Deeksha Arya

A pilot study to evaluate posttreatment cephalometric changes in subjects with OSA.

STATEMENT OF PROBLEM Obstructive sleep apnea (OSA) is a life-threatening condition that is diagnosed and evaluated primarily by polysomnography (PSG). The procedure is time consuming, expensive, and inconvenient for the patient, and may not be universally available. PURPOSE The purpose of this pilot study was to evaluate posttreatment results on lateral cephalograms in patients with OSA. MATERIAL AND METHODS Lateral cephalograms of 16 patients diagnosed with OSA were made at the beginning of treatment and 4-6 weeks following treatment. Treatment modalities used in the study were the mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy (n=8). Pharyngeal dimensions, soft palate area and angle, and hyoid bone position were recorded for the comparisons. The data were analyzed using Students t test for the parametric analysis (alpha=.05). RESULTS A significant increase in the pharyngeal area (P<.001), a significant decrease in the soft palate area (P<.001), and vertical changes in the hyoid position were observed, with no significant change in the anteroposterior position of the hyoid bone. CONCLUSIONS Within the limitations of this pilot study, lateral cephalograms were shown to be useful in evaluating treatment efficacy in subjects with OSA.

Evaluation of various treatment modalities in sleep bruxism

STATEMENT OF PROBLEM Sleep bruxism (SB) is an oral condition that is associated with tooth wear, orofacial pain, and interference with sleep. The most recommended management technique is the use of an occlusal splint. Although the mandibular advancement device (MAD) has shown good results, few well-designed randomized controlled trials are available with which to compare these treatment options. Therefore, an evaluation of the effect of these 2 appliances on SB is needed. PURPOSE The purpose of this study was to evaluate the effect of a MAD and a maxillary occlusal splint (MOS) on the sleep quality and SB activity of participants with SB. MATERIAL AND METHODS In this randomized controlled trial, 28 participants were randomly supplied with either a MAD or MOS. The sleep quality of the participants was evaluated with the Pittsburgh Sleep Quality Index (PSQI) and their SB activity with electromyographic activity of the masseter with polysomnography. These variables were measured at baseline, 1 month, and 3 months. RESULTS Of 32 participants, 28 had data available for statistical analysis, as 4 participants did not return for follow-up examination. Both the MOS and MAD significantly reduced the PSQI and SB episodes and bursts in participants after 3 months (P<.05). The MAD provided greater reduction in SB episodes per hour after 3 months compared to the MOS. Participants supplied with a MAD reported more discomfort in their feedback form than participants using a MOS. CONCLUSIONS Both the MAD and MOS provided significantly improved sleep quality and a decrease in SB episodes at 3 months.

Role of surface topography of titanium endosseous implants for improved osseointegration

Osseointegration is the basis of successful endosseous implantology. The process itself is complex, and many factors influence the formation and maintenance of bone at the implant surface. Studies have shown that implant-tissue interface can be influenced by different methods of surface treatment that affect the biologic response to the implant. Methods of surface treatment include alteration of the microstructure and physicochemical parameters of the implant surface.

Effect of mandibular advancement device on sleep bruxism score and sleep quality.

Statement of problem. The use of mandibular advancement devices (MADs) in the treatment of sleep bruxism is gaining widespread importance. However, the effects of MADs on sleep bruxism scores, sleep quality, and occlusal force are not clear. Purpose. The purpose of this clinical study was to analyze the effect of MADs on sleep bruxism scores, sleep quality, and occlusal force. Material and methods. This uncontrolled before and after study enrolled 30 participants with sleep bruxism. Outcomes assessed were sleep quality, sleep bruxism scores (sleep bruxism bursts and sleep bruxism episodes/hour), and occlusal force before and after 15 and 30 days of using a MAD. Sleep bruxism scores were assessed by ambulatory polysomnography and sleep quality by using the Pittsburgh sleep quality index (PSQI). Occlusal force was recorded by using a digital gnathodynamometer in the first molar region on both sides. Statistical analysis was done by 1‐factor repeated measures ANOVA (&agr;=.05). Results. Statistically significant reductions in sleep bruxism bursts/h, sleep bruxism episodes/h, and PSQI scores were found after 15 and 30 days of using a MAD (P<.001). Statistically significant reduction in occlusal force on both sides was found only after 15 days (P<.001) but not after 30 days of using a MAD (P=.292 on left side, and P=.575 on the right side). Conclusions. The study showed a short‐term improvement in sleep bruxism scores, sleep quality, and reduction in occlusal force in sleep bruxism participants after using MADs.

Prevalence of Taurodont molars in a North Indian population.

