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).

A Comparative Analysis of Skeletal and Dental Parameters in Bilateral Cleft Lip and Palate vs. Non-bilateral Cleft Lip and Palate Patients in the Central Indian Population: A NemoCeph Study.

Introduction Orthodontic diagnosis and treatment planning encounter distinctive complexities when dealing with cleft lip and palate anomalies. This research endeavors to thoroughly examine skeletal and dental characteristics through cephalometric analyses among individuals with bilateral cleft lip and palate (BCLP) within the central Indian population. Due to anatomical variations and growth constraints, traditional cephalometric mean values derived from standard population studies are often inadequate for these cases. Advanced technology, such as NemoCeph (Nemotech, Madrid, Spain) software, enhances measurement accuracy. Methods Fifty patients, including 25 with BCLP and 25 without BCLP, aged 10 to 18, were selected for this cross-sectional study. Lateral cephalograms were traced and analyzed using NemoCeph software. Skeletal and dental parameters were measured, and a comparison was made between BCLP patients and the general population. Statistical analysis was conducted using the Student's unpaired t-test. Both SPSS Statistics Version 24.0 (IBM Corp., Armonk, NY, USA) and GraphPad Prism Version 7.0 (GraphPad Software, San Diego, CA, USA) were used for data analysis. Results The investigation revealed significant disparities across several parameters, including sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), A point-nasion-B point angle (ANB), the inter-incisal angle (the angle between the long axes of the upper and lower incisors), and UP 1 to A-pog (a specific vertical measurement between anatomical markers labeled "upper 1" and "A point to pogonion"), with associated p-values for the skeletal and dental parameters of 0.310, 0.259, 0.195, 0.0001, and 0.0001, respectively. A comparison between manual tracing and digital methods indicated a reduction in errors and an improvement in measurement precision. Notably, patients diagnosed with BCLP exhibited distinctive skeletal and dental traits, highlighting the necessity for tailored treatment approaches. Conclusion This study emphasizes the importance of personalized cephalometric evaluations for patients with BCLP. Standard mean values may not be applicable due to unique anatomical considerations in these cases. Advanced technology and patient-specific assessments are crucial for accurate diagnosis, treatment planning, and orthognathic procedures in individuals with cleft lip and palate conditions. Embracing digital tools and tailored approaches can enhance patient care quality and lead to better clinical outcomes.

A Review on Orthodontic Brackets and Their Application in Clinical Orthodontics.

Braces are undoubtedly a blessing for those whose teeth are misaligned in various ways, yet many people may not enjoy the traditional metal braces. However, some people are totally fine with having their teeth fused with the set of metal brackets and various metal components flowing through. A few people may simply not feel comfortable in that way. Orthodontists have developed a huge array of bracket styles by concentrating on the wide range of preferences and financial constraints that their patients present. These various dental bracket types are all advantageous from one point of view or another. Orthodontic supplies and materials are being produced using technology that is advancing exponentially. Every day, more technologies, processes, and designs emerge. These tools assist the orthodontist in providing patients with the best functional and cosmetic outcomes. Since Edward Hartley Angle's time through MBT brackets and then lingual brackets, orthodontic brackets have advanced significantly. Orthodontists' lives have been greatly facilitated by these brackets. Numerous new materials and designs will be developed as technology progresses. The purpose of this article was to give a general overview of the different orthodontic brackets and demonstrate how the logic underlying them helps orthodontists in their day-to-day jobs.

Treatment of Skeletal Class II Division 1 Using Twin Block Myofunctional Appliance.

Myofunctional appliances are customarily used to treat Class II malocclusions in growing children to alter their growth. Functional appliances are widely accepted to enhance skeletal relationships in the short term efficiently. It utilizes muscular forces by muscles to make dental and skeleton modifications. The myofunctional appliance might be removable or fixed. The variation of mode and method of action depends on the design, but the forces created by the muscles' stretching provide their effect. According to research, the effectiveness of functional appliances as a therapy for Class II malocclusion might be influenced by mandibular growth patterns. Their low skeletal maturation influence outweighs the primary dentoalveolar impact of the twin block myofunctional orthodontic appliances. Class II malocclusions can benefit by using myofunctional appliances in specific clinical situations, such as when the patient is still developing. These devices make the fixed appliance phase easier to use, but their effectiveness depends heavily on the patient's compliance. In this case, an 11-year-old female expressed concern about the forward positioning of her upper front teeth when she visited the department of orthodontics. Twin block, a myofunctional appliance, was used to manage it, and then fixed orthodontic treatment was used to fine-tune the occlusion. This case report illustrates the design and treatment effects.

