Veerendra Prasad

Dynamics of a smile in different age groups.

OBJECTIVE To evaluate smile in different age groups and to detect gender differences in smile. MATERIALS AND METHODS Digital videographic records of 241 randomly selected subjects were obtained for smile analysis. The subjects were divided into four groups by age (15-20 years, 21-30 years, 31-40 years, and 41-50 years). Each group was further subdivided by gender. After 41 subjects were excluded, the smile dimensions of 200 subjects were analyzed by two-way multivariate analysis of variance (MANOVA) with Duncans multiple range post hoc test. RESULTS All dynamic measurements (change in upper lip length, upper lip thickness, commissure height, and intercommissural width from rest to smile) decreased with age in both males and females. Changes in upper lip length and commissure height on smiling were greater in males as compared with females of the same age groups. Changes in intercommissural width on smiling were greater in females as compared with males in all age groups. CONCLUSION Smile changes with increase in age, and the changes differ between males and females. Females had a wider smile as compared with males of similar age groups.

Blast injury face: An exemplified review of management

Facial injuries are extremely common due to increased incidence of vehicular and industrial trauma and warfare injuries. But isolated injury to the face due to low voltage cells exploding is rare. In blast injury, the force can cause massive soft tissue injury, along with injury to facial fractures and damage to adnexa. Facial injury is not life threatening unless associated with other injuries of the skull and airway. The major risks to airway in facial trauma are due to anatomic alteration of patient′s airway through bony and soft tissue disruption and increased chances of aspiration. The past several decades have seen a rapid growth in the range of procedures available for reconstructive purposes. However, the essential preliminary management is a must and needs to be structured. The patient, a 10-year-old boy, was joining three pencil batteries in series and twisting the wire with his teeth when one battery exploded causing severe injuries to midface and mandibular region. After stabilization, the patient was taken up for surgery. A cap splint with zygomatic suspension was done for the maxilla, and wiring of residual mandibular segments with lining and skin cover provided by a deltopectoral flap was done. Reconstructive surgeries for reconstruction of the upper lip and maintenance of oral continence were planned for the future. The present case stresses the importance of educating the masses about unsafe handling of low voltage devices, management of airway, massive soft tissue injury, along with facial fractures and damage to adnexa.

Early orthopedic correction of skeletal Class III malocclusion using combined reverse twin block and face mask therapy

A 6-year 8-month-old girl presented with a moderate Class III malocclusion characterized by mid-face deficiency and an anterior cross bite. In the first phase, the patient was treated with combination of reverse twin block and facemask therapy. In phase two, fixed appliances were placed in the permanent dentition. The post treatment results were good and a favorable growth tendency could be observed. The correction of the Class III malocclusion occurred by a combination of skeletal and dental improvements. This report shows successful correction of skeletal Class III malocclusion in the early transitional dentition using combination therapy.

Management of mucosal fenestration with external root resorption by multidisciplinary approach

Mucosal fenestration is a clinical condition in which the overlying gingiva is denuded and the root is exposed to the oral cavity. Invasive cervical resorption is an entirely uncommon entity and its aetiology is poorly understood. This case presents an invasive cervical resorption of maxillary right central incisor with fenestration at the cervical third of the tooth. The resorption area was chemomechanically debrided. It was then restored with Mineral Trioxide Aggregate over which pink glass ionomer cement (GC Fuji VII) was placed. Lateral pedicle flap was used to cover the fenestration. The resorptive defect was restored using tooth coloured restorative resin after removal of the pink glass ionomer cement. Orthodontic treatment was continued for correction of malocclusion.

Comparison of oral and dental health status in patients with or without cleft lip and palate deformities undergoing orthodontic treatment

Objective: To compare the oral and dental health in patients with or without cleft lip and palate (CLP) deformities, undergoing orthodontic treatment. Materials and Methods: The study group comprised fifty patients with CLP. These patients were compared with fifty matched patients (control group) who had no CLP and had undergone orthodontic treatment for other indications at the same institute. Oral hygiene was evaluated clinically according to the simplified oral hygiene index (OHI). Dental caries examination was done according to decayed, missing, and filled teeth (DMFT) index. The scores were compared between the two groups. Results: The mean OHI score in cleft patients was 4.5 and in noncleft patients was 3.9 (P < 0.001).The mean DMFT score was 0.980 in cleft patients and 0.380 in noncleft patients (P < 0.001). Conclusion: This study clearly found that oral and dental health is compromised in CLP patients undergoing orthodontic treatment compared to patients undergoing routine orthodontic treatment. This article also proves that CLP is more predominant in males than in females.

