Clinical Insights Into Addressing Constricted Maxillary Arch in Angle's Class II Malocclusion: A Case Report

The transverse dimension, often overlooked in orthodontics, plays a crucial role in malocclusions, affecting not only occlusion in that dimension but also sagittal and vertical dimensions. Posterior crossbites, indicative of transverse maxillary issues, are commonly addressed through palatal expansion. This case report explores the clinical insights into addressing a constricted maxillary arch in Angle's Class II malocclusion using a nickel-titanium (NiTi) expander. The NiTi expander provides constant and optimal expansion forces by incorporating a temperature-activated NiTi alloy. A 16-year-old male with irregularly placed teeth, high palatal vault, and posterior crossbite underwent treatment involving NiTi expander usage for maxillary expansion. The case presentation details the patient's journey, starting with upper arch bonding and expansion, then lower arch bonding, and concluding with complete leveling and alignment without extractions. The presented case demonstrates successful correction of a constricted maxillary arch, specifically in the canine and molar regions, utilizing the NiTi expander. The observed increase in intermolar width aligns with previous studies, showcasing the effectiveness of slow maxillary expansion. This article contributes valuable clinical insights into addressing transverse maxillary issues, emphasizing the importance of careful consideration in choosing the appropriate expansion method for optimal results.

Frictionless Mechanics for Correction of Bimaxillary Protrusion: A Case Report

The condition of bimaxillary protrusion is commonly seen by orthodontic practitioners in the course of our daily clinical work. It is characterized by both jaws being forwardly placed and increased prominence of the teeth along with lips. When there is a severe bimaxillary protrusion, it can be challenging to correct it effectively with maximum anchorage. In patients with protrusions or crowding, extraction therapy is often necessary. There are two ways to retract anteriors during extraction space closure: friction or frictionless. The present case report explains the frictionless mechanic protocol for the correction of bimaxillary protrusion using a reverse closing loop.

Harmonizing Dentofacial Balance: A Comprehensive Exploration of Class 1 Malocclusion Resolution With Impacted Maxillary Central Incisor Management

Permanent maxillary central incisor impaction is generally a rare phenomenon. Because the anterior teeth have a huge impact on a patient's facial aesthetics, missing anterior teeth are of major concern to patients who seek orthodontic treatment. However, correcting this type of malocclusion poses a challenge to the orthodontist. This case report of a 16-year-old male patient with an impacted maxillary right central incisor takes us through a series of events that are necessary to treat this type of malocclusion. The presenting case also had an impacted supernumerary tooth which was the primary cause for permanent tooth impaction. A combined treatment approach is usually needed to manage this type of case involving both the orthodontist and the surgeon.

Unveiling the Journey: A Case Report of Managing an Impacted Central Incisor

Although impaction of the maxillary permanent central incisor is uncommon in dentistry due to its significance to facial aesthetics which are challenging to treat. To abstain from the consequences related to aesthetic and functional occlusion, early detection of an impacted central incisor is imperative. This case report describes a male patient, aged 22 years, who had an impacted central incisor tooth in the maxillary anterior region. A surgery was performed to remove the impacted supernumerary tooth that was preventing the eruption of the central incisor. Using a combination of surgical exposure and orthodontic force, the impacted right maxillary central incisor was relocated to its proper occlusion in the dental arch.

COMPARISON OF ABDOMINAL EXERCISES AND NEUROMUSCULAR ELECTRICAL STIMULATION ON DIASTASIS RECTI ABDOMINIS MUSCLE IN POSTNATAL FEMALES WITH CAESAREAN SECTION

The separation of the two rectus abdominis muscles along the linea alba is termed diastasis of recti abdominis muscles (DRAM). DRAM is a common health problem in people that are both pregnant and postpartum. With a 100% frequency at gestational week 35, it is extremely frequent during pregnancy. Control and function of the trunk are greatly influenced by the musculature of the abdomen. The existence, extent, and duration of DRAM have been connected to low back and pelvic discomfort however the relationship is not conclusive. It has been proven to weaken abdominal muscles and impair their functioning in lumbo-pelvic stability. Additionally, DRAM has been linked to pelvic floor dysfunction. The mechanical control and function of the abdomen can be compromised by diastasis recti, which compromises the abdominal muscles. This study examined the impact of abdominal exercises and neuromuscular electrical stimulation on the DRAM in postnatal females who underwent Caesarean section. A total of 208 individuals, aged between 20 and 34, who had recti diastasis measuring more than 2.5 cm, underwent screening. They were split into two groups at random. Group B only received abdominal exercises, whereas Group A received NMES in addition to their activities. For a period of 12 weeks, the intervention was given to both groups three times a week. Changes have been recorded before and after the intervention. The pressure biofeedback unit, measuring tape, and vernier caliper were employed to evaluate the outcome measures of inter-recti distance, abdominal muscle strength, and waist-hip ratio, respectively. In every outcome, both groups had a highly significant (p<0.05) improvement. Furthermore, after 12 weeks, group A had improved in all measures with highly significant (p<0.05) intergroup comparisons. In comparison to MNES alone, NMES can have a more significant effect on reducing DRAM in postpartum women when paired with abdominal Exercise.

