A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial.

BACKGROUND: Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD: The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION: We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

The Future of Orthodontics: Deep Learning Technologies.

Deep learning has emerged as a revolutionary technical advancement in modern orthodontics, offering novel methods for diagnosis, treatment planning, and outcome prediction. Over the past 25 years, the field of dentistry has widely adopted information technology (IT), resulting in several benefits, including decreased expenses, increased efficiency, decreased need for human expertise, and reduced errors. The transition from preset rules to learning from real-world examples, particularly machine learning (ML) and artificial intelligence (AI), has greatly benefited the organization, analysis, and storage of medical data. Deep learning, a type of AI, enables robots to mimic human neural networks, allowing them to learn and make decisions independently without the need for explicit programming. Its ability to automate cephalometric analysis and enhance diagnosis through 3D imaging has revolutionized orthodontic operations. Deep learning models have the potential to significantly improve treatment outcomes and reduce human errors by accurately identifying anatomical characteristics on radiographs, thereby expediting analytical processes. Additionally, the use of 3D imaging technologies such as cone-beam computed tomography (CBCT) can facilitate precise treatment planning, allowing for comprehensive examinations of craniofacial architecture, tooth movements, and airway dimensions. In today's era of personalized medicine, deep learning's ability to customize treatments for individual patients has propelled the field of orthodontics forward tremendously. However, it is essential to address issues related to data privacy, model interpretability, and ethical considerations before orthodontic practices can use deep learning in an ethical and responsible manner. Modern orthodontics is evolving, thanks to the ability of deep learning to deliver more accurate, effective, and personalized orthodontic treatments, improving patient care as technology develops.

Non-extraction Approach in a Borderline Case of a Growing Patient: A Case Report.

This case presents the effective non-extraction orthodontic treatment of a 13-year-old boy with crowding in both upper and lower arches and deep bite. The patient's chief complaint was irregularly placed maxillary anterior teeth. The active treatment duration lasted for 10 months, which resulted in the successful alleviation of arch crowding and correction of the deep bite without the extraction of any sound erupted tooth. Posttreatment, all of the patient's chief complaints were relieved. Essix retainers were fitted post-debonding, with instructions for the patient to wear them for the subsequent year to maintain the achieved results. This case highlights the efficacy of non-extraction orthodontic strategies in addressing crowding and deep bite issues, drawing the importance of individualized treatment plans to achieve optimal outcomes.

Assessment of Aesthetic Smile Components in Patients With Skeletal Class II Vertical and Horizontal Growth Patterns Compared to Class I Cases.

Introduction In orthodontics, having a beautiful smile is very important. It is frequently the main driving force behind people's efforts to enhance their oral health and professional opportunities. Orthodontic and dental treatment planning might benefit greatly when evaluating the aesthetic components of a patient's smile in individuals with varying skeletal growth patterns. In order to help orthodontists achieve the best possible functional and aesthetic results for their patients, the eight elements of a balanced smile are essential to orthodontic therapy. This study aims to evaluate, in comparison to Skeletal Class I Average instances, eight balanced smile components in patients with Skeletal Class II Vertical and Horizontal growth patterns. Methodology A total of 45 patients aged 14-30 were selected from the Orthodontics and Dentofacial Orthopedics Out-Patient Department (OPD). They were divided into three groups: Skeletal Class I Average, Skeletal Class II Vertical, and Skeletal Class II Horizontal cases based on their malocclusion type. Patients were made to smile in response to a joke or social conversation and their photos were analyzed using Photopea software (Photopea Inc., Prague, Czech Republic) to determine the eight components of a balanced smile. Result Three skeletal classes' worth of smile components were examined in this study. Lip line measurements varied greatly; the highest mean measurement was found in the Skeletal Class II Vertical group (p-value < 0.01). There were no noteworthy correlations found between smile arc and upper lip curvature. Measurements of lateral negative space did not show any significant group differences. On the other hand, a significant correlation was seen in smile symmetry, where asymmetrical smiles were more prevalent in Skeletal Classes I and II Vertical groups (p-value is 0.00072). While arch symmetry suggested a potential relationship between the groups, dental midline alignment revealed possible associations. Conclusion Assessing the aesthetic components of smiles in patients with varying skeletal growth patterns, i.e., contrasting Class II Vertical and Horizontal growth patterns with Class I Average cases, provides valuable information about the connection between smile aesthetics and facial skeletal structure. The results suggest that when compared to Class I typical instances, Skeletal Class II Vertical and Horizontal growth patterns may show clear variations in certain aspects of an attractive smile. Comprehending these variations is essential for devising treatment strategies for patients, and additional investigation is needed. In order to obtain optimal aesthetic outcomes, treatment strategies should strive to optimize smile aesthetics while addressing personalized treatment plans that take into account the patient's unique facial features, smiling preferences, and functional requirements.

