs did not cause any significant surge in M-CSF levels postloading.

Role of S100 A7 as a diagnostic biomarker in oral potentially malignant disorders and oral cancer.

Background: S100 proteins have been implicated in the tumorigenesis of different human cancers and in oral dysplasia, as they are keratinocytes. Materials and Methods: In the present study, we have attempted to compare the expression of S100-A7 within young-onset (age ≤45 years, Group 1) oral squamous cell carcinoma (OSCC), OSCC in older age groups (age >45 years Group 2), oral potentially malignant disorders (OPMDs, Group 3) and inflammatory lesions (Group 4). The tissue sections were scored based on the percentage of immunostained cells and staining intensity. Nuclear, cytoplasmic and membrane immunoreactivity were also scored. Results: The present study comprised 153 histopathologically diagnosed case subjects of OSCC >45 years (n = 41), OSCC <45 years (n = 36), OPMD (n = 40) and inflammatory lesions (n = 36). The present study revealed a statistically significant difference of distribution with regard to S100A7 staining (cytoplasmic and nuclear) between OPMDs and OSCC (P < 0.05). The nuclear, cytoplasmic and membrane staining as well as the staining intensity had significantly different scoring patterns among the OSCC group, OPMD group and the inflammatory lesions with the OSCC group having the highest scoring of the S100A7 staining (irrespective of the age). Conclusions: The present study concludes that S100A7 can be used as a diagnostic biomarker to differentiate between OPMDs and OSCC lesions. However, the marker is unable to distinguish between OSCCs in younger and older patients as the molecular pathogenesis of tumors in either of these age groups is probably similar.

Effects of submucosally administered platelet-rich plasma on the rate of tooth movement.

OBJECTIVES: To evaluate the effects of submucosally administered platelet-rich plasma (PRP) on the rate of maxillary canine retraction. Levels of soluble receptor activator of nuclear factor-κb ligand (sRANKL) and osteoprotegerin (OPG) in the gingival crevicular fluid (GCF) were also measured over 2 months. MATERIALS AND METHODS: This split-mouth trial involved 20 sites in 10 subjects randomly assigned to PRP (experimental) side and control side. After alignment, the freshly prepared PRP was injected submucosally distal to the experimental side maxillary canine, and retraction was performed using NiTi closed-coil springs (150 g) on 0.019 × 0.025-inch stainless steel wire. The rate of canine movement was assessed using digital model superimposition at 0, 30, and 60 days. The OPG and sRANKL were assayed using enzyme-linked immunosorbent assay from GCF collected at 0, 1, 7, 21, 30, and 60 days. RESULTS: Twenty sites were analyzed using paired t test. The rate of tooth movement increased significantly by 35% on the PRP side compared with the control side in the first month (P = .0001) and by 14% at the end of the second month (P = .015). Using the Mann-Whitney U test, OPG levels were found to be significantly decreased on the 7th (P = .003) and 30th day on the PRP side (P = .01), while sRANKL became detectable by the third week postinjection on the PRP side (P = .069). CONCLUSIONS: Submucosal injection of platelet-rich plasma significantly increased tooth movement during the 60-day observation period. Local injection of PRP significantly altered the levels of OPG and sRANKL in GCF.

Fabrication and evaluation of antimicrobial biomimetic nanofiber coating for improved dental implant bioseal: An in vitro study.

BACKGROUND: A weak implant-soft tissue interface may lead to bacterial ingression, breakdown of underlying tissues, and eventually implant failure. This study proposes a surface modification technique of titanium alloy (Ti), using a nano-biopolymer scaffold to enhance soft tissue attachment in dental implants. METHODS: Gelatin (20% w/v) embedded with 10 ± 2 nm silver nanoparticles (AgNPs) was electrospun to form a gelatin electrospun mat (GEM) scaffold, bonded to Ti alloy surface using chemical surface functionalization. Antimicrobial activity of AgNPs was tested against representative Gram-positive (Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli) at 4, 24, and 48 hours and after embedding in scaffold at 48 hours. Cytotoxicity analysis (MTT assay) was performed using the 3T3 mouse fibroblast cell line at 24 and 72 hours for two groups: control (unmodified Ti disc) and experimental (GEM embedded with AgNPs); and further validated by scanning electron microscopy. RESULTS: The AgNPs-embedded GEM showed good antimicrobial activity at 48 hours, with the AgNPs showing complete (99.99%) inhibition of bacterial colony counts at 24 and 48 hours. Cell viability and proliferation over the GEM modified Ti discs were seen to be significantly increased (P < 0.05) at 72 hours as compared with control. SEM images revealed intimate spreading of fibroblasts, with differentiated cell morphology and pseudopodial processes, indicative of enhanced fibroblastic adhesion, growth, and differentiation over the scaffold. CONCLUSION: Results show good antifouling properties and biocompatibility of the fabricated coating, making it a promising strategy to reduce postoperative infections and peri-implant diseases in Ti dental implants.

