Evaluation of Skeletal and Dentoalveolar Changes in Patients With Class II Div 1 Malocclusion Treated With Twin Block Appliance.

Objective The study was focused on evaluating the change in mandibular morphology following the Twin Block appliance therapy and recording its effect on the maxilla and maxillary dentoalveolar complex. Also, the results of the Twin Block appliance between males and females were compared.  Material and methods In this two-armed retrospective cephalometric study, 30 patients (mean age 12 years) treated with Twin Block appliance for the period of 8-12 months were chosen, and their records were obtained to analyze. These results were compared with 15 control subjects of the same age group chosen from the American Association of Orthodontics Foundation (AAOF) growth legacy collection: Michigan Growth Study Class II subjects. Cephalometric tracing was done, and data was processed for descriptive statistical analysis. Results Paired sample t-test and ANOVA test were performed to evaluate the differences in the pre-treatment (T1) and post-functional (T2) values. ∠ANB showed a mean difference of -4.71°±1.55° for males and 6.22°±6.78° for females, which is significant. The mandibular length (Co-Gn), for male subjects, the mean difference was 5.14±1.74 mm, and for female subjects, it was 6±2mm, which is highly significant; 49.88% of skeletal changes and 50.12% of dentoalveolar changes were reported to bring about Class II correction with Twin Block. Conclusion A successful increase in mandibular length was achieved using a Twin Block as a functional appliance. Also, the significant maxillary restraining effect was recorded. More skeletal changes were observed in males than females.

The Impact of Interpretation Services Training on Contact Tracing Efforts During the COVID-19 Pandemic.

There is limited research regarding interpretation services training and its benefit in contact tracing programs. This study seeks to assess the impact of optional formal interpretation services training on contact tracers and identify specific barriers tracers face when contacting patients with limited English proficiency, who have been disproportionately impacted by the COVID-19 pandemic.

Association of Provider Specialty With Abortion-Related Morbidity and Adverse Events Among Patients Having Procedural and Medication Abortions.

OBJECTIVE: Since abortion was legalized throughout the United States in 1973, states have passed restrictive abortion policies, including permitting only obstetrician-gynecologist physicians (OBGYNs) to provide abortions. We are unaware of any research that directly compares patient safety-related outcomes by physician specialty. In this study, we compared major and any abortion-related morbidity and adverse events in abortion care provided by physicians of other specialties versus OBGYNs. STUDY DESIGN: Using the IBM Watson Health MarketScan claims database, we identified privately insured individuals who had an induced abortion between January 1, 2011, and December 31, 2014. The primary outcome was major abortion-related morbidity or adverse events, and the secondary outcome was any abortion-related morbidity or adverse events occurring within 6 weeks of the abortion. RESULTS: The study cohort included 34,764 patients who had 35,407 abortions-4,843 (13.7%) abortions provided by physicians of other specialties and 30,564 (86.3%) abortions provided by OBGYNs. Major and any abortion-related morbidity or adverse event occurred in 115 (0.3%) and 1,271 (3.6%) of 35,407 of abortions, respectively. In adjusted analyses, there was no statistically significant difference in major abortion-related morbidity or adverse events comparing physicians of other specialties versus OBGYNs (adjusted odds ratio, 1.02; 95% confidence interval, 0.59-1.75), and no statistically significant difference in any abortion-related morbidity or adverse events comparing physicians of other specialties versus OBGYNs (adjusted odds ratio, 0.91; 95% confidence interval, 0.77-1.09). CONCLUSIONS: There were no differences in abortion-related morbidity or adverse events by physician specialty. Our findings do not support state laws limiting abortion care to OBGYN physicians.

Endodontic Emergencies Encountered in a Tertiary Dental Hospital during the Periods of Prelockdown, Lockdown, and Sequential Unlock Phases of the First Wave of COVID-19 in Ahmedabad City, India.