The Intriguing Case of Impacted Teeth 11, 12, and 13: Unveiling the Dental Dilemma

This case study offers a rare and difficult condition involving the impaction of teeth 11, 12, and 13, providing a severe dental challenge. A thorough examination was performed on the patient, which included clinical evaluations and radiographic examinations. Because the impacted teeth were causing discomfort and functional impairment, a multidisciplinary approach was required, which included surgical exposure followed by traction forces to level and align the impacted teeth. The abstract emphasizes the case's complexity, digging into the diagnosis process and the establishment of a personalized treatment strategy. The complexities of handling many impacted teeth are explored in length, including surgical intervention, orthodontic considerations, and postoperative care.

An Oral Odyssey: Navigating the Complexity of Impacted Parapremolars and Paramolars in the Oral Landscape!

Supernumerary molars are an uncommon anomaly that can occur in the maxillofacial complex, referring to the presence of additional teeth in the dental arch. This condition is often associated with several rare disorders such as Gardner's syndrome, Cleidocranial dysplasia, Ehler-Danlos syndrome, and Down syndrome However, it is seldom observed in non-syndromic associations. They occur more frequently in the maxilla than in the mandible. This research represents a unique case study that explores unerupted paramolar and parapremolar follicles coexisting in both the maxillary and mandibular arches of a 17-year-old male patient. The discovery of these follicles was fortuitous, as the patient exhibited no symptoms during the initial orthopantomogram scan. Despite the absence of noticeable symptoms, vigilant monitoring and observation were employed over time. Subsequently, a substantial shift in the approach to management occurred with the integration of surgical and orthodontic methodologies, guided eruption strategies, and a collaborative, multidisciplinary effort.

Accelerated Orthodontics: Getting Ahead of Ourselves With Corticotomy

Corticotomy-assisted orthodontics is an emerging technique that combines orthodontic treatment with selective alveolar corticotomy to accelerate tooth movement and optimize treatment outcomes. This case report presents the successful application of corticotomy-assisted orthodontics in the management of a complex malocclusion. Following a comprehensive orthodontic assessment and treatment planning, corticotomy-assisted orthodontics was selected as the treatment approach. The surgical procedure involved selective alveolar corticotomy in the affected regions, followed by initiation of orthodontic mechanics. The case was closely monitored at regular intervals, and treatment progress was assessed using clinical examination and radiographs. The combined approach led to significantly accelerated tooth movement, a reduction in treatment time, and improved patient satisfaction. This case report underscores the potential benefits of corticotomy-assisted orthodontics in complex cases, providing clinicians with valuable insights into its successful application and the considerations involved in treatment planning and execution. Further research and long-term follow-up are warranted to elucidate the long-term stability and outcomes of this approach.

Rescuing the Hidden Canine: A Case Report of Successful Surgical Exposure and Orthodontic Management

Canine impaction, a recognized dental condition, particularly in the maxillary region, poses both functional and esthetic challenges. This case report explores the management of impacted maxillary canines coexisting with missing upper third molars in the same patient, showcasing the complexity of dental anomalies. Its multifaceted etiology includes complex eruption pathways and potential genetic factors. Addressing the impacted canine (upper left), particularly in the anterior region, is essential for oral health and aesthetics. Surgical-orthodontic techniques, guided eruption, and interdisciplinary collaboration have revolutionized management. This report emphasizes early diagnosis, personalized treatment, and the transformative potential of surgical exposure and orthodontic intervention in enhancing oral health, function, and aesthetics.

