Navneet Singh

A comparative evaluation of skeletal, dental, and soft tissue changes with skeletal anchored and conventional facemask protraction therapy.

Objective: To cephalometrically evaluate and compare the skeletal, dentoalveolar, and soft tissue changes after maxillary protraction with skeletally anchored and conventional facemask. Methods: The data for the study were collected from the pre- and post-treatment records of patients of maxillary retrusion treated with skeletally anchored and conventional facemask therapy. Twenty subjects were included in the study and were categorized into two groups, namely skeletal anchored maxillary protraction (SAMP) group with the mean age of 10.10 ± 1.1 years and conventional facemask maxillary protraction (CFMP) group with the mean age of 9.90 ± 1.1 years. Pre and post-treatment lateral cephalograms were assessed. Results: The data were analyzed by Mann-Whitney test and Wilcoxon signed-rank test. The mean duration of treatment in SAMP group and CFMP group was 5.8 months and 10 months, respectively. The mean forward displacement of the maxilla (vertical point A) was 3.40 ± 1.07 mm in SAMP group and 2.80 ± 0.79 mm in CFMP group. The mandible showed downward and backward rotation in both the groups with more rotation in CFMP group. A significant increase in maxillary incisor inclination was seen in CFMP group as compared to SAMP group. A significant decrease was found in mandibular incisor inclination in both the treatment groups. The soft tissue changes corresponded to underlying skeletal tissue. C onclusions: SAMP is proven to be a better treatment modality as compared to CFMP for achieving true skeletal changes and minimal dental changes in cases with developing skeletal Class III with maxillary retrusion.

Facilitated Eruption of an Impacted Premolar 8 Years Post-eruption Timing- Think before You Treat!!!

The treatment planning of impacted teeth usually involves surgical intervention for bringing about its eruption with traction. But a thoughtful analysis in such cases looking at the possible aetiology may save the complexity of therapy. The present case demonstrates the importance of correct diagnosis in resolving impaction wherein an impacted mandibular second premolar was made to erupt using a simple removable appliance 8 years after its normal range of eruption timing.

Bone-specific alkaline phosphatase – a potential biomarker for skeletal growth assessment

Objective The present study was aimed to assess levels of serum Bone-specific alkaline phosphatase (BALP) and serum Insulin-like growth factor-1 (IGF-1) and comparing with cervical vertebral maturation index (CVMI) stages. Design Cross-sectional study. Setting Maulana Azad Institute of Dental Sciences, New Delhi, India. Participants 150 subjects (75 males and 75 females) in the age group of 8–20 years. Methods Subjects were divided into six CVMI stages. Enzyme-linked immunosorbant assay was performed for the estimation of serum BALP and serum IGF-1 levels. Mann–Whitney U test was performed to compare mean ranks of serum BALP and serum IGF-1 with different CVMI stages. Spearman correlation between serum BALP and serum IGF-1 was done across 6 CVMI stages. Results Peak serum IGF-1 levels were found at CVMI stages 4 and 3 for males and females respectively. Peak levels for serum BALP were found at stage 3 for both genders with significant differences from other stages. A statistically significant correlation was seen between serum IGF-1 and serum BALP from CVMI stages 1 to 3 and 4 to 6 (p < .01). Conclusions BALP showed promising results and can be employed as a potential biomarker for the estimation of growth status.

A custom made appliance for correction of anterior crossbite in Class III malocclusion

Anterior crossbite is the most important concern in a patient with a Class III malocclusion. The current report demonstrates the use of a custom made removable appliance in a patient unwilling for fixed orthodontic therapy.

Orthodontic management of dilacerated impacted maxillary central incisor using closed eruption technique

An impacted incisor with dilaceration poses a clinical dilemma because of its difficult position. This case report describes the orthodontic management of impacted dilacerated maxillary left central incisor. Based on esthetic demand and patient compliance, orthodontic traction involving closed eruption technique was performed to achieve alignment of central incisor in the arch. Prudent application of biomechanics and radiographic evaluation at regular interval assisted in achieving good esthetic and patient satisfaction.

Molar distalization with 2K appliance: one-year follow-up

Correction of class II molars in growing patients with acceptable facial profile can be performed by distalization of maxillary first molars. However, in patients where compliance is difficult intraoral means of molar distalization is required. This case report describes the use and effectiveness of a novel 2K appliance in an 11-year-old female having an orthognathic profile, skeletal Class I relation, and Angles Class II division 1 malocclusion with crowding of 8 mm and 3 mm in the maxillary and mandibular arches, respectively. Nonextraction treatment was planned with bilateral distalization of the maxillary first molars. The amount of distalization achieved by 2K appliance was 3.5 mm with only 1° distal tipping. The 2K appliance required minimal patient cooperation, produced bodily movement of molars with minimal tipping/rotation, and prevented anchorage loss of the anterior teeth. This 2K molar distalization appliance was found to be an effective technique to control molars in all three planes of space.

