Awareness of Oral Submucous Fibrosis among the Quid-Chewing South-Asian Expatriates in the United Arab Emirates.

Oral submucous fibrosis (OSF) is a chronic disorder prevalent in South and Southeast Asia and is mainly related to the habit of chewing betel quid. Although there are numerous South-Asian studies about OSF, there is no study that evaluates the awareness of OSF among expatriate populations of South-Asian origin. Evaluated the awareness of OSF among South-Asian expatriate patients reporting to a dental hospital in Sharjah. Prevalidated questionnaires were given to 150 expatriate patients of South-Asian origin with quid-chewing habit reporting to the teaching clinics of a dental hospital in the United Arab Emirates. Among the 150 patients, 103 responded to the questionnaire. Among the 103 respondents, 11.65% were aware of OSF. Respondents living in shared residency and labor camps had significantly (P = 0.43) lower awareness of OSF compared to respondents living with their families. The results of our study show that the awareness of OSF is lower among the respondents living in labor camps and shared residencies. The younger respondents had more awareness of OSMF and were more likely to quit the quid-chewing habit.

The Prevalence of Smokeless Tobacco Consumption and Its Effects on Gingival and Periodontal Health Among the Adults in the Emirates of Sharjah, UAE - A Cross-Sectional Study.

Introduction: Smokeless tobacco (SLT) has been linked with various oral signs and symptoms, such as oral mucosal lesions and gingival and periodontal effects. However, there is limited research on the prevalence of SLT use and its impact on gingival and periodontal health in the adult population of the Emirates of Sharjah. Aim: To assess the prevalence of SLT consumption and its effects on gingival and periodontal health in the adult population of the Emirates of Sharjah. Methods: The study evaluated 171 dentate patients aged 18-77 years who use SLT or are nonsmokers. Data were collected through a questionnaire on SLT use and periodontal health assessed using plaque index, gingival index (GI), attachment score, and gingival recession (GR). Statistical analysis was done using SPSS 27.0 version. Results: Among 390 screened participants, 28 subjects (21 males and 7 females) were SLT users with prevalence of 7.18%. No significant differences were found in plaque index, GI, or periodontal pocket depth. However, SLT users had significantly higher clinical attachment loss scores (mean 4.01 mm, SD 0.35) compared to non-users (mean 1.49 mm, SD 1.12). Significant differences were also observed in GR. Conclusions: This study provides insights into the prevalence and impact of SLT use on periodontal and gingival health in UAE adults. SLT usage is associated with a higher risk of periodontitis and gingivitis, indicating the need for awareness and intervention. Further research is required to validate results and consider confounding factors.

Knowledge of undergraduate and postgraduate dental students about managing traumatic dental injuries based on the 2020 International Association of Dental Traumatology guidelines: A online survey of 10 dental schools from 10 countries.

BACKGROUND/AIM: The knowledge of dental students about managing traumatic dental injuries (TDIs) may not be uniform, depending on global location and dental education. The aim of this study was to evaluate the level of knowledge of undergraduate and postgraduate students specializing in endodontics and pediatric dentistry at 10 dental schools in 10 countries about the 2020 International Association of Dental Traumatology (IADT) guidelines regarding the management of TDIs. MATERIALS & METHODS: A previously published questionnaire was used in the current survey. It was an online survey with 12 questions regarding the management of TDIs and some additional questions regarding sociodemographic and professional profiles of the participants were added. The survey was distributed to final-year undergraduate students and postgraduate students in pediatric dentistry and endodontics from 10 dental schools. Simple frequency distributions and descriptive statistics were predominantly used to describe the data. Differences in the median percentage scores among the student categories were assessed using the Kruskal-Wallis test followed by Dwass-Steel-Critchlow-Fligner pairwise comparisons. RESULTS: A total of 347 undergraduates, 126 postgraduates in endodontics, and 72 postgraduates in pediatric dentistry from 10 dental schools participated in this survey. The postgraduates had a significantly higher percentage score for correct responses compared with the undergraduates. No significant difference was observed between the endodontic and pediatric dentistry postgraduates. CONCLUSION: The knowledge possessed by undergraduate and postgraduate students concerning the IADT-recommended management of TDIs varied across the globe and some aspects were found to be deficient. This study emphasizes the critical importance of reassessing the teaching and learning activities pertaining to the management of TDIs.