Expanding Horizons: A Case Report of Cleft Expansion in the Mixed Dentition Stage

A nine-year-old boy with a cleft lip and palate had midface retrusion as a result of maxillary complex growth inhibition. He sought treatment for total crossbite with a Class III skeletal pattern. The maxillary expansion widened the maxilla to improve the sagittal and transverse skeletal relationship. In skeletal Class III patients with a repaired cleft lip and palate, maxillary expansion and protraction usually provide effective improvement. The individual growth of the maxilla and mandible is crucial to the success of the orthopedic procedure.

A Clinical Odyssey Involving Cleidocranial Dysplasia: Report of a Rare Case

Cleidocranial dysplasia (CCD) is a rare genetic disorder that causes cranial and skeletal abnormalities. This case report presents a comprehensive analysis of a rare instance of CCD, highlighting its clinical manifestations through an orthodontic lens shedding light on the challenges and complexities associated with managing this uncommon condition. The patient, an 18-year-old female, presented with a variety of symptoms, including delayed eruption of permanent teeth, abnormal facial features, and prominent cranial abnormalities. Multiple teeth in both the arches were missing including over-retention of primary teeth. Features of cleidocranial dysplasia were evident in her facial appearance. Treatment of CCD requires a multifaceted approach, often involving orthodontic interventions, dental extractions, and corrective surgeries to address cranial deformities and other skeletal anomalies. The report emphasizes the importance of multidisciplinary collaboration in diagnosing and managing such cases, shedding light on the distinctive features of CCD and their implications for orthodontic treatment on what kind of best treatment can be given to these patients. This case serves as a reminder of the importance of raising awareness about rare genetic disorders like CCD, as early diagnosis and intervention can significantly improve the patient's quality of life. Furthermore, it underscores the significance of a collaborative and holistic healthcare approach in managing such complex conditions. It emphasizes the need for continued research, awareness, and support for individuals affected by such conditions.

Comparative Assessment of the Efficacy of Newly Designed Multiple Variability Loop and Opus Loop for Anterior en Masse Retraction in Orthodontics: A Finite Element Study

Introduction Two different mechanisms are used to close the space after extractions, i.e., friction/sliding mechanics and frictionless/loop mechanics. The focus of this study is on space closure using frictionless or loop mechanics, which utilize loops to achieve the desired tooth movement. Loops are designed to increase the resiliency of the archwire so that the ideal moment-to-force ratio (M/F) of 8:1 to 10:1 for bodily tooth movement can be obtained. By incorporating various loop designs, the resiliency of archwires may be increased, and an ideal M/F ratio can be obtained. Method Different pre-activation bends were incorporated in the titanium molybdenum alloy (TMA) wire at alpha (canine side) and beta (premolar side), respectively. A total of 36 finite element method (FEM) models were prepared with and without pre-activation bends to evaluate the moment-to-force ratio. Result The results obtained from the finite element method (FEM) analysis provided valuable insights into the force and moment generated during activation while retracting the tooth. Specifically, the alpha bend at 15 degrees and the beta bend at 20 degrees produced the most desirable results for generating moments on the anterior and posterior teeth, respectively. Conclusion To ensure the proper utilization of the multiple variability (MV) loop, we recommend its preparation using a 0.019 x 0.025-inch TMA wire. This selection will maximize the loop's capabilities and enhance its performance in achieving the desired tooth movement.

Interdisciplinary Treatment of a Case With Unilateral Cleft Lip and Palate in the Mixed Dentition

A 10-year-old girl had reported to Sharad Pawar Dental College. Her parents had chief complaints of lip and palate deformity. On examination, it was found that the patient had unilateral cleft lip and palate on the right side. The aim was to expand the maxilla with alveolar bone grafting in the cleft region to facilitate the eruption of permanent canine and further reduce the deformity to prepare the patient for face mask therapy, reduce morbidity in the permanent dentition, and avoid Le Fort one surgery in the future. She had been previously operated on for cleft lip repair and palatal fistula closure eight years back. The present condition in the mixed dentition needed arch expansion, bone in the cleft region for the eruption of permanent canine, and further arch alignment for facemask therapy. This would reduce the severity of skeletal deformity and later on avoid the surgical advancement of the maxilla.

Non-extraction Orthodontic Treatment Protocol of Moderate Crowding

Dental crowding is referred to as the swarming of teeth, mainly due to the discrepancy between the size of the jaw bases and that of the teeth. When the amount of space required for the teeth is more than that in the jaws, it leads to crowding. The prevalence of crowding has now increased to almost 30-60%. It can be classified into mild, moderate, and severe according to the amount of overlap. Depending on the severity of the crowding, the decision of extraction is made. The given case presents a non-extraction protocol for treating moderate crowding. The present case report explains the non-extraction treatment of moderate crowding using inter-proximal stripping.