From an Open Bite to a Harmonious Smile: Orthodontic Intervention With Bluegrass Appliance and Tongue Thrust Resolution.

The tongue-thrusting habit significantly contributes to the development of the anterior open bite (AOB), particularly when an infantile swallowing pattern persists into the later stages of childhood and adolescence. This habit results in the protrusion of the anterior teeth. Treatment typically involves addressing the underlying causes, incorporating retraining exercises, and utilizing mechanical appliances to control tongue positioning. However, commonly used devices such as palatal cribs or spurs may present challenges, including speech impediments, chewing difficulties, and the potential for unintended injuries. This paper presents a case report detailing the treatment of a patient with an AOB, dental protrusion, and spacing. The treatment approach included the application of a fixed tongue trainer, in the form of a modified bluegrass appliance. Subsequent fixed orthodontic therapy was employed to rectify proclined teeth within the dental arch.

Unveiling Symmetry Through Orthodontic-Surgical Management of Unilateral Mandibular Condylar Agenesis: A Rare Case Report.

This is a rare clinical case report of a 19-year-old male patient reported in the Department of Orthodontics and Dentofacial Orthodontics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, with chief complaint of asymmetry present on the lower left side of the face and forwardly placed upper front teeth. The asymmetry was due to the congenital complete absence of the left condyle and skeletal cant in the maxilla and functional occlusal plane. The true agenesis of the condyle is an extremely rare condition that requires proper diagnosis and interdisciplinary management. In this case, there was left-sided condylar agenesis with no other skeletal anomaly present, which was treated by pre-surgical orthodontics for decompensation and surgical correction of skeletal cant followed by Ramal distraction osteogenesis and advancement genioplasty. A condylar stock metal implant was placed on the left side for functional rehabilitation. The patient expressed satisfaction with the aesthetic and functional improvements, highlighting the effectiveness of the integrated orthodontic-surgical approach.

Clinical Insights Into Addressing Constricted Maxillary Arch in Angle's Class II Malocclusion: A Case Report.

The transverse dimension, often overlooked in orthodontics, plays a crucial role in malocclusions, affecting not only occlusion in that dimension but also sagittal and vertical dimensions. Posterior crossbites, indicative of transverse maxillary issues, are commonly addressed through palatal expansion. This case report explores the clinical insights into addressing a constricted maxillary arch in Angle's Class II malocclusion using a nickel-titanium (NiTi) expander. The NiTi expander provides constant and optimal expansion forces by incorporating a temperature-activated NiTi alloy. A 16-year-old male with irregularly placed teeth, high palatal vault, and posterior crossbite underwent treatment involving NiTi expander usage for maxillary expansion. The case presentation details the patient's journey, starting with upper arch bonding and expansion, then lower arch bonding, and concluding with complete leveling and alignment without extractions. The presented case demonstrates successful correction of a constricted maxillary arch, specifically in the canine and molar regions, utilizing the NiTi expander. The observed increase in intermolar width aligns with previous studies, showcasing the effectiveness of slow maxillary expansion. This article contributes valuable clinical insights into addressing transverse maxillary issues, emphasizing the importance of careful consideration in choosing the appropriate expansion method for optimal results.

Integrated Care Strategies for Unilateral Cleft Lip and Palate: A Multidisciplinary Treatment Approach for Profile Correction.