Integrating Dropout and Kullback-Leibler Regularization in Bayesian Neural Networks for improved uncertainty estimation in Regression.

The objective of the study is to enhance uncertainty prediction in regression problems by introducing a revolutionary Bayesian Neural Network (BNN) model. Experimental results reveal significant improvements in uncertainty prediction and point forecasts with the integrated BNN model compared to the plain BNN. Performance metrics, including mean squared error (MSE), mean absolute error (MAE), and R-squared (R²), demonstrate superior results for the proposed BNN. The experimental results show that for plain BNN, MSE is 87.3, MAE is 6.62 and R2 is -0.0492, whereas for the proposed BNN model MSE was found to be 44.64, MAE is 4.4 and R2 is 0.46. This research brings a fresh approach to Bayesian Neural Networks by incorporating both dropout and KL regularization techniques, resulting in a powerful tool for handling regression tasks with certainty. By combining these techniques, the study enhances model stability, avoids overfitting, and achieves more reliable uncertainty estimation. This study adds to our knowledge of uncertainty-aware machine learning models and offers a valuable solution for accurately assessing uncertainty in various applications.•The innovative BNN model merges the power of Bayesian principles with the effectiveness of dropout and KL regularization.•To test and refine our model, the study utilizes the Boston Housing dataset for both training and evaluation purposes.

Minor physical anomalies including palatal rugae pattern and palatal dimensions in children with sickle cell disease: A cross-sectional analytical study.

Background: Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy, which delays growth leading to an altered skeleton and craniofacial pattern. Palatal rugae patterning has been considered the regulator of the development of the palate. The purpose of the research work was to study the morphology of the palate, rugae pattern, and its dimensions in SCD children and compare them with healthy normal children, and to evaluate its role as minor physical anomalies (MPAs). Methods: A cross-sectional case-control study was designed as per STROBE guidelines. The sample comprised 50 children diagnosed with sickle cell disease (Group SCD) and 50 normal healthy children as control (Group C) belonging to the same age group (10-18 years). Dental impressions were made, followed by the pouring of dental casts. The length of the palatal rugae was measured and categorized into primary (>5 mm), secondary (3 mm-5 mm), and fragmentary rugae (<3 mm). The shape of each primary palatal rugae was identified and categorized as curved, wavy, straight, circular and non-specific. Linear and angular measurements of the palatal rugae patterns and palatal dimensions (width, height, area) were measured and recorded. Results: The total number of palatal rugae and fragmentary rugae was lesser in Group SCD than in Group C (p < 0.05). The depth of the palate was significantly increased, whereas the area of the palate significantly decreased in Group SCD. Conclusions: The children with SCD showed distinctive palatal rugae patterns and dimensions when compared with normal healthy children that can be attributed as potential MPAs for sickle cell disease. Children with SCD had an under-developed palatal rugae pattern with a deep, narrow and small palate when compared to healthy children.The dimensions of the palatal rugae pattern in SCD showed reduced distance between the incisive papilla and the first and last rugae, indicating a further decrease in the anteroposterior dimensions of the palate. These findings may aid in the early diagnosis and prevention of malocclusion in children with SCD by appropriate interceptive orthodontic treatment.

Antimicrobial Properties and Substantivity of Gentamicin, Amoxicillin and Metronidazole (GAM) Antibiotic Solution with Chitosan as a Root Canal Irrigant - A Preliminary Study.

Irrigation is one of the steps that is very crucial in a high-quality endodontic treatment. Hence, irrigant with good substantivity is essential which must not only be effective for the dissolution of the organic tissues but also effectively eliminate bacterial contamination. The aim of the study was to investigate and compare the antimicrobial efficacy of gentamicin, amoxicillin, and metronidazole (GAM) antibiotic solution, chitosan and their combination (GAMC), and analyze their sustained release property. Mueller-Hinton agar medium was inoculated with E. faecalis. The medicaments were then poured at the center of the plate in the prepared wells and incubated at 37°C. Antibacterial property of each medicament was evaluated by measuring the diameter of the zone of inhibition at the end of 48 hours. The substantivity of GAM antibiotic solution and the GAMC was checked using an ultraviolet spectrophotometer. The GAMC demonstrated the strongest antimicrobial activity and good sustained-release properties. Distilled water showed no activity, and chlorhexidine acted as the positive control. Conclusion: The combination of gentamicin, amoxicillin, and metronidazole (GAM) solution with chitosan (GAMC) can be used as an alternative intracanal irrigant as it was found to be a potent antibacterial agent.