A Case of Supernumerary Incisors in a Young Male Child: A Rare Occurrence of Four Central Incisors in the Maxillary Anterior Region

Multiple supernumerary teeth in the central incisor region are an uncommon occurrence; the most frequently occurring type of supernumerary teeth are mesiodens. A 10-year-old male had reported to Sharad Pawar Dental College with the chief complaint of extra teeth. An intraoral examination revealed the presence of two labially placed incisors and two palatally placed incisors at a transitional phase of dentition. During a radiographic examination, the maxillary occlusal view revealed four incisors with similar morphology. Extraction of the palatally placed incisor was done under local anaesthesia which was followed by alignment of the anterior teeth and closure of space. Supernumeraries that have erupted should always be removed, unless the teeth next to them are absent, in which case they should be left in place. After alignment, closure of spaces was done since the permanent canines had not yet erupted; it was decided against trying to completely close any gaps between the teeth.

Assessment and Comparison of Sense of Coherence in Young Individuals Participating in the Treatment of their Cleft Lip and Palate Anomalies: A Prospective Interventional Study

Introduction: Cleft lip and/or Cleft of Palate (CL/P) is amongst the most common congenital oral and maxillofacial deformities. CL/P is not thought to be harmful to one’s health. However, even if a cleft is treated early in a child’s development, there are genuine consequences, including the possibility of long-term negative health impacts such as functional and psychological issues. Antonovsky A developed a questionnaire to measure the Sense Of Coherence (SOC). It consists of three elements: comprehensibility, manageability, and meaningfulness. In patients having any kind of deviancy, SOC provides positive experiences such as increased sense of purpose, expectations, spiritual practices, respect and understanding, self-improvement and confidence, and connections have all improved. Aim: To assess changes in SOC of young patients undergoing treatment for cleft lip and palate anomalies. Materials and Methods: The present prospective interventional study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India, and to be conducted on 20 patients of 14 years and below, with cleft lip and palate. Data will be gathered via questionnaires which will be distributed to patients having CL/P undergoing orthodontic treatment. The questionnaires will be collected within half an hour and will be checked, if completed. Patients will be given the same questionnaires at different points of time, i.e., at the start of the treatment, two months, six months and one year after the start of treatment. Statistical Package for the Social Sciences (SPSS) statistical software (27.0) and Graph Pad Prism will be used to analyse the data (version 7.0). Expected Results: Undergoing orthodontic treatment along with psychologic counselling might have a positive impact on the patients undergoing treatment for cleft lip and palate. Conclusion: It will be observed that the mental, emotional and social well-being of patients undergoing orthodontic treatment for cleft lip and palate will be improved. The orthodontic treatment which will be planned for each patient will be directed at both physical and mental rehabilitation of the patients. For a satisfactory treatment outcome and the well-being of the patient and their families, timely counselling is essential.

Impacted Mandibular First Molar: A Rare Riddle

Tooth impaction incidence is in the range of 5.6 to 18.8% of the population. Eruption failure of the first permanent molar is very rare; the prevalence is 0.01% of the population. The permanent molars are of particular importance in providing adequate occlusal support as well as coordinating facial growth. Failure of the eruption of permanent molars might lead to an array of complications like a reduction in the vertical dimension, extrusion of the antagonist teeth, a posterior open bite, inclination and resorption of adjacent teeth, and cyst formation. Various treatment modalities for impacted teeth include periodic observation, orthodontic relocation, and partial dislocation. More invasively, surgical exposure and extraction of teeth before prosthetic treatment may be performed. It is imperative to diagnose and manage the condition early, as delayed treatment may result in a myriad of problems, like a decreased force of the spontaneous eruption, a decreased percentage of treatment success, and a prolonged period of treatment, increasing the complications furthermore. Because of the importance of permanent molars, eruptive guidance is required before impacted tooth extraction. This article summarizes a case in which the surgical-orthodontic combined approach to the impacted mandibular first molar avoided the need for prolonged orthodontic treatment that would have required repositioning the deeply impacted first molar to the dental arch. As an outcome, patient satisfaction improves.

