Ashok Utreja

Craniofacial Computerized Tomography Analysis of the midface of patients with repaired complete unilateral cleft lip and palate

INTRODUCTIONnComputerized tomography (CT) makes regional anatomy available as a series of cross-sectional axial images that can be analyzed unobstructed by other anatomic features. In this study, we aimed to analyze the maxillary dentoalveolar and deeper structures in patients with surgically repaired complete unilateral cleft lip and palate (CLP) and to investigate whether significant asymmetry existed in the deeper midfacial structures, using axial CT.nnnMETHODSnAxial CT scans of 15 children (7 boys, 8 girls; mean age, 11.59 +/- 1.34 years) with repaired complete unilateral CLP were acquired parallel to Reids base line. Specific landmarks applicable for CT were defined and plotted to undertake a comprehensive Craniofacial CT Analysis of the midface. Twenty-six pairs of transverse and sagittal measurements made to a cranial base midsagittal construct and interspinosum fit line, respectively, were compared by using the paired t test.nnnRESULTSnSignificant reduction of 19.05% in the nasal chamber width (2.54 +/- 1.49 mm; P <0.001), more distal position of the bony alar base (2.28 +/- 1.71 mm; P <0.001), and the sagittal position of the most prominent anterolateral point on the maxillary alveolar process (1.62 +/- 1.85 mm; P <0.01) were noted on the cleft side. The lower half of the bony nasal septum was consistently deviated toward the cleft side, and the nasal tip was deviated to the noncleft side in 60% of the subjects. The anterior nasal spine was deviated to the noncleft side in 73.3% of the subjects and a mean deviation of the anterior nasal spine of 2.84 +/- 3.90 mm toward the noncleft side was measured. Significant sagittal and transverse asymmetry in deeper midfacial regions was not observed. Unilateral dental-arch collapse was observed in 73.3% of the sample, bilateral collapse in 20%, and no collapse in 6.7%. The soft-tissue support of the alveolar margins of the cleft did not show significant differences between the cleft and noncleft sides.nnnCONCLUSIONSnCT is an excellent method for quantifying surface and deep craniofacial structures. Most asymmetries and deformities in the 10- to 14-year-old patients with repaired complete unilateral CLP we studied were in the dentoalveolar area near the cleft and the nasal chamber and not in the deeper regions of the maxillary complex.

Neural tube defects and their significance in clinical dentistry: a mini review.

Neural tube defects are common congenital malformations that could be apparent at birth or manifested in later stages of life. Morbidity is high in anencephaly, whereas in spina bifida, there are neurological and motor disorders. These defects deserve paramount importance in clinical dentistry. Latex allergy, dental caries, difficulty in mouth opening, and sitting in a dental chair are common problems. There is a high risk of anaphylactic response during anaesthesia. There could be associated craniosynostosis causing maxillary deficiency, and malformed sella turcica might be seen. An association of the defects has been linked with orofacial clefts and Down syndrome.

Solitary median maxillary central incisor in association with hemifacial microsomia: A rare case report and review of literature.

Solitary median maxillary central incisor (SMMCI) is a rare dental anomaly. It is estimated to occur in 1:50,000 live births. The SMMCI tooth differs from the normal central incisor in that the crown form is symmetric and it develops and erupts precisely in the midline of the maxillary dental arch in both primary and permanent dentitions. Presence of SMMCI with hemifacial microsomia (HFM) is a very rare clinical condition. We report a case of HFM in a male of Indian origin who presented with SMMCI in both primary and permanent dentitions. The association of HFM with SMMCI may be due to defective development of neural crest cells and/or lack of space in maxilla.