Management of maxillary lateral incisor: Canine transposition along with maxillary canine impaction on the contralateral side

This is a case of 24 years 5-month-old female whose chief complaint was irregularly arranged front teeth. The clinical and radiographical examination revealed pleasing profile, Angle′s Class I molar relationship, complete transposition of maxillary right lateral incisor and canine along with impacted left maxillary canine and retained deciduous canine. Maximal band tension 0.022″ × 0.028″ appliance was placed. Transposed right maxillary canine and lateral incisor as well as impacted left maxillary canine was aligned in the dental arch. The total treatment time taken was 24 months, which was followed by a lingual-bonded canine-to-canine retainer.

Evolving consensus in cleft care guidelines: Proceedings of the 13 th annual conference of the Indian society of cleft lip palate and craniofacial anomalies

Introduction: The multi-disciplinary approach to cleft care has been a reality since the beginning of the last century, but there is a paucity of literature discussing or recommending specific cleft protocols. This is understandable due to the significant difference in cleft protocols around the world and the controversies surrounding each of them. Material and Methods: The Indian Society of Cleft Lip Palate and Craniofacial Anomalies in its 13 th Annual Conference discussed threadbare the different protocols around the world and propose a guideline to Indian surgeons delivering cleft care. Results and Discussion: These guidelines though not binding, are supposed to be pointers to a generally accepted standard for cleft care, considering the unique circumstances and limitations of cleft care providers in developing countries like India. It is a best practice indicator which, if adhered to by all the cleft care providers, will soon bring about uniformity in cleft care deliverance and allow us to evaluate our results on a much larger scale than has hitherto been possible.

Multidisciplinary treatment focussing on comprehensive orthodontic approach for improving facial esthetics in cleft lip and palate patients

Cleft lip and palate (CLP) is one of the most prevalent congenital craniofacial deformities. CLP may result in impairments that stigmatize the individual and have an impact on health, emotions, and social interactions. This article describes the comprehensive orthodontic approach in the treatment of unilateral cleft of the lip and the palate. It also emphasizes the importance of orthodontic intervention to improve the facial esthetics in CLP patients. The treatment planning procedures and the results are presented below.

Photographical evaluation of smile esthetics after extraction orthodontic treatment

Aims: To evaluate and compare the smile esthetics in orthodontically treated subjects and subjects with an esthetically pleasing smile. Materials and Methods: Frontal smiling photographs of 80 subjects in the age group of 18-25 years (mean age of 21.97 years) were taken and divided into Group I (having an esthetically pleasing profile and normal occlusion) and Group II (orthodontically treated). Each Group had 40 subjects, who were further divided into male and female subgroups. Eight transverse and three vertical linear measurements were taken on the frontal photographs and eight ratios were derived. Esthetic scores and other variables were also obtained. The data so obtained were subjected to statistical analysis. Results: All seven ratios did not show any statistically significant differences in both the groups except for ratio 5 (<0.05) in Group IIb. No statistically significant differences were found in the variables of the upper lip curvature, visible marginal gingiva or visible mandibular teeth, except in the visible maxillary first molar (<0.05) for males. The esthetic score showed statistically higher values for males (<0.05) and females (<0.001) in Group I. Lay persons rated significantly higher mean values for esthetic scores in Group Ia (<0.05), Group Ib (<0.001), and Group IIb (<0.01). There were no significant correlations found between the esthetic scores and the seven ratios for both the groups. Conclusion: (1) Females had a more interpremolar/smile width ratio. (2) A greater positive upper lip curvature was found in Group I males and females and was rated higher for esthetic score. (3) The visible maxillary first molar was more in Group II males and females and rated lower for esthetic score. (4) Esthetic scores rated by lay persons were higher for all the subjects.