Satinder Pal Singh

Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible

OBJECTIVE To test the hypothesis that twin-block and Mandibular Protraction Appliance-IV (MPA-IV) are not effective in improving the pharyngeal airway passage (PAP) dimensions among Class II malocclusion subjects with a retrognathic mandible. MATERIALS AND METHODS Eighty-three subjects ranging in age from 8 to 14 years were divided into four groups. Group I included 30 Class I malocclusion subjects (healthy controls); group II consisted of 16 Class II malocclusion subjects (Class II controls); group III had 16 subjects in whom Class II malocclusion was treated by MPA-IV; and the remaining 21 subjects formed group IV, whose Class II malocclusions were corrected by twin-block appliance. Lateral cephalograms recorded at the beginning of orthodontic treatment in group I subjects and at the beginning and end of follow-up/treatment with functional appliance in group II, III, and IV subjects were analyzed to determine the PAP dimensions. Paired t-test, one-way analysis of variance, and Tukey tests were applied for statistical analysis, and a P-value .05 was considered statistically significant. RESULTS Soft palate length was decreased significantly in group III (P < .05) and group IV (P < .001) subjects. Soft palate thickness in group IV subjects was increased significantly as compared to group II (P < .05) and group III (P < .01) subjects. The improvement in soft palate inclination in group III and group IV subjects was significant (P < .01). The oropharynx depth was increased significantly in group III (P < .05) and group IV (P < .001) subjects. The depth of the hypopharynx was increased significantly (P < .01) in group IV subjects. CONCLUSIONS The twin-block appliance was more efficient than the MPA-IV in the improvement of PAP dimensions among Class II malocclusion subjects with retrognathic mandible.

Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in class II malocclusion subjects

BackgroundThe use of functional appliances for the correction of retrognathic mandible is very common in orthodontics. Similar appliances known as oral appliances are also frequently used in adults for the treatment of mild to moderate obstructive sleep apnea (OSA). Many studies have reported improvement of pharyngeal airway passage (PAP) dimensions following functional appliance therapy in children and oral appliance therapy in adults. There is only one study in the literature that discussed the effect of oral appliance therapy on posterior pharyngeal wall thickness (PPWT) among subjects with OSA. The effect of functional appliance therapy on PPWT has never been investigated. Thus the present study was conducted to evaluate the effects of twin-block appliance on pharyngeal airway passage (PAP) dimensions and posterior pharyngeal wall thickness (PPWT) in class II malocclusion subjects with retrognathic mandibles.MethodsThirty-eight class II malocclusion subjects in the age range of 8 to 14 years with mandibular retrusion were divided into a treatment (n = 20) and control (n = 18) group. Mandibular retrusion in the treatment group subjects was corrected by twin-block appliance. The effect of twin-block appliance on PAP and PPWT dimensions were evaluated from lateral cephalograms recorded prior-to and after 6 months of appliance therapy in the treatment group subjects and the changes were compared with the changes in the control group subjects. Student’s t-test was used for statistical analysis; P-value of 0.05 was considered a statistically significant level.ResultsThe depth of the oropharynx was increased significantly in the treatment group subjects (P < 0.001) as compared to the control group subjects (P < 0.05). The depth of the hypopharynx increased significantly in treatment group subjects (P < 0.01). The PPWT at the level of the nasopharynx, oropharynx, and hypopharynx were maintained in the treatment group subjects; whereas in control group subjects, the PPWT was further reduced although the changes were not statistically significant.ConclusionsCorrection of mandibular retrusion by twin-block appliance in class II malocclusion subjects increased the PAP dimensions and maintained the pre-treatment thickness of posterior pharyngeal wall.

Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate

Aim: To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Materials and Methods: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Results: Maxillary distraction resulted in significant advancement of maxilla (P<0.001). Counterclockwise rotation of the palatal plane took place after maxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. Conclusions: Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable.

Effects of sagittal maxillary growth hypoplasia severity on mandibular asymmetry in unilateral cleft lip and palate subjects

OBJECTIVE To test the hypothesis that sagittal maxillary growth hypoplasia has no effect on mandibular asymmetry among subjects with complete unilateral cleft lip and palate (UCLP). DESIGN A total of 86 subjects (normal noncleft, 42; UCLP, 44) in the age range of 15 to 25 years were chosen. Normal noncleft subjects were included in Group I. Based on the severity of sagittal maxillary growth hypoplasia, subjects with UCLP were divided into two groups. Subjects with UCLP in whom the SNM angle was ≥71 degrees and the M-point to Nasion perpendicular distance was ≤-10 mm were included in Group II. Group III consisted of subjects with UCLP in whom the SNM angle was <71 degrees and the M-point to Nasion perpendicular distance was >-10 mm. The mandibular asymmetry index (condylar, ramal, and condylar+ramal), gonial angle, and depth of the antigonial notch of three groups of subjects were examined on orthopantomograms (OPGs). RESULTS Among Group II subjects in whom sagittal maxillary growth was near normal, ramal and condylar+ramal heights were significantly less on the cleft side than on the normal side (P < .01). Condylar, ramal, and condylar+ramal asymmetry indices were significantly greater among Group II subjects. Mandibular asymmetry indices among Group III subjects were comparable with those in Group I subjects. CONCLUSION The hypothesis was rejected. The mandible was significantly asymmetrical among subjects with UCLP in whom sagittal maxillary growth was near normal, whereas the mandible was nearly symmetrical among subjects with UCLP in whom sagittal maxillary growth hypoplasia was very severe.