Prevalence of malocclusion and assessment of treatment needs in β-thalassemia major children

BackgroundThe objective of this study is to evaluate the prevalence of malocclusion and treatment needs in transfusion dependent β-thalassemia major children.MethodsOne hundred transfusion dependent β-thalassemia major children visiting the Department of Pediatrics were selected randomly and evaluated for malocclusion with Angle’s classification and Dewey’s modification. The orthodontic treatment needs were also assessed using Grainger’s treatment priority index (TPI). The orthodontic treatment needs were compared to normal children.ResultsThe assessment of treatment needs revealed a higher prevalence of handicapping and severely handicapping malocclusion in thalassemic children compared to normal children. The thalassemic patients were found to show significantly more Angle’s Class II malocclusion (55xa0% vs. 15.7xa0%) when compared to normal children.ConclusionsThe higher prevalence of Angle’s Class II malocclusion and definitive malocclusion in thalassemic children indicates the importance of preventive orthodontic procedures and efforts towards providing orthodontic treatment to these children.

Role of fluorine-18 fluoride PET-CT scan in the assessment of unilateral condylar hyperplasia in faciomandibular asymmetry patients: a preliminary study.

ObjectivesThis prospective study was aimed to determine and quantify the change in mandibular condylar hyperactivity over a period of time by using a fluorine-18 (18F) fluoride PET-computed tomography (CT) scan. Materials and methodsSixteen patients (age 19.50±2.58 years) with noticeable faciomandibular asymmetry caused by unilateral condylar hyperplasia (UCH) were included in the test group and underwent an 18F-fluoride PET-CT scan at the beginning of the study (T0); these patients were then followed up for a minimum of 12 months, after which the 18F-fluoride PET-CT scan was repeated at first follow-up (T1). An age-matched control group consisted of 10 patients with apparently symmetrical faces whose PET-CT scans were acquired for some other medical conditions. Statistical analysis of maximum standardized uptake values (SUVmax) obtained through 18F-fluoride PET-CT was performed using the paired t-test. ResultsMean SUVmax of the affected condyle at T0 and T1 was 9.18±4.07 and 9.18±3.88, respectively. The mean SUVmax of the contralateral condyle at T0 and T1 was 6.21±2.30 and 6.66±2.64, respectively. The mean right–left difference in tracer uptake between the test and control groups both at T0 and T1 was statistically significant. Right–left percentage difference of isotope uptake of the test group was 16.87±15.75% at T0 and 14.97±12.72% at T1. Right–left percentage difference of isotope uptake of the control group was 5.51±5.72%. Although these differences were statistically significant, their clinical relevance was insignificant. SUVmax of the higher uptake side and the lower uptake side of the control group was 5.63±1.85 and 5.09±1.83, respectively. ConclusionGreat diversity exists in the clinical presentation of UCH. The growth trend of UCH is highly variable because of the age and sex of patients. The results of the present study show that the 18F-fluoride PET-CT scan may guide us in determining the right time and in making the right choice of surgico-orthodontic intervention in UCH patients. The clinical presentation and SUVmax of PET-CT of UCH patients were in agreement with each other. The baseline values of the control group indicated that these could also be used to differentiate normal from abnormal condylar growth in potential class III skeletal pattern cases – that is, patients having sagittal skeletal dysplasia resulting from either maxillary deficiency or mandibular protrusion, or both in combination, thus resulting in a concave facial profile.

Satisfaction audit of patients undergoing mandibular distraction osteogenesis with extra-oral distraction appliances.

IntroductionThe aim of this research was to evaluate the level of satisfaction of patients who were undergoing distraction osteogenesis of mandible with extraoral distraction appliance.Material and MethodsThe prospective study was performed on 13 patients with facio-mandibular deformity reporting to the Oral Health Sciences Center, PGIMER, Chandigarh, India, who required surgical and orthodontic intervention for correction. A standardized multiple choice questionnaire was provided to all patients at 3 stages of treatment i.e. during predistraction, distraction and post distraction period.ResultsPredistraction evaluation showed that the main reason for patients to seek treatment was lack of facial esthetics and all of them were sure that there would be a change in their lives after they underwent this treatment procedure. During distraction phase the most common complaint was pain. None of the patients felt that they were suffering during active distraction phase and all felt that they made the right decision. In post distraction phase, all patients were satisfied with the treatment and felt that the treatment was worth it. Twelve out of 13 patients would recommend treatment to others without any hesitation.ConclusionOur study concludes that distraction osteogenesis of the mandible with extra-oral appliances is acceptable to patients, and improved facial appearance is a positive influence. The appliance and results of the procedure are socially accepted and appreciated.

