A Survey on Alveolar Bone Grafting in Indian Cleft Centers.

OBJECTIVE: To assess the factors influencing the type and timing of Alveolar Bone Grafting (ABG) among cleft centers throughout India. To examine the decision-making criteria for orthodontic treatment and the timing of ABG. DESIGN: Cross sectional survey. METHOD: This survey was based on a convenience-based sample selected from cleft teams across India. The survey was formulated using the SurveyMonkey platform and emailed to 40 cleft teams. The survey included questions on demographics, timing, surgical protocol, orthodontic protocol, radiograph prescription rate, assessment methods for the success of ABG and three scenarios for evaluating the timing of the bone graft. The Chi-squared test was performed to evaluate the difference in opinion between specialists. The inter-examiner reliability was assessed using Kappa statistics. RESULTS: Thirty-five units completed the questionnaire. Most units operate with 1-2 surgeons, with 42.9% of them treating cleft patients for under 5 years. Only 11.4% of centres routinely advised oblique occlusal radiographs for post-surgery evaluation, and 31.4% prescribed CBCT. However, 40% of cleft teams did not perform audits to evaluate the success of ABG, and less than 50% advised radiographs six months post-surgery. Around 26% of centres do not routinely provide orthodontic treatment pre-ABG. The inter-examiner reliability for case scenarios showed poor agreement between the clinicians. CONCLUSION: The survey showed a serious lack of consensus in the ABG treatment among cleft teams in India and emphasises the need for standardised protocols for the treatment of children with cleft palate. There is an urgent need to develop core outcome set in cleft.

The impact of COVID-19 pandemic on orthodontic services and trainees' mental health in India.

Aim: To evaluate the impact of COVID-19 on clinical orthodontic services, orthodontic education, and the emotional well-being of orthodontists and orthodontic trainees in India. Materials and methods: The survey was designed using Survey Monkey™ and distributed to members of the Indian Orthodontic Society via their registered email address and also via social media platforms (WhatsApp and LinkedIn). Results: A total of 610 responses to the survey were received. The majority of respondents agreed on the negative impact of COVID-19 on clinical activity and the associated income of orthodontists. Respondents reported that this was mainly due to national restrictions (70.1%), increased cross infection measures (59.6%), state restrictions (55.9%), and social distancing (39.4%). Ninety one percent of respondents agreed that orthodontic staff should have evidence of vaccination before providing care.COVID-19 was found to have a negative impact on the trainees' perceptions of their clinical dexterity (72.4%), their confidence with respect to academic knowledge (66.5%), their mental health (80.7%), and their stress levels during the pandemic (93.2%). Conclusion: The COVID-19 pandemic has had a negative impact on orthodontic specialists and post-graduate trainees in India. The impact on trainees' mental health was significantly higher compared to trainees from other countries. Decreased clinical activity has reduced the opportunities for learning, and trainers must rise to the challenge of providing additional support to this cohort of trainees who will progress to become the future orthodontic workforce.

Standard of Care for Patients With Cleft Lip and Palate in India-A Questionnaire-Based Study.

A national survey of cleft teams was undertaken to evaluate the current standard of care for patients with cleft lip and palate (CLP) in India as a part of Cleft Care India study.This was a cross-sectional questionnaire-based study.Cleft teams across India attending the 19th Annual Conference of the Indian Society of Cleft Lip and Palate were invited to complete the questionnaire. The questionnaire consisted of 18 questions that included demographics, institutional details, patient protocols, surgical technique, rehabilitation facilities, and accessibility. The data are descriptively reported.A total of 112 centers completed the survey. Nongovernment organizations funded 87% of the cleft centers and 8% did not receive any funding. Only 39% of the centers had centralized cleft services providing multidisciplinary care. Speech therapy was provided either onsite or through referral at 90% of the centers, whereas audiology was provided only at 4% of centers. Feeding advice was routinely provided in 52% of centers. Millard technique was the most preferred technique for unilateral cleft lip repair (66%). The 2-flap technique (37%) and pharyngeal flap (48%) were the most common surgeries for cleft palate and pharyngoplasty, respectively. Although 54% of centers reported their patients to be interested in comprehensive care, 43% reported that their patients only wanted surgical correction.There is wide diversity in access to cleft care and clinical practices across centers in India. Further work is needed to evaluate the quality of care by assessing outcomes of centers treating patients with CLP.

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.

The threshold of acceptability of excessive gingival display by laypersons: a systematic review.

OBJECTIVE: Excessive gingival display ('gummy smile') is often an esthetic concern for the patient. There is a difference in perception of smile esthetics between dentists and laypersons. Understanding what is acceptable to laypersons is critical to achieve patient satisfaction in terms of smile esthetics. The present study aimed to identify the ideal and acceptable range of excessive gingival display as defined by laypersons. MATERIALS AND METHODS: A systematic English language literature search was carried out in the following electronic bibliographic databases: PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, and EMBASE, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the articles was assessed using the AXIS tool as well as 11 additional criteria that were specifically designed for the study. RESULTS: Out of the 1263 potentially eligible articles selected in the initial search, 34 were included in the final review. A total of 16 articles identified both the ideal values and the range of acceptance of excessive gingival display, 10 only the range of acceptance, and 8 only the ideal values. From the pooled sample, the mean threshold of acceptance was -0.84 ± 1.43 mm, the range of acceptance was +3 to -2.7 mm, and the median was 0.0 mm. CONCLUSION: The present study concluded that laypersons considered minimal gingival exposure (GE) or minimal tooth coverage (TC) to be the most esthetic. However, a smile falling in the range of 3 mm of GE to 2.7 mm of TC was considered acceptable. Knowledge of laypersons' threshold of acceptance of excessive gingival display can guide clinicians in evidence-based dental esthetic treatments.