Reporting Quality of the Abstracts for Randomized Controlled Trials in Pediatric Dentistry.

OBJECTIVES: The purpose of this study is to systematically appraise the reporting quality of abstracts for randomized controlled trials (RCT) published in pediatric dentistry using Consolidated Standards of Reporting Trials (CONSORT) for abstracts and to analyze the relationship between the characteristics of the RCT to the quality of abstracts. MATERIALS AND METHODS: RCTs published in Pediatric Dentistry were retrieved from the PubMed database from 2016 to 2021. The quality of abstracts was appraised using CONSORT for abstracts checklist by two independent reviewers. STATISTICAL ANALYSIS: In descriptive statistics, frequency and percentage analysis were used for categorical variables, whereas mean and standard deviation were used for continuous variables. To find the significant difference between the bivariate samples in independent groups, Mann-Whitney U test was employed. Multivariate analysis was performed using Kruskal-Wallis test and Mann-Whitney U tests. Probability value of p-value less than 0.05 was considered as statistically significant. RESULTS: Two hundred abstracts were included in the study. All the abstracts adequately reported the "objective" item, whereas only 2 and 4% of abstracts adequately addressed "randomization" and "harms" items, respectively. A significant relationship was observed between the continent of first author/corresponding author, number of authors, impact factor, adherence to CONSORT guidelines, word count, focus of study, and a priori protocol registration to the quality of abstracts (p < 0.05). CONCLUSION: The abstracts of the RCT included in the study did not adequately follow the CONSORT for abstract guidelines. Adherence to the reporting guidelines would improve the overall reporting quality of abstracts of RCT published in Pediatric Dentistry. The overall mean score of the abstracts was 6.80 out of 15 indicating that the abstracts did not adequately follow the CONSORT for abstract reporting guidelines.

Antibacterial and Antibiofilm Efficacy of Copper-Doped Phosphate Glass on Pathogenic Bacteria.

This study aimed to investigate the antibacterial [minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC)] and antibiofilm activity [log10 colony forming unit/mL (CFU/mL) and biofilm disruption] of copper-doped phosphate glass (CDPG) against Streptococcus oralis, Enterococcus faecalis, Lactobacillus casei, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. METHODS: the antibacterial activity was determined using microbroth dilution and time-kill assay. The antibiofilm activity was investigated using crystal violet and confocal laser scanning microscopy. Bacteria growing in absence of CDPG were used as controls. RESULTS: the MIC was ≥125 mg of CPDG/mL; the log10 CFU/mL reduction ranged from 2.66-3.14 to 6.23-9.65 after 4 and 24 h respectively. Generally, no growth was observed after 24 h of treatment with CDPG; the MBC was 250 mg/mL for L. casei and S. oralis while 500 mg/mL for the rest of the bacteria. The highest and lowest antibiofilm activity was observed against S. oralis and E. coli respectively. Three patterns of complete biofilm disruption were seen: (i) large areas with E. fecalis and S. oralis, (ii) medium-size pockets with S. aureus and P. aeruginosa, or (iii) small areas with E. coli and L. casei. CONCLUSION: CDPG can be potentially used as an antibacterial and an antibiofilm agent against oral biofilm-forming bacteria.

Comparative evaluation of the antibacterial activity of red diode laser therapy and 0.2% chlorhexidine against Aggregatibacter actinomycetemcomitans on implant healing abutments: An ex vivo study.

