Puneet Batra

Analysis of Dental Arch Relationships in Swedish Unilateral Cleft Lip and Palate Subjects: 20-Year Longitudinal Consecutive Series Treated With Delayed Hard Palate Closure

Objective: To evaluate the dental arch relationships for a consecutive series from Goteborg, Sweden, who had delayed hard palate closure. Design: Retrospective study. Setting: Sahlgrenska University Hospital, Goteborg, Sweden. Patients: The dental study models of 104 consecutive unilateral cleft lip and palate subjects. The study cohort was born between 1979 and 1994. Longitudinal records were available at ages 5 (n = 94), 10 (n = 97), 16 (n = 59), and 19 years (n = 46). Five assessors rated models according to the GOSLON Yardstick on two separate occasions each. Interventions: These patients had been operated upon according to the Goteborg protocol of delayed hard palate closure (at age 8 years). Results: 85% of subjects were rated in groups 1 and 2 (excellent or very good outcome), 12% were rated in group 3 (satisfactory), and 3% were assigned to group 4 (poor). No patients presented in Group 5 (very poor). Weighted kappa statistics for double determination of Yardstick allocation for five assessors demonstrated values between .65 and .90 for interrater agreement (good/very good) and between .70 and .90 for intrarater agreement (very good). Conclusions: Delayed hard palate closure as practiced in Goteborg since 1979 has produced the best GOSLON Yardstick ratings in a consecutive series of patients ever recorded worldwide, since the Yardstick was first used in 1983. However, it is noteworthy that a new protocol has been introduced in Goteborg since 1994, in which hard palate closure is done at 3 years due to concerns regarding speech.

Complete Unilateral Cleft Lip and Palate: Validity of the Five-Year Index and the Goslon Yardstick in Predicting Long-Term Dental Arch Relationships

Objective: To assess the validity of the 5-year index by subjecting study models at the age of 5 years to both the 5-year index and the Goslon yardstick, and then relating these results to the Goslon ratings at 10 years. Design: Retrospective study. Setting: Sahlgrenska University Hospital, Gothenburg, Sweden. Patients: Study models of 94 patients with unilateral cleft lip and palate (UCLP) were evaluated at the ages of 5 and 10 years. The dental arch relationships were judged and categorized by using the Goslon yardstick for the 10-year models and both the Goslon yardstick and the 5-year index for the 5-year models. Results: When used for 5- and 10-year models, the Goslon yardstick showed a kappa score of 0.539 (weighted kappa = 0.579) with a moderate strength of agreement. However, 5-year index scores at 5 years compared with the Goslon scores at 10 years showed a kappa score of only 0.043 (weighted kappa = 0.090), showing poor strength of agreement. Goslon scores at 10 years showed improvement in 14 cases when graded by the same Goslon yardstick at 5 years, whereas there was improvement in 23 cases when the 5-year models were graded by the 5-year index (actual improvement in scores in UCLP cases is highly unlikely). Conclusions: Although use of the Goslon yardstick at 5 years has demonstrated some inherent flaws in its use at that age, these drawbacks are fewer than those when the 5-year index is used at 5 years of age.

Long term results of mandibular distraction.

Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction) where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

The Parental Dentocraniofacial Phenotype—An Orofacial Clefting Microform

Objective Using the systematic review method, (1) to identify the investigations of the parental dentocraniofacial phenotype in orofacial clefting, (2) synthesize the data to derive a model of the phenotypic features that will assist in the identification of cleft morphogenes, and (3) make recommendations for the future global strategy for researching the parental craniofacial phenotype in orofacial clefting. Search Strategy The Cochrane, Medline (via PubMed and OVID platforms [1966 to December 2006]), Embase, CINAHL, and ASKSAM Orthodontic Reference Database (1950–1997) databases were searched using a combination of the following keywords: microform, parent, craniofacial, dental, and cleft. All published articles were reviewed. There were no exclusions of non-English reports. Of the 36 studies identified using this strategy, 26 met the inclusion criteria. Data Abstraction/Synthesis The statistically significant data were abstracted using a pro forma, and the methodological quality of the selected studies was evaluated using a checklist. There was considerable heterogeneity among the studies, and therefore it was not possible to synthesize the data. We were, however, able to collate the data. Results/Conclusions (1) The craniofacial phenotype possessed by parents of children with orofacial clefting is distinctive when compared with that of the noncleft population. (2) There is insufficient evidence to produce a model of the phenotypic features to assist in the search for orofacial clefting morphogenes. (3) The pattern of expression of the phenotypic features identified to date supports the contention that there are differences in the inheritance of cleft lip with or without cleft palate and isolated cleft palate. Progress in this field is affected by extreme heterogeneity in etiology of cleft lip with or without cleft palate, as well as heterogeneity in study design. (4) Subphenotyping using features such as microforms should be employed to reduce the heterogeneity and to improve the power of future genetic investigations and will also assist in clinical management and genetic counseling for families.