INTRODUCTION: With the worldwide spread of SARS-CoV-2 infection, temporary suspension of all the elective dental procedures and an urgent shift to nonaerosol producing dental treatments were observed. This study provides a detailed description of emergency treatments provided in the Department of Endodontics at a tertiary healthcare centre during the period of prelockdown, lockdown, and sequential unlocking from March 1, 2020, to October 31, 2020. METHODS: Access to General and Departmental OPD data along with treatment records was obtained and was segregated based on age, sex, and treatments performed. Treatments were divided into aerosol generating procedures (AGPs) and non-AGPs and further subdivided into palliative treatment (PT), pulp capping (PC), incision and drainage (ID), temporary filling (TF), pulpectomy (PU), and pulpotomy (PO). Data was analysed and subjected to chi-square test. RESULTS: A total of 15052 patients approached general OPD during the period of 8 months of which 5698 (37.86%) were endodontic in origin and treatments offered were PT 858 (15.05%), PO 1560 (27.37%), PU 2018 (35.42%), TF 500 (8.78%), ID 164 (2.88%), and PC 598 (10.94%). Also, more females (57.28% (3264/5698)) visited the department as compared to males (42.72% (2434/5698)). CONCLUSION: The pandemic had turned the tables on over the people around the world, and it has become extremely necessary to rule out the emergencies needed to treat the patients accordingly shifting more towards non-AGPs compared to AGPs among the various age groups of the society.

Staging Orthodontic Aligners for Complex Orthodontic Tooth Movement.

The recent trend in orthodontics has shown an increased shift toward aligner therapy. For years, orthodontists have used fixed preadjusted appliances for orthodontic treatment. Even though fixed appliances have been highly efficient in the treatment of orthodontic malocclusions, they are not as esthetic as clear aligners. The purpose of this article is to review the staging of orthodontic tooth movement (OTM) with aligner therapy.

COVID-19 and Spontaneous Pneumomediastinum: A case series.

COVID-19 is a relatively new and rapidly emerging disease. Given current knowledge of the disease process, it is of the utmost importance to gain further insight into its different clinical manifestations. In this report we describe three cases involving Hispanic males with COVID-19 all of whom developed pneumomediastinum during their hospital course. We want to emphasize the importance of this adverse event despite their non-smoking history and the exclusion of positive pressure ventilation. Frequent chest radiographs help with early recognition of this disease process. Early detection of pneumomediastinum is important as this could lead to worse morbidity if left unrecognized despite its usually benign nature.

Class III Malocclusion Treated by Combined Orthodontic and Orthognathic Approach Along with Growth Prediction: A Case Report.

To devise a comprehensive treatment strategy for patients with Class III malocclusion, it is critical to address etiology in the process of differential diagnosis. Growth prediction has always been a part of the deduction science. It is important not only in treatment planning and treatment provision, but it is equally important in the evaluation of prognosis during retention and after retention. The visual treatment objective by Ricketts is a complete analysis and the first of its kind defining every aspect of malocclusion and also assessing where the etiology lies. Here, we present one such case of skeletal Class III in which the growth prediction has played a vital role in the comprehensive treatment planning and treatment outcome.

Overcoming the Challenges of COVID-19 Pandemic in Orthodontic Practice.

The coronavirus disease 2019 (COVID-19) turned into a pandemic in short-time with multi-dimensional effects on human lives. The containment of this infection has become a big challenge in all countries due to its rapid spread. In this situation, when there is no definitive cure or any vaccine available to overcome COVID-19, it is prudent for the world to live with this deadly virus for the many months to come. Hence, it is imperative for the dental professionals, particularly orthodontists, to modify their approach to learn the new normal of practicing dentistry.

Evaluation of skeletal maturation using mandibular third molar development in Indian adolescents.

OBJECTIVE: This study was done with the following objectives: to estimate dental maturity using the Demirjian Index (DI) for the mandibular third molar; to investigate the relationship between dental maturity and skeletal maturity among growing patients; to evaluate the use of the mandibular third molar as an adjunctive tool for adolescent growth assessment in combination with the cervical vertebrae; to evaluate the clinical value of the third molar as a growth evaluation index. MATERIALS AND METHODS: Samples were derived from panoramic radiographs and lateral cephalograms of 615 subjects (300 males and 315 females) of ages ranging 9-18 years, and estimates of dental maturity (DI) and skeletal maturity [cervical vertebrae maturation indicators (CVMI)] were made. RESULTS: A highly significant association (r = 0.81 for males and r = 0.72 for females) was found between DI and CVMI. DI Stage B corresponded to Stage 2 of CVMI (prepeak of pubertal growth spurt) in both sexes. In males, DI stages C and D represent the peak of the pubertal growth spurt. In females, stages B and C show that the peak of the pubertal growth spurt has not been passed. DI stage E in females and DI Stage F in males correlate that the peak of the pubertal growth spurt has been passed. CONCLUSION: A highly significant association exists between DI and CVMI. Mandibular third molar DI stages are reliable adjunctive indicators of skeletal maturity.