Cleft lip and palate (CLP) is a prevalent congenital craniofacial deformity that can be unilateral or bilateral. This case report highlights the interdisciplinary approach to managing a 24-year-old male with unilateral CLP (UCLP), emphasizing the complexity of associated dental and skeletal challenges. The patient had undergone multiple surgeries, including lip closure at three months, palate repair at seven years, and alveolar bone grafting at 12 years. Clinical assessments revealed a retruded maxilla, an absence of lateral incisors, and scars from previous surgeries. Radiographic evaluations indicated a Class III skeletal pattern and confirmed the presence of a cleft on the left side. Orthodontic treatment commenced with maxillary arch alignment, followed by Le Fort I surgery to address maxillary retrusion, correct skeletal malocclusion, and close the alveolar cleft space. The post-surgical phase involved orthodontic adjustments, crossbite correction, and alignment of the mandibular arch. Despite the discontinuation of treatment due to the patient's relocation, the interdisciplinary collaboration achieved significant improvements, including a corrected facial profile, maxillary advancement, closure of the cleft space, and enhanced dental alignment. The patient's confidence and functionality were positively impacted. This case underscores the importance of a coordinated interdisciplinary approach to addressing the multifaceted challenges associated with UCLP, aiming to optimize both aesthetic and functional outcomes for improved patient well-being.

Frictionless Mechanics for Correction of Bimaxillary Protrusion: A Case Report.

The condition of bimaxillary protrusion is commonly seen by orthodontic practitioners in the course of our daily clinical work. It is characterized by both jaws being forwardly placed and increased prominence of the teeth along with lips. When there is a severe bimaxillary protrusion, it can be challenging to correct it effectively with maximum anchorage. In patients with protrusions or crowding, extraction therapy is often necessary. There are two ways to retract anteriors during extraction space closure: friction or frictionless. The present case report explains the frictionless mechanic protocol for the correction of bimaxillary protrusion using a reverse closing loop.

From Twin Blocks to Quad Blocks: A Two-Phase Approach to Class II Correction.

Twin Block, a functional orthodontic appliance, has a major impact on the dentoalveolar structures with limited skeletal effects. In specific clinical scenarios, particularly in growing patients such as class II division 1 where the mandible is retropositioned, these appliances can effectively address the malocclusions. Patient compliance plays a crucial role in the success of these appliances, which also streamline subsequent phases of fixed appliance treatment. In the current case report, a Twin Block appliance followed by a Quad Block was given to a 12-year-old boy to refine the occlusion. The design and treatment outcomes of the appliance are discussed in this case study.

Unveiling the Journey: A Case Report of Managing an Impacted Central Incisor.

Although impaction of the maxillary permanent central incisor is uncommon in dentistry due to its significance to facial aesthetics which are challenging to treat. To abstain from the consequences related to aesthetic and functional occlusion, early detection of an impacted central incisor is imperative. This case report describes a male patient, aged 22 years, who had an impacted central incisor tooth in the maxillary anterior region. A surgery was performed to remove the impacted supernumerary tooth that was preventing the eruption of the central incisor. Using a combination of surgical exposure and orthodontic force, the impacted right maxillary central incisor was relocated to its proper occlusion in the dental arch.

Harmonizing Dentofacial Balance: A Comprehensive Exploration of Class 1 Malocclusion Resolution With Impacted Maxillary Central Incisor Management.

Permanent maxillary central incisor impaction is generally a rare phenomenon. Because the anterior teeth have a huge impact on a patient's facial aesthetics, missing anterior teeth are of major concern to patients who seek orthodontic treatment. However, correcting this type of malocclusion poses a challenge to the orthodontist. This case report of a 16-year-old male patient with an impacted maxillary right central incisor takes us through a series of events that are necessary to treat this type of malocclusion. The presenting case also had an impacted supernumerary tooth which was the primary cause for permanent tooth impaction. A combined treatment approach is usually needed to manage this type of case involving both the orthodontist and the surgeon.

The Intriguing Case of Impacted Teeth 11, 12, and 13: Unveiling the Dental Dilemma.

This case study offers a rare and difficult condition involving the impaction of teeth 11, 12, and 13, providing a severe dental challenge. A thorough examination was performed on the patient, which included clinical evaluations and radiographic examinations. Because the impacted teeth were causing discomfort and functional impairment, a multidisciplinary approach was required, which included surgical exposure followed by traction forces to level and align the impacted teeth. The abstract emphasizes the case's complexity, digging into the diagnosis process and the establishment of a personalized treatment strategy. The complexities of handling many impacted teeth are explored in length, including surgical intervention, orthodontic considerations, and postoperative care.