Facial talon cusp in primary maxillary lateral incisor: A report of two unusual cases

Talon cusp is an uncommon dental anomaly in which an accessory cusp-like structure projects from the cingulum area or cemento-enamel junction of the maxillary or mandibular anterior teeth. This anomalous cusp resembles an eagles talon. It occurs in both the primary and the permanent dentition. A comprehensive literature review shows that only 37 cases of talon cusps have been reported in the primary dentition, of which only 4 cases report this anomaly on the primary maxillary lateral incisor. Though labial/facial talon cusps have been reported in the permanent dentition, no case of a labial talon has been reported in the primary dentition. We report two females with cleft lip and palate with facial talon cusps on the primary lateral incisor and believe that these are the first cases to be reported. Clinical considerations and debate on the etiology of this anomaly are discussed.

Relative comparison and assessment of patient's attitude and discomfort between two different types of fixed functional appliances: A comprehensive survey

Objective: The aim of this study was to assess the patients attitude and follow the progress of patients adaptation to discomfort between two types of fixed functional appliances. Materials and Methods: A total of 16 patients undergoing treatment with either fixed functional appliance, i.e., forsus fatigue resistant device (FFRD) (hybrid) and mandibular protraction appliance (MPA) IV (rigid) rated their experiences during the 1 st day of treatment and after 7 days, 14 days and 30 days of appliance insertion. Results: There were no significant differences in patients attitude toward both the appliances. Soft-tissue laceration was the most serious side-effect (about 50% in MPA IV and 25% in FFRD). Soft-tissue laceration and other negative effects generally decreased over time. Conclusion: The results of the study indicate that there is no considerable difference in acceptance of FFRD and MPA IV by the patients. Most patients experience some discomfort and functional limitations; however, the effect generally diminishes with time and patients adapt to the appliance.

Use of Bauru Yardstick in Patients With Complete Bilateral Cleft Lip and Palate at an Indian Center

Objective: To evaluate dental arch relationship in treated bilateral cleft lip and palate (BCLP) cases at an Indian cleft center using the Bauru yardstick. Patients and methods: Digital photographs of the dental cast of 50 consecutively treated patients (28 males and 22 females) with nonsyndromic BCLP at an Indian cleft center were rated by 2 examiners as per the Bauru yardstick for the 12-year-old age group. The average age group was 12 ± 0.62 years. All cases were treated with same surgical protocol. Results: The inter-examiner agreement between the 3 examiners was found to be very high, with weighted kappa values ranging from 0.894 to 0.951. The intraexaminer agreement between the 2 examinations for all the examiners was also found to be very high, with weighted kappa values ranging from 0.894 to 0.931. Seventy-eight percent of patients were rated with a Bauru yardstick score of 1+2. In addition, 10% of patients were rated with a score of 3, 8% as 4, and 4% as 5. The overall Bauru yardstick score for the center was 2.36. Conclusion: The protocol followed for the repair of BCLP cases by the center was found to be a good regimen in regard to the Bauru yardstick score.

Comparison of rate of tooth movement and pain perception during accelerated tooth movement associated with conventional fixed appliances with micro-osteoperforations – a randomised controlled trial

Objectives To investigate the influence of micro-osteoperforation (MOP) on rate of orthodontic tooth movement and pain perception with fixed appliances. Design 2 arm parallel randomized controlled trial with an allocation ratio of 1:1. Setting The outpatient department of a dental college. Participants 105 patients were screened, out of which 60 met the inclusion criteria and consented to participate; consisting of 33 females and 27 males requiring en-masse retraction following first premolar extractions. Methods The experimental group consisted of patients bonded with a fixed appliance (Gemini 3M) who received MOP distal to canines throughout the period of retraction every 28 days. These were compared with a control group treated with identical brackets without MOP and were assessed for rate of tooth movement (canine retraction) and pain perception using a Visual Analogue Scale (VAS) of 10 mm. Results Prior to commencement, all baseline parameters were matched between the two groups (p>0.05). A statistically significant increase in rate of tooth movement in the MOP group (p<0.05). Conclusion MOP appears to enhance the rate of tooth movement with no differences in pain perception.

Alignment efficiency of standard versus tandem wire mechanics using conventional and self-ligating brackets: A pilot study

Objective: The objective of this study is to evaluate the clinical efficiency of 0.018″/0.022″ slot self-ligating (SL) bracket system (standard and tandem mechanics) in terms of rate of alignment by comparing it with a 0.022″ slot conventional ligating appliance system (MBT). Settings and Sample Population: The Department of Orthodontics. Materials and Methods: The pilot study was carried out using randomized controlled trial design. Forty patients having Littles irregularity index (II) of 6–15 mm, treated by all first premolars extractions, were randomly allocated to 0.022″ slot conventional ligating bracket system, 0.018″ slot SL bracket system, 0.018″ slot SL bracket system (tandem archwires), 0.022″ slot SL bracket system, and 0.022″ slot SL bracket system (tandem archwires). The rate of alignment for each bracket system was measured from the difference in the II of serial casts taken at pretreatment and at the end of alignment, divided by the number of days between the two measurements. A one-way ANOVA model with post hoc Bonferroni multiple comparison procedures was used to identify intergroup differences. Results: The mean value of alignment efficiency was not found to be statistically significant in any of the five groups using digital models (P = 0.104). Conclusions: Alignment efficiency was not different between SL versus conventional ligating group, the 0.018″ slot versus 0.022″ slot and tandem versus standard mechanics.

Combined orthodontic and anterior segmental osteotomy-a case report

Case report of 19 year old female patient with dentoalveolar excess treated with combined orthodontics and anterior maxillary osteotomy.