Comparative Evaluation and Correlation of Pain Pattern in Neck Musculature Observed in Mild, Moderate, and Severe Temporomandibular Joint Disorder Cases as Compared to Non-temporomandibular Joint Disorder Cases

Introduction

Temporomandibular disorder (TMD) is a broad term used to describe several interlinked disorders affecting the temporomandibular joint (TMJ), muscles of the craniofacial region, and associated structures, all of which have common symptoms such as pain and reduced jaw opening. Along with these, extra-craniofacial symptoms may also be present, which need to be assessed for early diagnosis of TMD. Considering the extra-craniofacial symptoms of TMD, this observational study aimed to evaluate the severity of pain in the neck musculature of patients with TMD and correlate it with the severity of the disorder.

Material and methods

A total of 44 patients were included in the study who were graded for severity of TMD based on the amnestic and dysfunctional components of the Helkimo index separately. The pain was evaluated bilaterally in five groups of neck muscles in all cases using manual palpation. The severity of pain in these neck muscles was then correlated with the severity of both subjective and objective symptoms of TMD and compared with patients without TMD.

Results

The Chi-square test revealed a statistically significant association between the severity of pain in all five groups of neck muscles and the severity of TMD. The severity of pain increased with the increasing severity of TMD, with a total of 59.09% of TMD patients presenting with varying degrees of pain in the neck musculature and a p-value of 0.0001% which was significant. Negligible pain in the neck musculature was present in patients without TMD.

Conclusion

Based on the results, it was observed that the severity of TMD directly correlated with pain in various groups of neck muscles. 59.09% of patients with TMD reported varying degrees of pain in the neck musculature. The severity and distribution of pain in the neck muscles increased with the increasing severity of TMD.

The Comparative Evaluation of the Morphology and Dimensions of the Sella Turcica in Skeletal Class III Patients and Patients With Unilateral Cleft Lip and Palate in Post-Pubertal Age Group

Background

The clinical features of unilateral cleft patients have great similarity to class III patients, viz., ANB <2° and Wits appraisal <-3 mm. In this study, we determined the frequency of various shapes of the sella in cleft and class III patients. We also measured the dimensions of the sella turcica in the aforementioned groups. Studying the morphology and dimensions of the sella in different groups can help us to understand the role of the cranial base in the development of malocclusion.

Material and methods

The study is composed of 46 patients, divided into two groups with an age range of 14 to 21 years. The linear dimensions of the sella were measured, and the shape of the sella was determined. Comparison was done between the two groups using Student’s t-test.

Result

When the two groups were compared, length was found to be similar in both groups, but depth and diameter were greater in the class III group. An abnormal shape of the sella was found predominantly in both class III and cleft cases. The normal morphology accounted for only 13.04% of all the cleft patients, whereas 39.13% of the class III cases exhibited a normal shape of the sella. Sella turcica bridging was seen in 30.43% of cleft patients as opposed to 21.73% of class III patients exhibiting the bridging.

Conclusion

With the finding that 74% of the subjects exhibited abnormal morphology of the sella, confirming that it can be one of the factors for malocclusion must be given more consideration.

Analysis of Nasal Morphology in Skeletal Class I and Skeletal Class II Malocclusion: An Observational Study

Background and objectives

The nose is one of the major focuses of face attractiveness. Through careful evaluation of the soft tissue drape, a treatment plan can be designed to enhance a patient's facial attractiveness. The aim of this study was to evaluate and assess the variations in nasal morphology among class I malocclusion and class II horizontal and class II vertical malocclusion.

Material and method

Lateral cephalograms of 27 patients were taken and consisted of three groups: skeletal class I malocclusion, class II horizontal malocclusion, and class II vertical malocclusion. The various linear and angular measurements specific to nose were assessed.

Results and conclusion

In class II and class I malocclusion, the nose is observed to be straight and convex, respectively. Additionally, compared to class II horizontal malocclusion, it is more convex in class II vertical malocclusion. Vertical growers or high-angle cases are more likely to have a nose with an increased inclination toward nasal dorsum convexity than horizontal growers or low-angle instances.

Evaluation of Masticatory Forces in Patients Treated for Mandibular Fractures: A Case-Control Study

Purpose:​​​​​ This study aimed to evaluate the masticatory forces in patients treated for mandibular fractures. To assess the magnitude of damage to the masticatory system caused by the various mandibular fractures and the period required for their normalization.