Aims: The intraoral microbiota has a high potential to undergo dysbiosis, causing inflammatory changes with respect to the tissues surrounding either a natural tooth or an implant. Thus, the longevity of implant prosthesis depends on a thorough implant decontamination protocol. Among all the techniques available for doing so, laser is garnering increasing popularity, owing to minimal bleeding, high efficiency, and faster healing. However, limited literature exists regarding the superiority of lasers over chlorhexidine (CHX), the indisputable gold standard antibacterial chemical agent. The aim of this study was to compare the percentage of bacterial reduction of Aggregatibacter actinomycetemcomitans from implant healing abutments post red diode laser therapy versus 0.2% CHX treatment. Settings and Design: The current study had an ex vivo, observational, case-control design. Materials and Methods: Patients reporting for the second stage of the implant surgery were taken as the source of data and the healing abutments, the clinical samples. Eleven patients were chosen with one intraoral implant serving as the test site for laser treatment and another, the control site for CHX treatment. Microbiological analysis was performed via quantitative real time polymerase chain reaction to compare the bacterial reduction percentage after each treatment. Statistical Analysis Used: Repeated measures ANOVA and independent sample t test were used. Results: The mean bacterial viability of the test group (laser) was 1.2%-1.6%, and 0.6%-1.4% for the control group (CHX). The former caused a mean bacterial reduction of 96.1% while the latter, 96.3%. Both the treatments caused a highly statistically significant reduction of viable bacterial counts (P = 0.001). However, when compared, there was no statistically significant difference in the bacterial reduction, when compared in between the two (P = 0.902). Conclusion: Laser treatment is at par with chemical implant surface decontamination. It can help bypass the complications of CHX and revolutionize the protocols for implant surface decontamination.

Parents' and Children's Acceptance of Silver Diamine Fluoride Application on Primary Teeth in the United Arab Emirates.

PURPOSE: To assess the acceptance of silver diamine fluoride (SDF) application on children's teeth among parents and children in the United Arab Emirates (UAE). MATERIALS AND METHODS: A pre-tested questionnaire and clinical photographs of SDF-treated teeth were employed to determine preferences among 370 parents for its use in managing dental caries in their children's teeth. A similar number of children ages 4 to 8 years were also interviewed, and their reaction to SDF was assessed through a facial image scale after showing pictures of pre- and post-SDF treated primary teeth. RESULTS: 265 mothers and 105 fathers participated in this study. The Χ2 test was used to test for the statistically significant differences between parental perceptions. Almost all parents responded that SDF was either unacceptable or extremely unacceptable for their children's anterior teeth in comparison to 63% for posterior teeth (p = 0.009). Fathers were more comfortable with SDF treatment for posterior teeth on a scale of 3.1 out of 4, in comparison to 1.8 for mothers (p = 0.007). Parents with limited education (up to primary school) showed greater SDF acceptance in comparison to college-graduate parents (p = 0.000). The level of parental SDF acceptance increased with the children's behavioural barriers. The older children had a lower acceptance rate, at 1.2 and 2.5 for anterior and posterior teeth, respectively (p = 0.000). CONCLUSIONS: SDF was acceptable to UAE-based parents for posterior teeth; however, they preferred it for anterior teeth only when advanced behavioural management (e.g., sedation) was advocated. Socioeconomic factors moderated their SDF preference regarding the location of tooth and treatment difficulty. Younger children were relatively more receptive to SDF use than were older children.

Clinical efficacy of green tea, aloe vera and chlorhexidine mouthwashes in the treatment of dental biofilm induced gingivitis: A multi-arm, double-blinded, randomized controlled clinical trial.

OBJECTIVE: This multi-arm, randomized, double-blinded, controlled clinical trial was designed to evaluate the clinical efficacy of 0.5% green tea (GT), 0.2% chlorhexidine (CHX) and aloe vera (AV) mouthwash as compared to the control (CNT) group (scaling and polishing alone with no mouthwash) in the management of dental biofilm induced gingivitis among 18-40-year-old patients. MATERIAL AND METHODS: Sixty patients with generalized dental biofilm-induced gingivitis were randomly allocated to four study groups (n = 15 each) for treatment, namely Group GT, Group CHX, Group AV and Group CNT after scaling and polishing were administered to all the patients. Plaque index (PI), gingival index (GI) and sulcular bleeding index (SBI) were recorded at baseline, 14th and 21st day. RESULTS: PI, GI and SBI at various time intervals (baseline, 14th and 21st day) showed high statistically significant differences within the group (p < 0.01). Among these, the maximum percentage change was found in the CHX group followed by GT when evaluated from baseline to 21st day. The least percentage change was found in the AV group for PI and GI while the CNT group showed the least percentage change for sulcular index when evaluated from 14th to 21st day. Inter-group results showed high statistically significant differences (p < 0.01) for PI and GI when evaluated between baseline to 14th day and baseline to 21st day. SBI also showed statistically significant differences (p < 0.05) when evaluated between baselines to 14th day and baseline to 21st day. CONCLUSION: Green tea mouthwash displayed a significant reduction in plaque index, gingival index and sulcular bleeding index. 0.5% green tea catechin has equivalent anti-plaque efficacy as 0.2% chlorhexidine gluconate and can be considered a potent alternative to prevent and treat gingival diseases.