Microneedles and Nanopatches-Based Delivery Devices in Dentistry.

Needle-based devices are evolving as a promising diagnostic and therapeutic tool in the field of medicine. They can be used for drug delivery, as well as extraction of fluids, for systemic and local effects. The conventional methods of drug delivery require repeated dosing in the oral cavity due to the presence of saliva. Hence delivery systems, such as needle-based devices that could provide sustained release of the drug in the oral cavity, are required. These devices could also be a useful adjunct in diagnosis and therapy of oral cancers, delivering anti-cariogenic and antiplaque agents, for remote monitoring of oral health, and for administering painless and fearless local anesthesia. Since they offer many advantages, such as increased compliance, absence of needle phobia, they are painless, safe, self-applicable and are minimally invasive, they will have a major impact in the field of dentistry. This paper summarizes the various types of needle-based devices and their manufacturing technologies. The manuscript aims to serve as a foundational review that highlights and proposes several current and prospective impactful applications of these devices in various fields of dentistry.

Oral health concerns in India.

Oral health is an integral part of general health. There are many oral health issues which are of concern to India, despite having the maximum number of dental schools in the world. Dental caries, oral cancers and periodontal diseases are areas of national oral health concern. India lacks baseline data to know the exact prevalence of oral diseases, which is the first requirement to frame any national policies or manpower allocation. India is a vast country, nations within a nation, with great diversity in eating and behavioural practices. With a population of 1.21 billion and 68.84% of population residing in villages, the strategies need to be customised based on the population subgroup. Low level of awareness, strained and skewed infrastructure and resources, lack of motivation and research and oral health policies are some major factors that need to be tackled. This paper would attempt to highlight the oral health concerns of India, lacunae in the current system and possible strategies to address these issues.

Impact of altered gingival characteristics on smile esthetics: Laypersons' perspectives by Q sort methodology.

INTRODUCTION: Smile esthetics includes the white esthetics related to the teeth and the pink esthetics related to the mucosa. Many surveys have been conducted to evaluate laypersons' perceptions to altered dental characteristics, but few have focused on the soft tissue factors. This study was designed to determine the perceptions of laypeople to variations in soft tissue esthetics during smile. METHODS: An ideal smile photograph was intentionally altered to produce variations in gingival inflammation, pigmentation, contour, position of free gingival margins (with and without recession), zeniths, and interdental papilla. Sixty-seven images thus produced were rated for attractiveness by 100 laypersons with the Q sort technique. RESULTS: Variations in interdental papilla (black triangles) were the most negatively ranked gingival factor by laypersons closely followed by color changes of the gingiva due to inflammation and pigmentation. Alteration of gingival contour and gingival zenith had the least impact on smile esthetics, and changes in the free gingival margin with and without recession were moderately perceived. Furthermore, laypersons considered unilateral or asymmetric alterations more unesthetic compared with bilateral or generalized alterations for factors such as free gingival margin without the recession, and color changes caused by inflammation and pigmentation. CONCLUSIONS: Laypersons have considerable negative perception to asymmetric gingival alterations and to optical color changes caused due to black triangles, inflammation, and pigmentation of the gingiva. Whereas alteration in gingival contour and zenith have least impact on smile esthetics.

Tips for maintaining sterilization in your orthodontic work station.

Sterilization and disinfection have been a matter of concern amongst dental health care workers since long. Delicate materials, electrical parts, orthodontic pliers, orthodontic wire cutters, are to be treated according to the manufacturer's instructions to safe guard the life of the instrument as well as to claim warranty for any damage incurred. Sterilization procedures used in Orthodontics should be simple but effective and of relatively short duration so that there is a readily available supply of sterile instruments and materials. The procedure should not cause any appreciable damage to dental instruments and other materials. An attempt has been made through this article, to provide information concerning methods and means of disinfection and sterilization of orthodontic clinics, instruments, materials and also waste disposal which can be adopted in private clinics as well as in hospital set ups.

Total recall: an update on orthodontic wires.

Orthodontic therapy is a force management procedure largely based on use of arch wires for storing and distributing biologically tolerable forces by means of which position of teeth is altered. Advances in material science and technology has resulted in an array of newer arch wire materials, opening new vistas, in orthodontic treatment. Materials with widely diverging properties are in the market today and their usage has profound implications on appliance mechanics, and are very much different from stainless steel which is popular even today. The dentists who practise orthodontics have to therefore clearly outline the phases of treatment and select the arch wire most suited for attaining specific treatment goals.

Treatment of a patient with a bilateral cleft lip and palate with implants and surgery of the maxillary anterior region.

Caring for patients with bilateral cleft lips and palates requires an interdisciplinary approach. The treatment of such a patient is described. Therapy comprised maxillary expansion, mini-implant insertion, premaxillary osteotomy, and vomeroplasty, which led to a drastic improvement of the occlusion and facial appearance.