Increase in sagittal depth of the bony nasopharynx following maxillary protraction in patients with unilateral cleft lip and palate.

Objective To study the change in the sagittal depth of the bony nasopharynx in patients with unilateral cleft lip and palate (UCLP), following maxillary protraction using reverse headgear. Methods Nineteen patients (14 male, five female; aged 9.36 ± 2.89 years) with repaired complete UCLP underwent maxillary protraction with a Delaire type reverse headgear at a tertiary-care referral teaching hospital. Control data were taken from five patients (four male, one female; aged 8.25 ± 2.25 years) who did not receive any orthopedic/orthodontic treatment for a similar duration of time as the treated patients. Average treatment/observation period was 11.71 ± 3.39 months for the treated patients and 12.40 ± 2.60 months for the untreated subjects. Changes in the sagittal bony nasopharynx depth were measured by comparing pretreatment (T1) and posttreatment (T2) lateral cephalograms. Correlations between the changes in the bony nasopharynx depth and in other variables measured in the treated patients were analyzed. An exploratory analysis of differences in the changes from T1 to T2 between the treated patients and untreated subjects was also conducted. Results The favorable skeletal changes seen in SNA and ANB following maxillary protraction were accompanied by a significant increase in the sagittal depth of bony nasopharynx (1.74 ± 1.10 mm; P < .001). This change was significant when compared with the data from the untreated subjects (P = .004). Correlations between the increase in bony nasopharynx depth and changes in other variables studied in the treated patients were weak and not statistically significant. Conclusion Sagittal depth of the bony nasopharynx in patients with repaired UCLP increased following maxillary protraction therapy using reverse headgear.

Genetic Paradigm in Orthodontics

Orthodontics, the oldest discipline of dental specialty concerns with the treatment of malocclusion both dental and skeletal. Although etiology of malocclusion is multifactorial, genes do have influence on this condition, beside their role in mechanism of tooth movement and unwanted sequel like external root resorption following orthodontic treatment. This short communication will focus the issue on role of gene in various conditions which have paramount effect either on the etiology of malocclusion or mechanism by which tooth movement occurs. Human genome project and future advancement in genomic medicine will help us in clear identification of conditions causing mutation and the unsolved zigzag puzzle of molecular interaction can be solved.

Clinical blackout in orthodontics

Due to increased awareness of the general public in today′s world of consumer information the nobility related to the health profession has become a thing of the past. Now-a-day, the patients are consumers, and the malpractice lawsuits are on the rise. There is a strong need to focus our mind and body while working on the patients. Further, there is an urgent need to make the body of literature that can help the common practitioner to see what are the most common error/mistakes, usually, committed and at least avoid those which have been reported.

A normative study to evaluate inclination and angulation of teeth in North Indian population and comparision of expression of torque in preadjusted appliances

Aim: The aim of this study was to evaluate angulation and inclination of teeth from the study models of individuals with normal occlusion and evaluation of actual expression of torque expressed by three different bracket systems. Materials and Methods: In this study, the inclination and angulation were measured on 30 study models of North Indian individuals. A self-developed instrument (torque angle gauge) was used for the measurement. Fifteen study models were duplicated for the evaluation of torque expression in the bracket of three different manufacturers with different shape and size of bases. Results: The results give the mean, minimum and maximum, standard deviation of the normative data individually for each tooth. A significant correlation was noted in the angulation of maxillary canine and first premolar, and between premolars; and between mandibular central incisor with lateral incisor and canine, and between premolars. Conclusions: There was a highly significant correlation of teeth angulation and inclination in the maxillary and mandibular arch. Though the error in expression of torque was not significant, but it showed a large range, indicating the need to vary the position of brackets in different bracket systems for achieving optimum torque.