Management of a Rare Tessier 30 Median Mandibular Cleft Anomaly: A Comprehensive Review.

Introduction: The median mandibular cleft (MMC) is a rare craniofacial anomaly manifesting as a cleft of the lower lip and mandible, which may extend to the neck to a variable extent and severity. Its management involves a timely, staged, and multidisciplinary approach. Unlike for maxillary cleft lip and palate, the literature on this anomaly is scarce and scattered. Also, guidelines for the management of mandibular cleft are not clearly outlined. This narrative review aims to consolidate the prevalence, classification, pathophysiology, and management of MMC. Materials and methods: A literature search was performed on PubMed, SCOPUS, and Web of Science for terms "Mandibular cleft" OR "Tessier 30." From the preliminary search, n = 68 articles were hand-filtered as per relevance to MMC from the title and abstract. Results: Among these articles, n = 56 were case reports, n = 2 were articles related to genetic associations, n = 4 syndromes associated, n = 3 discussed the classification of craniofacial clefts, and n = 3 were literature reviews. The findings from the literature are presented under subheadings embryonic origin, clinical presentation, diagnostic workup, and multidisciplinary management of MMC. Conclusion: Traditionally, MMC was treated by multistep surgical procedures; however, the contemporary approach promotes early and single-step correction of both soft and hard tissue defects for better growth outcomes. These cases demand comprehensive workup and timely management. Newer innovations, such as the use of BMPs and resorbable reduction plates, need further validation. How to cite this article: Katyal S, Mohanty S, Miglani S, et al. Management of a Rare Tessier 30 Median Mandibular Cleft Anomaly: A Comprehensive Review. Int J Clin Pediatr Dent 2023;16(6):875-881.

Artificial Intelligence in Teledentistry.

Artificial intelligence (AI) has grown tremendously in the past decade. The application of AI in teledentistry can reform the way dental care, dental education, research, and subsequent innovations can happen remotely. Machine learning including deep learning-based algorithms can be developed to create predictive models of risk assessment for oral health related conditions, consequent complications, and patient stratification. Patients can be empowered to self-diagnose and apply preventive measures or self-manage some early stages of dental diseases. Applications of AI in teledentistry can be beneficial for both, the dental surgeon and the patient. AI enables better remote screening, diagnosis, record keeping, triaging, and monitoring of dental patients based on smart devices. This will take away rudimentary cases requiring run-of-the-mill treatments from dentists and enable them to concentrate on highly complex cases. This would also enable the dentists to serve a larger and deprived population in inaccessible areas. Its usage in teledentistry can bring a paradigm shift from curative to preventive personalised approach in dentistry. A strong asset to teledentistry could be a robust and comprehensive feedback mechanism routed through various channels proposed in this paper. This paper discusses the application of AI in teledentistry and proposes a feedback mechanism to enhance performance in teledentistry.

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.

Diagnostic and Treatment Approach in the Management of Dental Anomalies Associated with Stevens-Johnson Syndrome: A Case Report.

BACKGROUND: Stevens-Johnson syndrome is a rare medical condition with severe mucocutaneous lesions due to adverse drug reactions characterized by exudative multiform erythema, stomatitis, and conjunctivitis. Long-term oral consequences of such cases include xerostomia, caries, impactions, and multiple dental developmental aberrations as short root anomalies. AIM AND OBJECTIVE: To highlight the role of pedodontist in early diagnosis and treatment planning of dental abnormalities due to Stevens-Johnson syndrome (SJS) using a cone-beam computed tomography (CBCT). CASE DESCRIPTION: A 16-year-old male reported a chief complaint of decayed posterior teeth. Past medical history revealed adverse reactions to an unknown drug at the age of 4 to 5 years. In addition to carious teeth, clinical examination revealed that all canines were missing along with mandibular incisors. On CBCT examination, abnormal short, plump roots with normal crown were seen in all permanent first molars and incisors along with impacted canines and mandibular incisors. This condition was diagnosed as a "Short root anomaly" (SRA) due to SJS. He was found positive to allergy tests for NSAIDs such as ibuprofen and paracetamol. CONCLUSION: NSAIDs can cause a severe adverse reaction resulting in SJS. If this hypersensitivity reaction occurs early during the development of a permanent tooth it may cause dental anomalies such as short roots, root dysmorphia, agenesis, and multiple impacted teeth. CLINICAL SIGNIFICANCE: This report highlights a unique case of multiple dental aberrations due to SJS and the role of a pedodontist in the early diagnosis and treatment planning of such cases with the help of CBCT. Short root anomalies can be misdiagnosed as root resorption or immature apex. Medical history, clinical and CBCT findings are essential for diagnosis and treatment in SJS patients. Careful orthodontic treatment planning is required in cases of short root anomalies. HOW TO CITE THIS ARTICLE: Katyal S, Yadav V. Diagnostic and Treatment Approach in the Management of Dental Anomalies Associated with Stevens-Johnson Syndrome: A Case Report. Int J Clin Pediatr Dent 2021;14(4):569-574.