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.

Association of tuberculosis and Diabetes Mellitus: an analysis of 1000 consecutively admitted cases in a tertiary care hospital of North India

Introduction The association of Tuberculosis and Diabetes Mellitus is a cause of concern for the health sector. The coexistence of these two highly prevalent diseases has made the already existing treatments very complex. This issue is of particular significance to developing countries like India that bear a significant burden of these two diseases. Methods Retrospective analysis of 1000 consecutively admitted patients in a tertiary care hospital were analyzed for the coexistence of Tuberculosis and Diabetes Mellitus. Results The study found that a significant proportion of diabetic patients had coexistent tuberculosis (65.5%). Rural population was predominantly affected in both the genders. The study observed that the coexistence of these two conditions increased with advanced age. Conclusion The coexistence of Diabetes Mellitus with Tuberculosis needs to identified early and adequately addressed. The rural population needs to be educated about these two conditions and seek timely medical care.

Efficacy of resin-modified glass ionomer cement varnish in the prevention of white spot lesions during comprehensive orthodontic treatment: a split-mouth study

AbstractObjective:To evaluate the efficacy of resin-modified glass ionomer cement varnish in the prevention of white spot lesions (WSLs) during early orthodontic treatment with fixed appliances.Materials and methods:A total of 480 maxillary and mandibular anterior teeth were studied. The varnish was applied to either the right or left side of the maxillary or mandibular anterior teeth on a random basis. For each experimental quadrant in each patient, the varnish was applied to the labial surfaces of incisors and canines, from the gingival surface of the bracket to the free gingival margin. White spot lesions were recorded on a standard pro forma before (T 0) and approximately 6 months following varnish application (T 1) by DIAGNOdent and direct visual inspection.Results:The DIAGNOdent score at T 1 was increased significantly in the control maxillary lateral and mandibular central (P < 0·05), and lateral incisors (P < 0·01). The visual scores in experimental maxillary lateral incisors and mandibular canine...OBJECTIVE To evaluate the efficacy of resin-modified glass ionomer cement varnish in the prevention of white spot lesions (WSLs) during early orthodontic treatment with fixed appliances. MATERIALS AND METHODS A total of 480 maxillary and mandibular anterior teeth were studied. The varnish was applied to either the right or left side of the maxillary or mandibular anterior teeth on a random basis. For each experimental quadrant in each patient, the varnish was applied to the labial surfaces of incisors and canines, from the gingival surface of the bracket to the free gingival margin. White spot lesions were recorded on a standard pro forma before (T(0)) and approximately 6 months following varnish application (T(1)) by DIAGNOdent and direct visual inspection. RESULTS The DIAGNOdent score at T(1) was increased significantly in the control maxillary lateral and mandibular central (P < 0·05), and lateral incisors (P < 0·01). The visual scores in experimental maxillary lateral incisors and mandibular canines were decreased significantly at T(1) (P < 0·05). The sidewise post-treatment (T(1)) comparisons of control and experimental teeth for visual scores revealed significant decreases for maxillary lateral incisors, maxillary canines and mandibular canines (P < 0·05). CONCLUSION Application of resin-modified glass ionomer cement varnish had a favourable effect in the prevention of WSLs during comprehensive orthodontic treatment.

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.

Lorazepam: a weapon of offence.

The use of knock out drugs for perpetuation of crime has significantly increased in recent years. These drug facilitated crimes mainly involve robbery and sexual offences. Most of the drugs employed for these purposes affect the nervous system and bring a state of incapacitation and amnesia. The miscreants exploit these properties of drugs to commit such crimes. The unsuspecting travellers on public transport vehicles and women in disco parties are most vulnerable to such crimes. The unrestricted and unregulated sale of prescription drugs and general ignorance of such incidents is a challenge that needs to be addressed promptly.

Cephalometric norms for orthognathic surgery for North Indian population

Objective: The objective of this study is to establish the cephalometric hard tissue norm for orthognathic surgery for North Indian subjects. Materials and Methods: A total of 100 young adults which consists of 46 males and 54 females with the age range of 14-24 years with balanced facial profile and minimum arch length discrepancies were chosen for the study. Lateral cephalograms with teeth in occlusion were recorded and analyzed manually to establish the norm. The mean values of various cephalometric hard tissue variables for North Indian males and females were compared with those Caucasians. P < 0.05 was considered to be statistically significant. Results: All the cephalometric parameters for orthognathic surgery except mandibular length and lower incisor inclination were comparable among North Indian males and females. The mandibular length was significantly more among North Indian males than females (P < 0.05) and the inclination of lower incisors was significantly more among North Indian females than males (P < 0.05). However, many of the cephalometric parameters for orthognathic surgery were significantly different among North Indian and Caucasian males and females. Conclusion: The cephalometric norms for orthognathic surgery were established for North Indians and many measurements were different from those for Caucasians.