Evaluation of arch width among Class I normal occlusion, Class II Division 1, Class II Division 2, and Class III malocclusion in Indian population.

OBJECTIVE: To test the hypothesis that there is no difference between Class I (CI) normal occlusion, Class II division 1 (CIId1) and CII division 2 (CIId2), and Class III (CIII) malocclusion with respect to arch widths, width of the maxillary and mandibular arches, gender dimorphism within groups, and gender comparisons. MATERIALS AND METHODS: Samples of 40 CI subjects, 40 CIId1 subjects, 40 CIId2 subjects, and 34 CIII subjects were studied. All subjects were Indians with no history of orthodontic treatment. An analysis of variance and Duncan's test statistically compared the groups and genders. RESULTS: CIId1 malocclusion showed the narrowest maxillary arch compared with the other types of malocclusions. CIII malocclusion showed largest mandibular arch than other types of malocclusions. Gender dimorphism is more commonly seen in CI normal occlusion than other types of malocclusions. Gender dimorphism is not observed in CIId1 group. Gender comparisons revealed arch width differences between different types of malocclusions more pronounced in males than in females. The maxillary/mandibular intermolar width difference is positive for CI normal occlusion and negative for CIId1, CIId2, and CIII malocclusions, which suggested, the presence of crossbite tendency in CII and CIII malocclusions. CONCLUSION: The hypothesis is rejected by the findings of this study.

Cephalometric study to test the reliability of anteroposterior skeletal discrepancy indicators using the twin block appliance.

BACKGROUND: The objectives of this study were to check the reliability of the five angular and two linear parameters for sagittal maxillo-mandibular discrepancy and to compare and correlate angular parameters with the ANB angle, and the linear parameter with Wits analysis. METHODS: The pre-treatment and post-functional lateral cephalograms of 25 subjects (17 males, 8 females) with class II division 1 malocclusion treated with twin block functional appliance were selected. Five angular (ANB, ß angle, APDI, YEN angle, W angle) and two linear (Wits analysis, App-Bpp) parameters were traced on both sets of cephalograms. Paired Student's t-test, one-way ANOVA, post hoc test, and Karl Pearson correlation statistical analysis were performed. RESULTS: All the parameters considered in our study showed highly significant difference in pre-treatment and post-functional values, suggesting their reliability (p < 0.0001). When ANB angle was compared with the other angular parameters, a highly significant change in the mean value of the difference in pre-treatment (T1) and post-functional (T2) values was noted (p < 0.001). No significant change was seen when comparing the mean value of the difference in T1 and T2 between linear parameters (p = 0.949). CONCLUSIONS: All the parameters used in the study can be reliably used to assess anteroposterior skeletal discrepancy. Whenever limitations of the ANB angle and Wits analysis are foreseen, the W angle and App-Bpp, respectively, can be reliably used. The YEN angle may reliably predict the post-functional change with the use of twin block appliance.

Evaluation of relationship between cranial base angle and maxillofacial morphology in Indian population: A cephalometric study.

OBJECTIVE: To investigate the role played by the cranial base flexure in influencing the sagittal and vertical position of the jaws in Indian population. MATERIALS AND METHODS: Lateral cephalograms of 108 subjects were divided into three categories (Group A: NSAr > 125°, Group B: NSAr-120°-125°, Group C: NSAr < 120°) according to value of NSAr. Measurement of eight angular (SNA, SNB, NPg-FH, ANB, NAPg, SN-GoGn, Y-Axis, ArGo-SN) and seven linear (N-S, S-Ar, Ar-N, Ar-Pt A, Ar-Gn, Wits appraisal, N- Pt A) variables were taken. RESULTS: Pearson correlation coefficient test was used to individually correlate angular and linear variables with NSAr for the whole sample as well as in individual group. Unpaired t-test was used to analyze the difference in the means of all the variables between the three groups. Significance was determined only when the confidence level was P < 0.05. Several parameters (SNB, NAPg, ANB, Y-Axis, GoGn-SN) showed significant positive correlation while others showed negative correlation (SNA, NPg-FH, N-S) with NSAr. CONCLUSIONS: This study show cranial base angle has a determinant role in influencing the mandibular position and it also affects both the mandibular plane angle and y-axis. Flattening of the cranial base angle caused a clockwise rotation of the mandible. The jaw relation tends to change from class III to class II, with progressive flattening of the cranial base and vice-versa.