Expression of circulating cell-free nucleic acids around miniscrew implant during orthodontic tooth movement-a prospective study.

OBJECTIVES: Literature shows that the expression of various biomarkers in peri-miniscrew crevicular fluid (PMICF) is related to the stability of miniscrew implants (MSIs). The present study investigated the role and alterations in levels of circulating cell-free nucleic acids (cfNAs) in PMICF before and after orthodontic loading. MATERIAL AND METHODS: This prospective study consisted of forty-six MSIs placed between the second premolar and first molar in the maxillary and mandibular arches. Direct loading was done after 3 weeks of MSI insertion with nickel-titanium closed coil spring exerting a force of 200 g. The PMICF sample was collected at various time intervals, and the level of cfNA was determined. Clinical parameters, including implant mobility and gingival health, were also assessed. Pre-loading and post-loading parameters were assessed using Wilcoxon's rank-sum test. RESULTS: Among 46 MSIs, 36 were stable during the study and 10 MSIs showed peri-implant inflammation and increased mobility. There was a significant rise in the cfNA concentration 24 h after implant insertion (0.4 ± 0.86 ng/µl). The level of cfNAs significantly decreased over 3 weeks and reached the baseline level (0.2 ± 0.31 ng/µl). There was also a significant rise in the levels of cfNA (0.8 ± 0.70 ng/µl) at 24 h after loading MSIs, which gradually decreased to 0.2 ± 0.24 ng/µl after 63 days. The expression of cfNAs was on the average 0.32 units more in the cases with failed implants (P = 0.05). CONCLUSIONS: cfNA levels in PMICF showed an upward trend 24 h after MSI insertion and 24 h after orthodontic loading. The expression of cfNA was more in cases with failed MSIs. Hence, the cfNAs can be considered as a prognostic biomarker of MSI stability.

Effectiveness of an oral health training program for nursing professionals in India: An interventional study.

OBJECTIVES: Nursing professionals form the first line of contact and are in a unique place to provide appropriate oral advice to patients. The study assessed the effectiveness of oral health training program for nurses. DESIGN: The effectiveness of the program was evaluated by a pre and post questionnaire assessment on 50 nurses. RESULTS: Nursing professionals had a significant increase (p < .003) in post-training knowledge scores compared to pre-training scores. CONCLUSION: Improvement in oral health knowledge of nursing professionals has the potential for translation into practice for oral health promotion of patients and the general population.

Comparison of the efficacy of two-time versus one-time micro-osteoperforation on maxillary canine retraction in orthodontic patients: A split-mouth randomized controlled clinical trial.

BACKGROUND: Micro-osteoperforation (MOP), a minimally invasive technique for accelerating the rate of orthodontic tooth movement has been research extensively, but with varied clinical results. OBJECTIVE: To compare the efficacy of one-time versus two-time micro-osteoperforation on the rate of maxillary canine retraction, its influence on anchorage loss, canine angulation and the levels of interleukin (IL-1ß) in gingival crevicular fluid (GCF). MATERIALS AND METHODS: The split-mouth study included 16 patients in which the left and right sides were randomly allocated to the control side (one-time MOP) and experimental side (two-time MOP). MOP was performed on both sides distal to the maxillary canines and canine retraction was carried out using NiTi closed coil springs (150gm) and direct anchorage with miniscrew implants. The second MOP was performed on experimental side one month after the first MOP. The rate of canine movement was assessed using 3D model superimposition over a period of six months. The type of tooth movement, anchorage loss and levels of IL-1ß were also evaluated. RESULTS: Sixteen patients (mean age, 17.87±3.34 years) were analysed for a rate of canine retraction, anchorage loss, and type of tooth movement, while 15 patients were analysed for IL-1ß. The rate was significantly higher on two-time MOP side after two months (P<0.001). No statistical difference was found in anchorage loss and controlled tipping of canines was observed. The IL-1ß levels immediately after 2nd MOP were significantly higher than 1st MOP (P<0.001). CONCLUSION: The two-time intervention of MOP is more efficacious than one-time MOP in accelerating tooth movement.

Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions.

INTRODUCTION: Molecular diagnostics for SARS-CoV-2 infection characteristically involves the sampling of the throat or nasopharyngeal swab (NPS). However, these procedures are invasive, require necessary skills for sample collection, cause patient discomfort, and are non-conducive for extensive scale testing. Saliva is increasingly being suggested as an alternate diagnostic sample in SARS-CoV-2 infection. OBJECTIVES: This scoping review was done with the objective of exploring the evidence on the role of saliva as an alternate diagnostic sample in SARS-CoV-2 condition. METHODS: Thorough search of the literature in major databases was undertaken in June 2020 using free text and MESH terms, followed by PRISMA to identify 17 studies for data extraction. RESULTS AND CONCLUSIONS: Evidence was summarised for study characteristics, salivary sampling characteristics, viral load, and longevity of virus in saliva. The literature supports that saliva offers a simple sample collection method compared to technique-sensitive NPS and has the advantage of point-of-care testing for initial screening in community or hospital-based set-up. The additional highlights of this review are heterogeneity in the current literature and the gaps in methodology. Therefore, a robust study design to generate higher levels of evidence has been proposed.

Levels of TGF-ß1 in peri-miniscrew implant crevicular fluid.

The peri-miniscrew implant crevicular fluid is analogous to gingival crevicular fluid, and its contents reflect the state of inflammation and health during the life of the miniscrews in the mouth. The stability of MSI is fundamental to its role as an anchorage. This study aimed to evaluate transforming growth factor-beta one (TGF-ß1) of the peri-miniscrew implant crevicular fluid (PMICF), on implant insertion, pre- and post-loading of MSIs to find a clue to their role in the stability of MSI. Fifty-two MSIs sites were placed in the mouths of 13 patients aged 12-26 years undergoing orthodontic treatment. PMICF was collected using micro-pipettes at T1 (day 0, 1 h after MSI implantation), T2 (day 1), T3/baseline (day 21, preloading of MSI), T4 (day 21, 1 h post loading), T5 (day 22, 1 day post loading), T6 (day 43, 3 weeks post loading). The levels of TGF-ß1 were estimated by enzyme-linked immunosorbent assay (ELISA). The data were subjected to statistical analysis. Of the 52 MSIs, 20 MSIs failed at T3. In the case of successful MSIs, the TGF-ß1 levels were found to monotonously decrease from T1 (~1400 pg/mL) until T3 (~700 pg/mL) and saturate thereafter. In the case of failed MSIs, the levels of TGF-ß1 at various time periods were approximately constant and of much lower value than corresponding time periods of successful MSIs. This study highlights the role of TGF- ß1 in bone metabolism around miniscrew reflecting the state of inflammation from 1 h post-implantation.

Palatal volume estimation in operated unilateral and bilateral cleft lip and palate subjects using digital study models.

OBJECTIVE: To quantify and compare palatal volume of operated unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) subjects. SETTING AND SAMPLE POPULATION: This cross-sectional study was conducted on 85 study models comprising of 40 operated UCLP subjects (UG; mean age 10.33 ± 1.76 years), 25 operated BCLP subjects (BG; mean age 10.44 ± 1.92 years) and 20 non-cleft controls (C; mean age 12.90 ± 1.68 years). MATERIALS AND METHOD: The study models were scanned using 3D scanner and palatal volume assessment done using 3-matic software. Kruskal-Wallis test for palatal volume and one-way ANOVA for intercanine (IC), interpremolar (IPM) and intermolar (IM) width comparison were used. Pearson correlation was done between IM, IPM, and IC width, and palatal volume for three groups. The control group sample was evaluated by two observers to evaluate the interobserver reliability. RESULTS: The median palatal volume of C, UG and BG groups was 5814.31 mm3 , 2452.34 mm3 and 1688.39 mm3 , respectively. Significantly smaller palatal volume was found in UG and BG compared to control. Significant difference was seen in IC width between three groups. The IM, IPM and IC width with palatal volume in UG and IM width with palatal volume in BG group showed significant correlation. The ICC showed excellent agreement (>0.9) between observers. CONCLUSION: Palatal volume of UG and BG groups was smaller by 57.82% and 71.1%, respectively, compared to controls. Improving IPM width in UG and IM width in BG seems to have more impact in correction of palatal volume.

Interdisciplinary Management of an Adult Bilateral Cleft Lip and Palate Patient with Excessive Incisor Display - A Case Report.