Influence of trazodone on the pharmacodynamics and pharmacokinetics of pioglitazone.

BACKGROUND: These days, poly pharmacy is very common for the treatment of multiple diseases and majority of drugs were metabolized with CYP 450 enzymes. Diabetes mellitus is such a disorder, which requires continuous therapy for the control of blood glucose concentration. Depression was quite common in diabetic patients. Therefore, multiple drugs required to treat diabetes mellitus and depression. Simultaneous administration of these drugs leads to drug interaction. Pioglitazone and trazodone metabolized by CYP3A4 enzymes which may lead to potential drug interaction. OBJECTIVES: This study aimed to find the influence of trazodone on the pharmacokinetics & pharmacodynamics of pioglitazone in normal & diabetic rats, also on rabbits and subsequently effectiveness and safety of the combination was evaluated. METHODS AND MATERIAL: Blood glucose concentration was determined by Glucose oxidase/peroxidase method in normal and diabetic rats. Diabetes was induced with Streptozotocin at a dose of 55 mg/kg body weight. Serum pioglitazone concentration was estimated by high performance liquid chromatography method for pharmacokinetic data. The values were expressed as Mean ± Standard Error Mean (SEM), GraphPad Prism 3.0 (San Diego, California, USA) software was used to express the data. Student's paired 't' test was used to determine the significance. RESULTS: Pioglitazone produces hypoglycaemia in normal rats with a maximum decrease of 36.78 % ± 0.81 at 3 hours interval and anti-hyperglycaemic activity in diabetic rats with maximum reduction of 45.13 % ± 1.52 at 2 hours interval. Trazodone altered the pharmacokinetics of pioglitazone and improved the pioglitazone hypoglycaemic effect. CONCLUSION: Trazodone apparently produced pharmacokinetic interaction with pioglitazone which might be by attenuating the metabolism of pioglitazone. Therefore, care should be taken in simultaneous therapy with pioglitazone and trazodone.

Comparison of clinical outcomes of non-surgical adjunctive use of the 980-nm diode laser to conventional periodontal flap procedure-a randomised controlled split-mouth clinical trial.

Lasers have been found to be effective as an adjunctive in periodontal therapy. The objective of the study was to compare the outcomes of non-surgical adjunctive use of 980-nm diode laser to that of conventional flap surgery in terms of clinical outcome measures and radiographic osseous defect depths. This study was designed as a double-blinded split-mouth randomised controlled clinical trial. A total of fifteen patients (30 quadrants) with generalised periodontitis stage III grade B were randomly assigned test group (diode laser) and control group (conventional flap surgery). Both test and control groups had 15 quadrants each. At 3 months, the probing pocket depth (PPD) was 3.46 ± 0.19 mm (test) and 4.20 ± 0.20 mm (control), with a statistically significant difference between the groups (p = 0.01). Similarly, at 6 months re-evaluation, PPD was 1.46 ± 0.12 mm (test) and 2.33 ± 0.13 mm (control) with a highly significant statistical difference (p = 0.001). Plaque index showed a difference between both test and control groups at baseline, 3 months and 6 months (p = 0.001) while gingival index, modified sulcular bleeding index and radiographic osseous defect depth showed a difference at 3 months and 6 months (p = 0.001). Within the study's limitations, 980-nm diode laser can result in significant improvements in the clinical and radiographic parameters and is very well tolerated by the subjects.

Comparison of Time-kill Assay to Evaluate the Antimicrobial Efficacy of Garlic (Allium sativum) and Guava (Psidium guajava) Extracts on Periodontal Pathogens.