Materials and Methods: Data were recorded from the authentic and original bite force measurement device from 2015 to 2017. The sample was composed of 30 isolated mandible fractures patients, Group 1 consisting 15 patients with unilateral mandible fractures, Group 2 consisting 15 patients with bilateral mandible fractures, treated with ORIF (open reduction immobilization fixation) under general anesthesia, and Group 3 was a control group. Predictor variables were drawn from predefined intervals for three months (ninth POW) postoperative week.

The condition of wound healing was checked, and masticatory forces are measured at the first, fourth, sixth, and ninth postoperative weeks and compared with a control group of the same age and gender. The outcome variables were the success rate and associated complications.

Results: For the study, a total of 30 patients with 15 bilateral and 15 unilateral isolated mandibular fractures were included. The study result suggests that the patient had lower bite forces relative to the control group at all intervals. All patients showed a significant increase in the bite force values from the first to the fourth postoperative weeks (p = ‹0.001), which also increased significantly from the fourth to sixth postoperative weeks (p = ‹0.001), and from the sixth to the ninth week. 

Conclusion: ​​​​ Based on the results obtained from our study, we conclude that there is a temporary adverse effect on masticatory forces. Fracture of the bilateral mandible has a stronger influence on bite force than unilateral mandible fracture. These fractures also take a longer time to normalize.

Evaluation and Comparison of Biomechanical Properties of a New “PRP Loop” with that of Opus Loop and L-Loop - a FEM Study

Introduction: Closure of space is a salient factor in orthodontic treatment. Friction and frictionless mechanics are the methods of extraction space closure. Retraction loops eg. T loop, Opus loop, K Sir loop, L loop etc used force system as frictionless mechanics. An attempt has been made to blend the design of both Opus and L loops to form a new loop called “PRP loop” so that the beneficial properties of L loop and Opus loop can be integrated into the new loop. This study is therefore undertaken to evaluate the biomechanical effect of PRP loop and compare it to the “L loop and Opus loop”. Objectives: To evaluate and compare the moment to force ratio of PRP loop, Opus loop and L loop fabricated in “0.019×0.025 inch” and “0.017×0.025 inch” “TMA wire with and” without any “ preactivation bends” and to “compare the moment to force ratio” of PRP loop with “Opus loop”, and L loop fabricated in 0.019×0.025 wire with those fabricated in 0.017×0.025 wire. Methodology: PRP loop, “L loop and Opus loop” will be fabricated in “0.019×0.025 and 0.017×0.025 inch TMA wire” without pre activation bends. Using the dHAL software moment to force ratio will be calculated for PRP loop of “0.019×0.025 inch” and “0.017×0.025 inch” “TMA wire with and” without different degrees of alpha pre-activation bends. Ansys 16.0 finite element analysis software will be used to form the loops of three dimensional model after that the forces and moments in all three dimensions will be studied. Expected Result: The moment to force of PRP loop will be evaluated to so that optimum force level can be determined to prove its clinical efficiency. Conclusion: No such study has been done on PRP loop. Hence, a study is planned to evaluate and compare the ”biomechanical properties of PRP loop with that of Opus loop and L loop”

Comparative Evaluation of Preventive and Interceptive Orthodontic Treatment Need in Children of 6-9 Years and 9.1- 12 Years

Introduction: Preventive and interceptive orthodontics, emphasizes on reduction of later need for complex orthodontic treatment. This thus increases the comprehensiveness of healthcare and help in strengthening the primary care. In literature, there is no comparison between the preventive and interceptive treatment needs in patients belonging to growing age (6-9 years) and those belonging to non-growing age (9.1-12 years). There is a need to compare these finding according to the age group. The present study aims to utilize the IPION to quantify the proportion of central Indian children who would gain from the preventive and interceptive orthodontics. Materials and Methods: The study will be conducted in the Department of Orthodontics, SPDC, Wardha in collaboration with Department of Public Health Dentistry, SPDC, Wardha. Total 383 patient in age group of 6 to 12 years, will be selected. All the features of the IPION-6 and IPION-9 will be recorded, and the variables will be multiplied by weighting factors according to the instructions of the original study by Coetzee. All the features of IPION-12 will be recorded, and the variables will be multiplied by weighting factors. Expected Results: There will be a decrease in the need of orthodontic treatment in patients who have completed the age of 9 years.