This case report shows a successful orthodontic treatment of an operated adult bilateral cleft lip and palate subject with short upper lip and excessive incisor display. The patient underwent cleft lip repair at an early age of 2.5 years, followed by palatoplasty at the age of 21 years. She presented with malaligned teeth, inability to close the lips, excessive upper incisor display, and difficulty in speech. She was treated with upper and lower arch alignment and intrusion of the upper incisors, followed by prosthetic replacement of the missing right lateral incisor and left lateral incisor and canine. Normal dental occlusion was achieved using orthodontic procedures, followed by prosthodontic rehabilitation that resulted in significant improvement in facial aesthetics and psychosocial benefit to the individual.

Digital possibilities in the prevention and early detection of oral cancer in the WHO South-East Asia Region.

Cancers of the lip and oral cavity are the most common cancers among men in the World Health Organization (WHO) South-East Asia Region. Most cancers of the oral cavity are attributable to tobacco smoking, smokeless tobacco use and areca-nut product use, alone or in combination, and excessive consumption of alcohol. These risk factors are highly prevalent in parts of the region. This paper outlines an integrated framework for oral cancer prevention, which includes a strengthened primary health-care workforce, enhanced community engagement and a positive policy environment. Operationalizing this framework could be greatly facilitated by the application of digital technologies. Robust evidence exists for the effectiveness of using appropriately trained primary health-care workers to screen for oral cancer by oral visual examination; this can be combined with counselling for riskbehaviour modification as part of an overall strategy on noncommunicable diseases. This needs to be supported by greater overall community engagement, for example to tackle low levels of awareness of the harmful effects of smokeless tobacco and areca-nut products. A strong policy environment that supports and promotes these efforts is essential, along with the enforcement of the measures required by the WHO Framework Convention on Tobacco Control. Despite the burden of disease, oral cancer has been a neglected area of public health. This paper considers how the positively disruptive effects of digital technology may enable much-needed acceleration in prevention and control efforts.

Accidental Swallowing of a Molar Band.

Accidental ingestion or aspiration of foreign bodies is considered as a medical emergency in dentistry. Despite their rare occurrence, accidental ingestions are associated with various complications and morbidity, thereby necessitating prevention of their incidence along with early and effective management. Herein, we report a case of accidental swallowing of an orthodontic molar band in a patient with unilateral cleft lip and palate and its management.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review.

OBJECTIVE: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. METHODS: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. RESULTS: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), ß-glucuronidase (ßG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. CONCLUSIONS: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review

Abstract Objective: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. Methods: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. Results: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), β-glucuronidase (βG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. Conclusions: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Resumo Objetivo: a aplicação da força ortodôntica libera múltiplas enzimas no fluído crevicular gengival (FCG), desencadeando a ativação, reabsorção, reversão, deposição de elementos ósseos e degradação da matriz extracelular. A presente revisão sistemática avaliou criticamente toda a evidência disponível sobre os níveis de enzimas durante a movimentação ortodôntica. Métodos: utilizando-se estratégias predeterminadas, foram realizadas buscas em bases de dados eletrônicas (PubMed, Scopus, Embase), sendo também feitas buscas manuais. Resultados: a busca inicial identificou 652 estudos e, com base nas diretrizes do PRISMA, foram selecionados 52 estudos. A avaliação qualitativa resultou na inclusão final de 48 estudos (13 estudos com moderada sensibilidade e 35 com alto nível de sensibilidade). Os desfechos primários foram o aumento significativo dos níveis no FCG das enzimas aspartato aminotransferase (AST), fosfatase alcalina (FA), metaloproteinases de matriz (MMPs), lactato desidrogenase (LDH), β-glucuronidase (βG), fosfatase ácido-resistente ao tartarato (TRAP), fosfatase ácida (FAC) e baixa regulação de catepsina B (Cb). Especificidade quanto ao local foi mostrada para FA, TRAP, AST, LDH e MMP9 com os níveis no lado de compressão aumentando mais rápido e em maiores quantidades, quando comparado ao lado de tensão. Os níveis de FA foram maiores no lado de tensão somente no período de contenção. Uma correlação positiva de LDH, FA e AST também foi observada à medida que a magnitude de força ortodôntica aumentou. Conclusões: há fortes evidências indicando que as variações nas enzimas (FA, AST, FAC, TRAP, LDH, MMPs, Cb) presentes no FCG estão associadas a diferentes magnitudes, estágios e locais de aplicação da força ortodôntica.