Progressive Strategy for Congenitally Missing Anteriors in Binder Syndrome: A Case Report.

Binder syndrome (maxillonasal dysplasia) is an uncommon congenital craniofacial condition. It is marked by distinctive facial characteristics including a flat, vertically oriented nose, maxillary underdevelopment, malocclusion, and nasal bone irregularities. This case study introduces an inventive strategy for addressing congenitally absent anterior teeth in a patient diagnosed with Binder syndrome. Our treatment approach combined orthodontic interventions and prosthetic restorations to enhance both aesthetics and function. This report explores the diagnostic and therapeutic aspects of the case, underscoring the encountered challenges and the ultimately successful outcome. This approach provides valuable insights into managing dental anomalies linked to Binder syndrome, emphasizing the necessity of a multidisciplinary approach for comprehensive patient care. A suitable strategy for adult patients might be slow maxillary expansion. This case report is about a rare case of maxillonasal dysplasia managed with the esthetic replacement of anterior teeth.

Comprehensive Multidisciplinary Management of Bilateral Cleft Lip and Palate.

Cleft lip and palate (CLP) represent a multifaceted congenital deformity encompassing skeletal, dental, and functional discrepancies. This case report presents the management of a 13-year-old female with bilateral CLP, focusing on the challenges associated with permanent dentition and retained deciduous teeth. The patient's history included prior lip and palate repair surgeries, leading to poor aesthetics and functional concerns. A multidisciplinary approach involving orthodontics, oral surgery, and prosthodontics was implemented. Clinical examinations revealed dental abnormalities, oro-nasal fistula, and skeletal discrepancies, necessitating a comprehensive treatment plan. The orthodontic intervention aimed at aligning the dentition, followed by surgical closure of the oro-nasal fistula and alveolar bone grafting (ABG) to facilitate permanent canine eruption. Prosthetic replacement of missing maxillary lateral incisors was accomplished, enhancing aesthetics with minimal invasiveness. Results demonstrated significant improvements in profile, dental alignment, and functional stability. Cephalometric and dental parameter analyses confirmed the corrections and enhancements achieved, affirming the success of the multidisciplinary treatment. This case report emphasizes the importance of a collaborative multidisciplinary approach in effectively addressing the complexities of bilateral CLP in patients with permanent dentition and retained deciduous teeth. The comprehensive treatment strategy rectified dental and skeletal issues and positively impacted the patient's overall well-being and self-confidence.

An Oral Odyssey: Navigating the Complexity of Impacted Parapremolars and Paramolars in the Oral Landscape!

Supernumerary molars are an uncommon anomaly that can occur in the maxillofacial complex, referring to the presence of additional teeth in the dental arch. This condition is often associated with several rare disorders such as Gardner's syndrome, Cleidocranial dysplasia, Ehler-Danlos syndrome, and Down syndrome However, it is seldom observed in non-syndromic associations. They occur more frequently in the maxilla than in the mandible. This research represents a unique case study that explores unerupted paramolar and parapremolar follicles coexisting in both the maxillary and mandibular arches of a 17-year-old male patient. The discovery of these follicles was fortuitous, as the patient exhibited no symptoms during the initial orthopantomogram scan. Despite the absence of noticeable symptoms, vigilant monitoring and observation were employed over time. Subsequently, a substantial shift in the approach to management occurred with the integration of surgical and orthodontic methodologies, guided eruption strategies, and a collaborative, multidisciplinary effort.

Comparative Assessment of the Efficacy of Newly Designed Multiple Variability Loop and Opus Loop for Anterior en Masse Retraction in Orthodontics: A Finite Element Study.

Introduction Two different mechanisms are used to close the space after extractions, i.e., friction/sliding mechanics and frictionless/loop mechanics. The focus of this study is on space closure using frictionless or loop mechanics, which utilize loops to achieve the desired tooth movement. Loops are designed to increase the resiliency of the archwire so that the ideal moment-to-force ratio (M/F) of 8:1 to 10:1 for bodily tooth movement can be obtained. By incorporating various loop designs, the resiliency of archwires may be increased, and an ideal M/F ratio can be obtained. Method Different pre-activation bends were incorporated in the titanium molybdenum alloy (TMA) wire at alpha (canine side) and beta (premolar side), respectively. A total of 36 finite element method (FEM) models were prepared with and without pre-activation bends to evaluate the moment-to-force ratio. Result The results obtained from the finite element method (FEM) analysis provided valuable insights into the force and moment generated during activation while retracting the tooth. Specifically, the alpha bend at 15 degrees and the beta bend at 20 degrees produced the most desirable results for generating moments on the anterior and posterior teeth, respectively. Conclusion To ensure the proper utilization of the multiple variability (MV) loop, we recommend its preparation using a 0.019 x 0.025-inch TMA wire. This selection will maximize the loop's capabilities and enhance its performance in achieving the desired tooth movement.