Assessment and Comparison of Temporomandibular Joint for Occurrence and Severity of Disorders in Adult Cases with Unilateral Cleft Lip and Palate and Non-cleft Class I: An Observational Study

Background: Cleft Lip and Palate (CLP) are hereditary deformity of craniofacial structure. Temporomandibular disorder has number of clinical problems affecting muscles of mastication and its associated structures. There are several methods used to evaluate temporomandibular dysfunction (MRI, etc), Helkimo index is a settler in advancing indices, other indices used are CMI, MFIQ, FONSECA. The design of the following study was to evaluate the TMJ disorders in UCLP, if any, and compare with the non-cleft cases. Methodology: Total 30 patients aged 16 to 20 years, will be selected from the patients coming to smile train Out Patient Department (OPD) of Orthodontics and Dentofacial Orthopaedics, Wardha. The total cases will be divided into two groups: a) Group I -   unliteral cleft lip and palate cases b) Group II - non cleft class I cases Digital records of the patient (lateral cephalogram, photograph, models) will be taken and stored. Helkimo, MFIQ, CMI, Fonseca will be recorded on all patients participated in study. The Helkimo index will be taken to assess the presence and severity and   MFIQ index will be taken to assess mandibular functioning in cleft cases based on the questionnaire. Expected Results: The dental apparatus (interdental relation of maxillary and mandibular dentition) plays an important role in the temporomandibular joint's well-being. Trauma due to the occlusal instability has definite effect on the TMJ in long run. Cleft is always associated with inter jaw malocclusion and therefore TMDs in the cleft patient is thought to occur. The treatment protocol for grown cases with severe skeletal malocclusion is orthognathic surgery. The TMJ correction remains untouched. It can be expected that altered TMJ anatomy can lead to TMDs in cleft lip and palate cases. Conclusion: To convey the occurrence of TMDs in cleft due to the inter jaw malocclusion and its early treatment approach for TMJ deprogramming along with dental and surgical correction in CLP.

Broadening the Scope and Utility of Frontal Sinus Morphology for Predicting the Growth Pattern and Skeletal Malocclusion in Cleft Lip and Palate Cases

Introduction: The three dimensionally affected growth and development of craniofacial structures in CLCP leads to problems dealing with facial appearance, skeletal and dental malocclusion, feeding, airway, hearing, and speech. Objectives: Evaluation and utilisation of fs morphology as a forecast of future growth for growth pattern and skeletal malocclusion in CLCP cases. Methodology: A 30 Cases from Skeletal Class I, III and CLCP will be selected from Department of Orthodontics. Dimensions and area of frontal sinus is evaluated using 3DVT. Parameters are evaluated in sagittal and coronal section. The measurement's dependability will be determined using a reliability test (Cronbach alpha test). Chisquare Test, One Way ANOVA, and Multiple Comparison will be used to do descriptive and analytical statistics. The Tukey Test is a statistical test that is used. Expected Results: Frontal sinus dimensions when observed for Class III will be found greater. Average dimensions will be observed for skeletal Class I cases. Based on the dimensions of frontal sinus observed in cleft lip and palate, we can predict the skeletal malocclusion and growth pattern. Conclusion: The morphology of the fs is evaluated in cleft cases for the upcoming growth pattern and skeletal malocclusion if is known during formulating a treatment plan for the three dimensionally affected jaw bases and craniofacial structure the requirement for later surgical intervention can be prevented.

1284 Comparison of British Association of Urological Surgeons (BAUS) 2008 and NICE 2015 Guidelines for Patients with Suspected Urinary Tract Cancer: An Audit of Haematuria Referrals

Introduction

BAUS guidelines for the investigation of haematuria were replaced by NICE guidelines in 2015. However, both criteria are currently used to refer patients to our Haematuria Clinic. We audit the haematuria referrals made to our unit and compare cancer yield.

Method

A retrospective review of all two-week wait haematuria referrals to a single UK teaching hospital between October 2019 and April 2020 was performed. Referrals were stratified into two groups: BAUS 2008 and NICE 2015 referral criteria. The outcomes of haematuria investigations were analyzed and the incidence of urinary tract cancer (UTC) compared between groups.

Results

316 referrals were analyzed. Of these, 123 (39%) and 193 (61%) referrals were made using BAUS and NICE criteria respectively. 233 (74%) patients were investigated for visible haematuria of which 68 (29%) were referred using BAUS criteria and 165 (71%) using NICE. UTC was identified in 20% of patients referred using NICE criteria and 4.4% using BAUS criteria. 83 (26%) patients were referred with non-visible haematuria. Of these, 55 (66%) were referred using BAUS criteria and 28 (34%) using NICE. UTC was identified in 2.5% of patients referred using BAUS criteria. No UTC was identified in referrals using NICE criteria.