Comparative Evaluation of Cleaning Efficacy of Interdental Brush and Interdental Floss in Orthodontics Patients From Vidarbha Region: An Interventional Study.

Background Plaque and dental caries are the primary agents causing gingival and periodontal diseases, eventually progressing into tooth loss. If oral hygiene practice is poor, plaque easily accumulates on the tooth surface, especially in interproximal areas. To maintain a good oral environment, it is mandatory to remove or at least reduce the percentage of plaque formation from the oral cavity. To achieve this, interdental aids should be used along with toothbrushes, as cleansing the teeth only with a toothbrush is not effective. Various interdental aids, like interdental brushes, floss, toothpicks, etc., are now available on the market. The objective of the current survey was to rate knowledge as well as make a comparison between the cleaning effectiveness of interdental brushes and interdental floss to determine which was better at reducing plaque accumulation and, subsequently, dental caries. The survey was accessed by measuring individual plaque and gingival index before and after using interdental cleaning aids. Methodology The objective of the survey was to evaluate and analyze the efficiency of interdental brushes and interdental floss in maintaining oral hygiene among orthodontic patients residing in the Vidarbha region. After receiving approval from the Ethical Committee DMIHER(DU)/IEC/2023/721, a study was conducted over a 30-day period, focusing on a group of 100 individuals aged between 15 and 30 years, and their assessments were analyzed. The patient was briefed about the study and asked to make use of an interdental brush and interdental floss. The gingival index and plaque index were calculated on the same patients before and after the use of the interdental brush and interdental floss to determine which was better at reducing plaque accumulation on the surface of teeth. Descriptive analysis, unpaired for intergroup comparison, and paired T-tests for intragroup comparison were used. The software used was SPSS 24.0 (IBM Corp., Armonk, NY) and GraphPad Prism 7.0 (GraphPad Software, Inc., La Jolla, CA). Result Everyone's tooth surfaces naturally develop a thin layer of plaque biofilm, but the presence of heavy plaque deposits on teeth indicates poor dental hygiene, which can lead to various oral health issues. Failure to improve dental hygiene status can result in problems such as halitosis, gingival issues, periodontal disease, and eventually tooth loss. Dentists play a crucial role in raising awareness about these concerns among their patients and providing education on effective oral care practices, including the use of interdental aids in conjunction with toothbrushes. When comparing the effectiveness of interdental brushes and dental floss in removing plaque, interdental brushes have been found to be more efficient. They not only excel in plaque removal but also contribute to a reduction in gingival problems. The statistical analysis supports this, with a significant p-value of less than 0.01 for both the plaque index and gingival index when using interdental brushes, indicating their superior performance in maintaining oral health. Conclusion The study will help every individual improve their oral hygiene status with the help of an interdental aid and a toothbrush. This will reduce the chances of having gingival and periodontal diseases and eventually reduce the risk of tooth loss.

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.

Anterior En Masse Retraction in Orthodontics.

This article reviews and critically analyzes the literature on mini-implants (temporary anchorage devices) for anterior en masse retraction in orthodontics. The search methods used were an E-database search, a secondary computerized search of orthodontics journals, and a reference list of selected studies. Eligibility criteria included individuals who underwent orthodontic treatment for correction of malocclusion with premolar extraction. Data were taken from PubMed and Scopus as well as the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Keywords used for searching the article were temporary anchorage devices, premolar extraction, orthodontics, and anterior en masse retraction, Anterior en masse retraction with sliding mechanics in pre-adjusted edgewise appliances was considered for the study. Data collection and analysis involved three different researchers performing three steps of selection. All titles were initially filtered for irrelevant review articles. In the first step, all summaries from the selected studies were reviewed, and in the second, the entire content of the papers was read. The study was then discarded based on qualifying standards. A chart was created using the data from the final chosen research as well as the findings. The following information was evaluated for the final table: author, publication year, research structure, study group, sample size, methods/measures, study findings, and conclusion about frictionless mechanics. Results showed that a meta-analysis was not feasible due to clinical and statistical variability, as well as variations in study design, sample selection, and sample size. Thus, it was concluded that sliding mechanisms are widely employed in orthodontic treatment, but temporary anchorage devices and sliding mechanisms deliver great results. There is a need to raise awareness about these devices and use them with care.