Correction of severe class II skeletal discrepancy with fixed twin block and high pull headgear--a case report.

This case report describes the management of a girl with a severe Class II skeletal discrepancy, Class II molar and canine relationship, a large overjet, an impinging overbite and a steep mandibular plane angle. Seemingly a surgical case, but as the patient was in CVMI stage 4, the treatment was initiated with a fixed twin block extending up to the maxillary second molars along with high pull headgear for the vertical control. This promoted the growth of the mandible, restrained maxilla in anteroposterior and vertical directions, combined with the fixed appliances for the aligning and levelling of the dentition improved the soft tissue profile. Thus severe skeletal Class II discrepancy with noncompensatory dental occlusion was successfully managed non-surgically with the combination of dentofacial orthopaedics along with comprehensive orthodontic mechanism without any extraction resulting in acceptable soft tissue changes.

Photography versus lateral cephalogram: role in facial diagnosis.

CONTEXT: In a developing country like India, where expensive cephalometric apparatus is unavailable everywhere, photography assumes importance for diagnostic and treatment planning procedures as it is low cost and less technique sensitive. AIMS AND OBJECTIVES: The aim of this study was to compare and correlate craniofacial measurements from cephalometric radiographs with analogous measurements from standardized facial photographs in the Gujarati population. MATERIALS AND METHODS: The study was carried out using standardized cephalometric radiographs and photographs of 60 Gujarati subjects (30 males, 30 females). Eight facial landmarks were identified on both the photograph and cephalogram. Five angular and three linear measurements were created from these landmarks and planes. STATISTICAL ANALYSIS USED: The Pearson correlation coefficient was used to estimate the correlations between the photographic and cephalometric variables. The intraclass correlation coefficient (ICC) was estimated to measure the reliability of the repeated tracings. RESULTS: On comparing the cephalometric and photographic variables for the entire sample, positive and significant correlations were found for all the variables studied (r > 0, P < 0.05). The ICCs for all of the angular measurements were higher than those for linear measurements. CONCLUSION: Photographs may be used reliably for epidemiological purposes, screening, initial consultations and cases where irradiation is contraindicated or needs to be avoided.

Pre-surgical nasoalveolar moulding in patient with unilateral cleft of lip, alveolus and palate: case report.

INTRODUCTION: A 2 month-old infant with unilateral cleft lip, alveolus and palate was presented with wide alveolar defect, soft-tissue deformity and a markedly sunken nasal wing at the cleft side. METHODS: The patient was treated with a moulding plate and additionally with a nasal stent. The device consisted of an acrylic plate with an attached nasal stent that lifted the nasal dome. RESULTS: Under this pre-surgical treatment, the cleft edges moved closer by 9 mm and 6 mm at the alveolar ridge and palate, respectively. The nasal wing was lifted considerably. CONCLUSION: Pre-surgical nasoalveolar moulding helped to reduce the cleft gap, improve the arch form, approximate lip segments and distinctly improve the morphology of the nose by correcting flattened nasal wings.

Comparison study of porous, fused-core, and monolithic silica-based C18 HPLC columns for Celestoderm-V Ointment analysis.

In this paper, three C18 columns with different substrates (i.e., porous ACE-3 C18, 3 microm, fused-core Halo C18, 2.7 microm, and monolithic Chromolith C18 were compared for the analysis of a pharmaceutical product, Celestoderm-V Ointment, that contains one active pharmaceutical ingredient, betamethasone-17-valerate and one critical pair of low level impurities, betamethasone-E-enolaldehyde and betamethasone-Z-enolaldehyde. Key column performance for the analysis of pharmaceutical products including selectivity, efficiency, separation impedance, resolution factor, sample loading capacity, linearity and lifetime from the three columns were determined. The potential applications of these three C18 columns for different methods for Celestoderm-V Ointment analysis are also recommended.