Background: It is very important for dentists to be familiar with anomalies of teeth not only for the clinical complications but also their management. Taurodontism also provides a valuable clue in detecting its association with various syndromes and other systemic conditions. The purpose of this study was to assess the prevalence of Taurodont molars among a North Indian population. Materials and Methods: A total of 1000 patients′ full-mouth periapical radiographs were screened. The radiographs were evaluated under optimal conditions using double magnifying glasses. A total of 7615 molars (including third molars) were evaluated. The relative incidence and the correlations regarding the location of Taurodont teeth (right versus left side and maxillary versus mandibular) were analyzed using the Chi-square test. Results: Twenty-eight patients were found to have a Taurodont molar (11 women and 17 men [P = 0.250]). The prevalence of Taurodont molar was 2.8%. Males had a higher prevalence rate than females (3.4% vs. 2.2%, respectively). A cluster analysis of total Taurodonts in the mandible (45%) versus maxilla (55%) of both males and females combined showed a statistically significant difference (P < 0.05). Conclusion: The occurrence of Taurodontism is basically based on racial expression in different populations. These variations in prevalence between different populations may be due to ethnic variations. The occurrence of Taurodont molars among this Indian population was rare.

Oral care needs, barriers and challenges among elderly in India.

Objective: This paper presents an approach to the assessment of oral health needs of elderly and barriers to receive oral care in the life course. Background: The dental needs of the elderly are changing and growing day by day. The management of older patients requires not only an understanding of the medical and dental aspects of ageing but also provide them good oral health service. In the life course of elderly there are many hurdles to receive proper oral care. The use of an assessment of oral health need will be essential in the development of care pathways to the elderly. Methods: The proportion of older people is growing faster than that of any other age group. There is no sound database regarding the oral disease burden and treatment needs of the elderly in India. Physical and biological barriers with age can also affect oral health care either directly or indirectly. Conclusion: Oral care guidelines designed to assist elderly should consider not only prevention and treatment modalities but also the means of implementing such therapies in varying settings and utilizing the whole dental team.

Maxillary canine transposition – A literature review with case report

Tooth transposition is a severe disturbance of tooth eruptive position and their sequence, which involve certain teeth occurring at any of several specific sites in the mouth. Tooth transposition is of several types and their classification depends on the teeth involved. The review of literature aims to discuss the incidence and identifying factors related to occurrence of this dental anomaly. The present study aims to discuss about the prosthetic treatment of a patient with unilateral maxillary canine - lateral incisor transposition with the absence of permanent lateral incisor.

Nonimplant, Nonadhesive Overlay Approach to Retain a Partial Auricular Prosthesis: Overlay Approach for Partial Auricular Prosthesis

Partial auricular prosthesis fabrication presents a more complex challenge than complete ear fabrication, with added aspects of merging/camouflaging a larger prosthetic marginal area, pattern try-in, and compromised retention. Better alternatives are excision of the remnant ear to make an implant-retained complete ear prosthesis or surgical reconstruction of the missing ear portion. Both need additional surgery/ies and expenses, neither of which may be acceptable to the patient. This report describes a prosthesis fabrication approach for such patients. This approach does not require implants or adhesives for retention. Issues of marginal camouflage and pattern trial were also addressed satisfactorily.

A Pilot Study to Determine the Effect of Three Months of Oral Appliance Therapy using a Mandibular Advancement Device on HbA1c in Subjects with Type 2 Diabetes Mellitus and Obstructive Sleep Apnea: OSA with Type II Diabetes Mellitus

PURPOSE Continuous positive air pressure (CPAP) is recommended for obstructive sleep apnea (OSA) with type 2 diabetes mellitus (T2DM) but cost and compliance are major barriers. A mandibular advancement device (MAD) may be an economical, feasible alternative to CPAP. Various studies have been published to recommend MAD as an alternative to CPAP for OSA, but not regarding its efficacy for patients having OSA as well as T2DM. This study aims to objectively and subjectively evaluate oral appliance therapy using a MAD in patients having OSA as well as T2DM. MATERIALS AND METHODS Patients who visited the hospital clinic having OSA as well as T2DM were recruited. After giving informed consent, participants were divided into three equally sized groups of three grades of OSA (mild, moderate, severe) on the basis of a polysomnography report and were given intervention of MAD at 50% of maximum mandibular protrusion and 20% of maximum interincisal opening. Objective outcomes were HbA1c level and apnea hypopnea index score (AHI). Subjective outcomes were Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire. All outcomes were assessed before and after 3 months of intervention. RESULTS A statistically significant difference was seen in all outcomes after intervention with MAD (p < 0.01) in all groups except HbA1c level in participants having severe OSA. CONCLUSION MAD may be recommended in patients having OSA as well as T2DM. This study provides evidence to inform health care workers about possible use of MAD in OSA with T2DM.

Low-Cost Adjustable Mandibular Advancement Device for Obstructive Sleep Apnea Patients

Objectives: Nasal continuous positive airway pressure (nCPAP), though an effective therapy for obstructive sleep apnea syndrome, has a low compliance rate and is costly. As a result, newer designs of mandibular advancement devices (MADs) have gained considerable interest and are available as adjustable/nonadjustable/stock/custom-made types. Methods: This article presents a novel economical custom-made MAD. It has an expansion screw for advancement of the mandible that has a calibration accuracy of 0.2 mm. Conclusions: This device is cost effective, adjustable and less bulky for obstructive sleep apnea patients.