Modern Anchorage Systems in Orthodontics.

Anchorage has been a vital topic since the origin of orthodontics. In the orthodontic process, gentle, constant pressure is applied to the teeth that need to be moved against the other teeth, which serve as the anchoring unit. The anchoring teeth must be completely stable. The introduction of temporary anchorage devices to the orthodontic field has made it possible to overcome conventional anchorage and its limitations. Mini implants have widened the horizon of the orthodontic field. Skeletal anchorage has, to a large degree, replaced conventional anchorage in a situation where anchorage is considered either critical, insufficient, or likely to result in undesirable side effects such as vertical displacements generated by intermaxillary force systems. Over the last few years, anchorage control with mini-implants has acquired plenty of significance in the clinical management of orthodontic patients. The mode of anchorage facilitated by these implant systems has a unique characteristic owing to their temporary use, which results in a transient, albeit absolute anchorage. The foregoing properties, together with the recently achieved simple application of these screws, have increased their popularity, establishing them as a necessary treatment option in complex cases that would have otherwise been impossible to treat. This comprehensive review aims to present and discuss the historical view, clinical uses, benefits, and drawbacks of the mini-screw implants used to obtain a temporary anchorage for orthodontic applications. Topics to be discussed include classification, types and properties, types of screw, head, and thread, their clinical applications, sites, and placement method selection.

Clinical profile of cutaneous tuberculosis at Nashik.

INTRODUCTION: This study was conducted to determine the clinical pattern, nature and prevalence of cutaneous tuberculosis in Nashik, India. METHODS: We report 52 cases of cutaneous tuberculosis that were diagnosed at our outpatient department from January 2018 to December 2019. All the cases were diagnosed clinically, and biopsies were examined for histopathological evidence. RESULTS: Clinically, 26 (50%) cases of lupus vulgaris, 15 (29%) of scrofuloderma, six (12%) of tuberculosis verrucosa cutis, four (8%) of papulonectrotic tuberculid, and one (2%) of lichen scrofulosorum were observed in our department from 2018 to 2019. All the patients were between 5 and 65 years old. Five patients were children under 10, 29 (56%) were between 10 and 30 years old, 13 (25%) were between 30 and 50 years old, and five (10%) were over 50. There was a male (64%) predominance compared to female patients (37%). Histopathology of all the specimens showed granulomatous changes, in the majority of cases Langhans giant cells. Epithelioid cell infiltration and other inflammatory cells, such as lymphocytes, neutrophils, and eosinophils, were seen in ulcerated lesions. CONCLUSIONS: The study had some limitations. The sample size was small and the study was carried out in a rural setting, where agriculture is the main source of income and most of the patients treated are farm laborers. Lupus vulgaris was the most common form of cutaneous tuberculosis in this area. The incidence was higher in working adult males, indicating that trauma may be one of the causes of cutaneous tuberculosis. The high rate of clinical-histological confirmation seen in this study emphasizes the importance of skin biopsy in patients with cutaneous TB.

Dramatic response of propranolol in hemangioma: report of two cases.

Hemangiomas are indolent birthmarks of vascular origin, which are known to appear soon after birth, proliferate for 8-18 months, and then slowly regress over the next 5-8 years, leaving behind normal or slightly blemished skin. In rare instances, hemangiomas may encroach upon and endanger vital structures with a mortality of up to 60%. Multiple therapeutic modalities are available for hemangiomas with variable results and associated with side effects. We report two cases of hemangioma, successfully treated with propranolol. Case 1 was a 5-month-old female child who presented with a giant segmental hemangioma since birth. She was unable to open her left eye over the past 7 days. Within 48 hours of administering full dose of oral propranolol (2 mg/kg/day), the lesion decreased considerably, and the patient was able to open her eye. Case 2 was a 1-year-old female child who presented with hemangioma over the danger area of face. Oral propranolol was given for a period of 6 months with monthly follow up. Both the cases showed dramatic response, with more than 80% regression, without any relapse after stopping the treatment.