BACKGROUND: The role of Gram-negative anaerobic periodontal pathogens in periodontal diseases has led to the loss of tooth-supporting structures. These diseases can be prevented by the inhibition of bacterial biofilm on the tooth surfaces. Many treatment modalities have been tried to prevent periodontal diseases. With the rise in resistance to synthetic antimicrobials, there is a requirement to develop natural antimicrobials for the control of periodontitis. AIM: The aim of the study was to evaluate and compare the efficacy of garlic (Allium sativum) and guava (Psidium guajava) extracts on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans using time-kill assay. MATERIALS AND METHODS: Aqueous garlic extract (AGaE), ethanolic garlic extract (EGaE), aqueous guava extract (AGuE), and ethanolic guava extract (EGuE) were prepared. Time-kill assays were performed on P. gingivalis and A. actinomycetemcomitans. The aqueous and ethanolic extracts of guava and garlic were compared to assess the maximum bactericidal potency. RESULTS: The comparison of time-kill assay of AGaE and AGuE on P. gingivalis showed a statistically significant difference at 2 h (t = 5.29, P < 0.01), 4 h (t = -4.867, P < 0.01), and 6 h (t = -3.647, P < 0.001). The comparison of time-kill assay of EGaE and EGuE on A. actinomycetemcomitans showed a statistically significant difference at 2 h (t = 4.54, P < 0.01) and highly significant difference at 4 h (t = 6.57, P < 0.001). CONCLUSIONS: The, judicious use of these phytomedicinal products could be cost-effective and also the adverse effects caused due to the long-term usage of synthetic antimicrobials can be avoided.

Efficacy of Psidium guajava and Allium sativum Extracts as Antimicrobial Agents against Periodontal Pathogens.

BACKGROUND: The accumulation and maturation of bacterial plaque at the gingival margin is widely recognized as the primary etiological factor in the development of chronic periodontitis. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. AIM: The aim of this study was to evaluate the efficacy of Psidium guajava (guava) and Allium sativum (garlic) on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. MATERIALS AND METHODS: Aqueous guava extract (AGvE), ethanolic guava extract (EGvE), aqueous garlic extract (AGE), and ethanolic garlic extract (EGE) were prepared. The inhibitory effects of these extracts for the periodontal pathogens were tested by agar well diffusion method. Minimal inhibitory concentration (MIC) of the aqueous and ethanol extracts of guava and garlic was determined by macrobroth dilution method. Minimum bactericidal concentration (MBC) was done to observe the bactericidal effect of the guava and garlic extracts against the organisms. RESULTS: Of the AGE, 25, 50, and 75 µL showed 16, 20, and 25 mm zone of inhibition, respectively, on P. gingivalis. The AGE showed greater bacteriostatic activity against the P. gingivalis with MIC determined at 16.6 µL/mL. MIC determined for AGvE and EGvE was at 75 µL/mL concentration for P. gingivalis, whereas EGvE showed the activity at 75 µL/mL on P. gingivalis. MIC determined for AGvE was at 50 µL/mL, whereas MIC determined for EGvE was at 3.12 µL/mL for A. actinomycetemcomitans. CONCLUSION: P. guajava and A. sativum displayed a significant antibacterial effect. A. sativum was found to be most effective against P. gingivalis, whereas P. guajava showed the highest efficacy on A. actinomycetemcomitans.

Modified Transclavicular-Transmanubrial Approach to Cervicothoracic Spine: Revisiting and Renovating the Path - Lessons Learned.

INTRODUCTION: A thorough knowledge of the vital structures adds to the safety in approaching the cervicothoracic spine junction. The best described method to reach the spine is via viscero-neurovascular space. We present our experience of 10 cases operated at our institute using the modified transclavicular transmanubrial approach to the cervicothoracic spine pathology.As we gained experience we have used various corridors to the operating field and used a new space to approach the lower cervicothoracic junction spine. METHODS: Between February 2011 to August 2015, 10 patients with disease in upper thoracic vertebral body were admitted and evaluated clinically and radiologically. Neurological status in all cases was graded according to Frankel grading system.Patients were followed up with Histopathological reports and treated accordingly. RESULTS: All patients(except metastasis) improved by 1 or 2 grade in post op period. Metastasis patients remained in same grade. CONCLUSION: Anterior approach with its modifications are the better suited biomechanically for exploring the pathology of cervicothoracic spine,its decompression and stabilization. Also it preserves the stability of shoulder girdle with good neurological and cosmetic outcome.