The Effects of Fixed Versus Removable Orthodontic Retainers on Stability and Periodontal Health: 4-Year Follow-Up of a Randomized Controlled Trial.

Introduction: Long-term or even indefinite retention is routinely prescribed after orthodontic treatment as a preventive safeguard against post-treatment changes induced by tooth movement, physiological healing, and the aging process. Though both fixed and removable versions of retainers may be equally effective in terms of results, sufficient research to support this assumption is missing at the moment. Objectives: Long-term effects of fixed and removable retention on the periodontium, and the compliance level when used for an extended period of time. Methods: For 4 years participants were given a supply of canine-to-canine retainers and vacuum-formed canine-to-canine retainers. The inter-canine, as well as inter-molar widths, the length, and the extraction space opening of the mandibular anterior portion, were measured. Gingival inflammation, calculus, and plaque were observed, as well as the attachment of clinical and the case of bleeding during probing. 42 members had returned in the follow-up period, with 21 from each of the two groups. Measurements of the modified gingival index and plaque scoring were performed on the 10 intra-oral photographs that were taken at 4-week intervals in this study to investigate the intra-examiner reliability. Results: After controlling for confounding variables, there was a 1.64 mm (95% confidence interval [CI], 0.30, 2.98 mm) median between-groups difference among patients who utilized vacuum-formed retainers (VFRs). The treatment groups did not vary in inter-canine and intermolar widths (P = 0.52; 95% CI, -1.07, 1.05), arch length (P = 0.99; 95% CI, -1.15, 1.14), or opening of extraction spaces (P = 0.84). Conclusion: A long-term study demonstrates that fixed retention can preserve the alignment of the mandibular anterior over time for the first time. Gingival discomfort and higher plaque scores were reported in both types of retainers.

Interdisciplinary Treatment of a Case With Unilateral Cleft Lip and Palate in the Mixed Dentition.

A 10-year-old girl had reported to Sharad Pawar Dental College. Her parents had chief complaints of lip and palate deformity. On examination, it was found that the patient had unilateral cleft lip and palate on the right side. The aim was to expand the maxilla with alveolar bone grafting in the cleft region to facilitate the eruption of permanent canine and further reduce the deformity to prepare the patient for face mask therapy, reduce morbidity in the permanent dentition, and avoid Le Fort one surgery in the future. She had been previously operated on for cleft lip repair and palatal fistula closure eight years back. The present condition in the mixed dentition needed arch expansion, bone in the cleft region for the eruption of permanent canine, and further arch alignment for facemask therapy. This would reduce the severity of skeletal deformity and later on avoid the surgical advancement of the maxilla.

Mean Bone Density in Interadicular Areas of Maxilla among Patients Visiting Dental Unit of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: A close relationship occurs between the type of bone density and the success of orthodontic mini-implant. The aim of this study was to find out the mean bone density in interradicular areas of the maxilla among patients visiting dental unit of a tertiary care centre. Methods: A descriptive cross-sectional study was performed at the Department of Orthodontics and Dentofacial Orthopedics at a tertiary care centre from 15 January 2022 to 28 June 2022 after taking ethical approval from the Institutional Review Committee (Reference number: UCMS/IRC/175/21). Data was collected from scan reports obtained with a computed tomography scanner. Bone density was measured at 6 mm height from the alveolar crest. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 70 patients, mean bone density at interradicular areas of maxilla was 992.31±204.20 HU (944.46-1040.13, 95% Confidence Interval). Between central and lateral incisor 50 (71.44%) had D2 type of bone density. Conclusions: The mean bone density in inter radicular areas of the maxilla among patients visiting the dental outpatient department was similar to other studies done in similar settings. Keywords: bone density; prevalence; prostheses and implants.