Impacted Central Incisor with Dilacerated Root-Treat with Ease

A 12-year-old female patient reported to the Department of Orthodontics of Maulana Azad Institute of Dental Sciences, New Delhi with chief complaint of missing upper front tooth. On clinical examination it was found that maxillary left central incisor (21) was missing [Table/Fig-1]. No significant history of trauma or premature/delayed shedding of primary left central incisor was reported. Panoramic and maxillary occlusal view revealed impacted left central incisor with dilacerated root [Table/Fig-2,3]. Since the contralateral central incisor had erupted fully in the mouth and the root formation of the impacted central incisor was almost complete, it was decided to disimpact the tooth (21). Disimpaction was planned by surgical exposure followed by elastic traction with the help of removable appliance. Since the patient had well aligned upper and lower arches in good occlusion, it was decided to use a modified removable appliance for extrusion of 21. A removable appliance with modified labial bow was fabricated. Labial bow in the anterior region was fabricated with 22 gauge wire and helices were incorporated in the labial bow adjacent to left central incisor region. Retention was provided by the acrylic coverage in the palatal region and by well formed retentive clasps. Surgical exposure of left central incisor was performed by open exposure technique. A bondable button was placed onto the labial surface of exposed left central incisor crown [Table/Fig-4]. Patient was trained to use elastic in triangular fashion to engage button on 21, and two helices of the labial bow, which resulted in an extrusive force of 20 grams for disimpaction of 21[Table/Fig-5] [1]. Patient was advised to change the elastic daily and was reviewed every three weeks. At the end of six months, complete disimpaction of 21 was achieved with the tooth in its optimal alignment into the upper dental arch and in good relation with lower teeth [Table/Fig-6,7]. Post disimpaction panoramic view reveals tooth 21 in the optimal position with respect to maxillary occlusal plane [Table/Fig-8]. [Table/Fig-1]: Pretreatment intraoral maxillary occlusal photograph showing missing maxillary left central incisor. [Table/Fig-2,3]: Pretreatment panoramic and maxillary occlusal view showing vertically impacted maxillary left central Incisor with dilacerated root. [Table/Fig-4]: Intraoral frontal photograph after surgical exposure and with bonded attachment on labial surface of 21. [Table/Fig-5]: Intraoral frontal photograph showing mechanics for extrusion of 21 with elastic traction force. [Table/Fig-6,7]: Post treatment intraoral frontal and maxillary occlusal photographs showing 21 in alignment and good occlusion. [Table/Fig-8]: Post treatment panoramic view. In young patients, absence of maxillary anterior teeth has a major impact on esthetics, phonetics, mastication and psychosocial well being. Impaction of maxillary permanent central incisor due to dilaceration in the root is a rare condition which is associated with trauma to primary anterior tooth early in life leading to dilaceration of permanent succedaneous tooth [2]. Depending on the severity of dilacerations, decision is usually taken to either expose and align the maxillary central incisor or extract and replace it with prosthesis. Although prognosis of disimpaction of dilacerated central incisor is questionable but orthodontic alignment was preferred in this case due to two reasons. Following extraction of a tooth, the alveolar ridge becomes deficient both vertically and labiolingually which makes it unsuitable for prosthetic implant. Also, the region becomes unaesthetic for conventional prosthetic bridge placement. Any fixed prosthesis for replacement of missing central incisor cannot be given before 18 year of age to allow for completion of alveolar bone growth in growing children [3]. The removable appliance treatment chosen for this patient was a convenient treatment option with less chair side involvement with the patient. Moreover it reduces the overall treatment time required for fully bonded fixed appliance therapy since traction could be applied to the impacted tooth immediately after removable appliance insertion. Also, one of the major advantages of using this simple appliance is that it overcomes the detrimental effects encountered with fixed appliances such as demineralization and difficulty in maintenance of oral hygiene [4]. Orthodontic extrusion of an impacted tooth is usually carried out by a trained specialist by using fixed mechanics. A modified removable appliance with bonded attachment and elastic traction has been used to successfully disimpact and align maxillary central incisor in this case. Such an appliance can be fabricated and used by even a general practitioner with basic knowledge about optimal force delivery.

Effect of Habits and Nutritional Status on Clinical Grading and Histopathological Staging in Patients with Oral Sub Mucous Fibrosis

BACKGROUND Oral submucous fibrosis (OSMF) is a chronic progressive debilitating disease affecting the oral, oropharyngeal and sometimes the oesophageal mucosa resulting in inability to eat due to burning, ulcers and stiffness. AIM The study was undertaken, to evaluate the correlation of clinical staging, histological grading and nutritional status using body mass index (BMI) with gutkha (habit) index in OSMF patients. MATERIALS AND METHODS The study group comprised of 50 patients clinically diagnosed and histopathologically confirmed cases of OSMF. Habit (gutkha) index was calculated by multiplying duration and frequency. Body mass index was calculated by dividing weight in kilograms and height in centimetres of the patient. RESULTS Male to female ratio was 2.8:1. Clinical grading increased with increase in gutkha index, patients with gutkha index 1-50, maximum were in mild stage; with gutkha index 51-100, maximum in moderate and patients with gutkha index 101-150, all were in severe stage. Histological staging showed direct correlation with gutkha index, it increased with increase in gutkha index with p <0.05. Site analysis showed that buccal mucosa and retromolar area were involved in all the patient and floor of mouth in 46% of patients Body mass index analysis revealed that out of 27 patients with moderate clinical staging 3 was underweight; out of 3 with severe clinical staging, 2 was underweight. CONCLUSION The duration and frequency of areca nut product use effects on the incidence and severity of OSMF and the patient becomes unable to eat due to burning, ulcers and inability to open mouth which affect the health of the individual. Thus it is important to access the nutritional status to improve the survival rate of patients.