RMS-MP3 Classification: A Newly Proposed Digital MP3 Classification in Assessing Skeletal Maturity.

BACKGROUND: Growth is a crucial inconsistent parameter, which is a primary requisite in diagnosing and planning orthodontic and orthopedic treatment. The use of the epiphyseal development of the middle phalanx of the third finger (MP3) radiograph is advisable instead of hand and wrist radiographs for growth assessment. AIM: (1) To propose a simple, precise, and reliable classification system of MP3 staging-RMS MP3 classification and (2) to check the reliability of newly proposed RMS-MP3 classification in assessing the skeletal maturity. MATERIALS AND METHODS: Standardized MP3 digital radiographs of 276 children between 5 years and 13 years of age were included in the study. The epiphysis and diaphysis were measured, and the percentage of epiphysis formed when compared to diaphysis was obtained using our formula. A new classification was designed and proposed. The assessment of the MP3 developmental stages was carried out by all the four investigators (two pedodontists and two nonpedodontists) according to the older classification by Liete et al. and the newly proposed RMS-MP3 classification. RESULTS: Among nonpedodontists, there was 51% perfect agreement of maturity stages according to old classification and 90% perfect agreement according to newly proposed classification. Among pedodontists, there was 90% perfect agreement of maturity stages according to old classification and 99% perfect agreement according to the newly proposed classification. An estimated 89% of agreement was seen in RMS-MP3 classification among all the four observers when compared to 38% of agreement in the old classification. CONCLUSION: The newly proposed RMS-MP3 classification can be an alternative and perfect aid in assessing growth with accuracy, precision, ease, and an increased reliability. HOW TO CITE THIS ARTICLE: Shetty RM, Hanumanta S. RMS-MP3 Classification: A Newly Proposed Digital MP3 Classification in Assessing Skeletal Maturity. Int J Clin Pediatr Dent 2019;12(4):255-260.

Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients.

AIM: Children having dental anxiety usually hesitate to seek dental care which can result in poor oral health and may lead to expensive and complex dental treatment in the future. The aim of the present study is to compare and evaluate the effectiveness of various distraction techniques in managing pediatric dental patients. MATERIALS AND METHODS: Eighty healthy children selected for the study were randomly divided into 4 groups with 20 children in each group. Group I was termed as the control group; in group II, the audio distraction technique was used. Group III received audio-video distraction (AVD) by means of a chair-mounted audio-video device and group IV received AVD by means of a ceiling-mounted television. Each child had four dental visits. Child's anxiety in each visit was assessed using four parameters: RMS pictorial scale (RMS-PS), Venham picture test (VPT), pulse rate, and oxygen saturation. RESULTS: Ceiling-mounted AVD was found to be the most effective in reducing the anxiety followed by chair-mounted AVD. Audio distraction was found to be the least effective but was better than the control group. CONCLUSION: The AVD technique is simple, passive, and noninvasive means of behavior management and can be used alternatively in managing anxious pediatric dental patients. HOW TO CITE THIS ARTICLE: Khandelwal M, Shetty RM, et al. Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients. Int J Clin Pediatr Dent 2019;12(1):18-24.

Periodontal Accelerated Osteogenic Orthodontics Technique for Rapid Orthodontic Tooth Movement: A Systematic Review.

AIM: The aim of this review was to analyze the data in the available literature regarding aspects of periodontally accelerated orthodontic therapy such as reduction in treatment time, variation in surgical techniques, and patient satisfaction. MATERIALS AND METHODS: An internet-based search was performed for the articles published between January 2008 and August 2018 using keywords periodontal accelerated orthodontic tooth movement, corticotomy, bone grafting, tooth movement, and treatment duration. A total of 84 articles were obtained from MEDLINE and Embase search engines, of which 31 articles were eligible to be included for the systematic review. RESULTS: On analysis, it was observed that the earlier studies were predominantly pertaining to case reports. In the later part of the decade considered in this review, it was observed that the emphasis was given to clinical and animal studies. CONCLUSIONS: Most of the studies included in the review concluded that there was a significant reduction in orthodontic treatment duration using periodontal accelerated techniques compared to conventional orthodontic treatment.