Morphological changes in temporomandibular joint architecture in patients with temporomandibular disorders: systematic review protocol.

OBJECTIVE: The review involves the assessment of morphological variations in the temporomandibular joint (TMJ) and its associated structures in patients with temporomandibular disorder. INTRODUCTION: Temporomandibular disorders (TMD) are debilitating conditions that affect the TMJ complex, surrounding musculature and osseous components. Studies have reported that TMD result from morphological alterations in TMJ. These alterations can be efficiently studied using three-dimensional imaging. This review will summarise the morphological changes in TMJ and associated structures based on studies with three-dimensional imaging in patients with TMD. INCLUSION CRITERIA: The systematic review will include studies with adult subjects with any one symptom of TMD and those studies that assessed TMJ morphology using three-dimensional imaging like CT, cone beam CT, MRI or arthrography. METHODS: Systematic searches for relevant studies will be carried out in multiple databases. Sources will include MEDLINE, Scopus, Dentistry and Oral Sciences Source, Cochrane CENTRAL, CINAHL, Web of Science, ProQuest Dissertation and Thesis and Google Scholar. The databases will be searched from inception to November 2023. Analytical observational studies comprising retrospective and prospective cohort studies, case-control studies and analytical cross-sectional studies will be selected and critical appraisal will be performed. No restrictions will be imposed on the date and country of publication. Joanna Briggs Institute (JBI) guidelines for systematic effectiveness reviews will be followed for data appraisal, extraction and synthesis. The strength of evidence will be graded using the Grading of Recommendations, Assessment, Development and Evaluation method and the summary of findings will be created using GRADEpro software. ETHICS AND DISSEMINATION: Ethical approval is not applicable for this study since this involves analysis of secondary data. Results will be disseminated through peer-reviewed publications and cnference presentations. A comprehensive summary of morphological alterations in TMJ is essential for assessing risk factors, accurate diagnosis, treatment planning and will collectively contribute to enhanced clinical care and overall patient well-being. PROSPERO REGISTRATION NUMBER: The protocol is registered in PROSPERO: CRD42023448882.

Excessive Daytime Sleepiness as a Risk Factor for Obstructive Sleep Apnoea among Public Transport Drivers: A Cross-Sectional Study.

Context: Excessive daytime sleepiness (EDS) due to obstructive sleep apnoea (OSA) is reported to be a major contributor to many road traffic accidents. Lack of awareness and diagnosis of OSA among public transport workers remains a threat to the society. Aims: The primary aim of this study was to assess the risk of OSA among transport drivers of south Kerala using modified Berlin questionnaire. The secondary objective included craniofacial assessment of the high-risk patients identified through the questionnaire using lateral cephalogram. Settings and Design: A cross-sectional study was conducted among 180 transport drivers of south Kerala. Methods and Material: Modified Berlin questionnaire and limited physical examination [body mass index (kg/m2), neck circumference (cm), waist circumference (cm), hip circumference and waist to hip ratio, blood pressure (mm Hg)] were recorded. The screened subjects were categorized as high-risk snorers and low-risk snorers based on modified Berlin questionnaire. Craniofacial morphological variations of high-risk group were assessed by lateral cephalograms. Statistical Analysis Used: The descriptive statistics were represented as mean and standard deviation and percentage. Inter-group comparison was performed with independent sample t test. Results: The study demonstrated 64.4% of subjects were non-snorers and 35.6% were snorers. Furthermore, among the snorers, 46.9% were identified as high-risk snorers, whereas the remaining 53.1% represented low-risk snorers. Conclusions: The study revealed the concealed risk of OSA among transport drivers could be screened through the questionnaires and demographics assessment. The application of the proposed screening protocol would triage and enhance safety of OSA affected transport drivers.

Epidemiological study on prevalent risk factors and craniofacial skeletal patterns in obstructive sleep apnea among South Indian population.

CONTEXT: Obstructive sleep apnea (OSA) is a condition affecting the upper airway among a vast number of people around the world. AIMS: To determine the prevalent risk factors of OSA and its association with craniofacial skeletal pattern. SETTINGS AND DESIGN: Cross-sectional, community-based study. MATERIALS AND METHODS: In the first stage, questionnaire and physical examination were done for 1000 subjects between 20 and 70 years of age. Subjects were categorized as snorers and non-snorers. Snorers were further grouped as high-risk and low-risk snorers. In the second stage, polysomnography (PSG) was done for randomly selected high-risk subjects. Craniofacial skeletal pattern of OSA-diagnosed subjects were compared with non-OSA subjects using lateral cephalograms. STATISTICAL ANALYSIS: Analysis was performed using IBM SPSS 20. Independent sample t-test was used. A P value < 0.05 was considered as statistically significant. RESULTS: The study population represented the following: high-risk snorers: 22.4%, low-risk snorers: 13.9%, and non-snorers: 63.7%. Excessive daytime sleepiness was present in 7.7%. Among high-risk, 80 underwent PSG, and 75 were diagnosed as OSA (94%) and 5 non-OSA subjects. Increased body mass index and neck circumference were statistically significant. Cephalometric evaluation showed difference in maxillomandibular relationship, narrowing of airway space, and inferiorly displaced hyoid. CONCLUSION: OSA is a major public health problem. Obesity is a strong predictor for OSA. Thus, high-risk subjects for sleep apnea could be identified using routine clinical examination, investigations, and anthropometric parameters.

Strontium functionalized scaffold for bone tissue engineering.

Drug functionalized scaffolds are currently being employed to improve local delivery of osteoprotective drugs with the aim of reducing their loading dose as well as unwanted systemic complications. In this study we tested a poly-(ε) caprolactone (PCL)-laponite-strontium ranelate (SRA) composite scaffold (PLS3) for its abilities to support growth and osteogenic differentiation of human marrow derived stromal stem cells (hMSC). The in vitro experiments showed the PLS3 scaffold supported cell growth and osteogenic differentiation. The in vivo implantation of hMSC seeded PLS3 scaffold in immunocompromised mice revealed vascularized ectopic bone formation. PLS3 scaffolds can be useful in bone regenerative applications in the fields of orthopaedics and dentistry.