Conclusions

Despite BAUS haematuria guidelines being superseded by NICE guidelines in 2015, these older guidelines still account for 40% of our two-week wait referrals. Furthermore, NICE guidelines have a higher cancer yield for visible haematuria compared to BAUS guidelines and should therefore take precedence to avoid subjecting patients to unnecessary and costly investigations.

909 Modern Integrated Surgical Teaching for Junior Doctors: Local Workshops and Online Webinars

Introduction

Reforms in the postgraduate and undergraduate curriculum have resulted in a lack of surgical teaching. By tailoring educational objectives to learning needs of junior doctors, we assessed the perceptions and knowledge transfer of our 2-phase surgical teaching programme.

Method

A perception questionnaire was distributed amongst junior doctors to establish confidence levels in surgical topics. Junior doctors were invited to attend (1) a local surgical techniques workshop and (2) an online national webinar. Perception questionnaire and knowledge tests were delivered before and after each session.

Result

87.5% (n = 14) participants were not confident assessing an unwell surgical patient when on-call. Mean confidence gain before and after the practical session was 4.18 (W = 91.0, p = 0.0002). 106 participants attended the online webinar. 61.3% (n = 65) were quite confident in assessing a sick surgical patient and 56.6% (n = 60) were quite confident managing a sick surgical patient. The majority (97.2%, n = 103) deemed the session to be useful to very useful. Mean knowledge gain before and after the session was 32.8% (t = 4.67, p = 0.009).

Conclusions

Improvement in confidence and knowledge in surgical topics amongst juniors can be feasible by implementing blended learning tools, such as online webinars.

Evaluation and Comparison of Condylar Head Inclination With Respect to Glenoid Fossa in Cleft, Class III, and Class I Individuals

Background:

Cleft lip and palate are the most common congenital craniofacial defects, which need early intervention with a multidisciplinary approach including surgeons, orthodontists, speech therapists, pedodontists, etc. Craniofacial growth is affected the most, leading to marked skeletal discrepancies. Constricted maxillary arch is one of the reasons for faulty occlusal inclined planes which results in abnormal loading of condyles, thus leading to temporomandibular disorders (TMDs) in cleft. Condylar head inclination helps to evaluate the position of condyle in the glenoid fossa. Thus, changing the position of condylar head in the glenoid fossa at an early age prevents further worsening of TMD condition. The purpose of this study was to evaluate condylar inclination in individuals with cleft lip and palate and compare it with non-cleft individuals.

Method:

The study comprised of 40 subjects aged between 9 and 12 years, divided into 4 groups (10 in each)—unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and class III and class I malocclusion. Scanned three-dimensional digital volume tomography (3D-DVT) images were taken, and condylar head inclination was evaluated and compared.

Result:

Significant findings were obtained when group 1 was compared to group 2, group 3, and group 4 ( P-value = .001). Also, when group 2 was compared to group 3 and group 4, the values were statistically significant with P-value = .001.

Conclusion:

Condylar head inclination was found to be most anteriorly angulated in the class III group compared to all the other groups. Unilateral cleft lip and palate had more anteriorly angulated condyle than bilateral cleft lip and palate.

Comparison of Cervical Vertebral Body Volume in Class II Vertical and Class II Horizontal Cases With Class I Cases Using 3D-DVT

The branch of orthodontics has had an interest in the cervical vertebrae wherein cervical spine is used as a reference structure for natural head position, so skeletal age was evaluated by studying variations in the cervical vertebral morphologies. Among all evaluations, very limited data is available wherein comparison between cervical vertebral body volumes between the different malocclusions has been done. This study aimed to compare the differences in the volumes of cervical vertebral bodies of C2, C3, and C4 between skeletal class I and class II malocclusions of both horizontal and vertical growth patterns. In class I the volume was significantly lesser as compared to class II. It was seen that there was statistically no significant difference in the volume between the horizontal and vertical growers. It can be concluded from this study that cervical vertebral body volume has no effect on growth pattern. However, variations in cervical vertebral body volume are seen with different malocclusions.

Three-dimensional comparative evaluation of articular disc position and other temporomandibular joint morphology in Class II horizontal and vertical cases with Class I malocclusion

OBJECTIVE

To evaluate and compare articular disk position, condylar position, and joint spaces in Class II vertical, Class II horizontal, and Class I cases. The purpose was to assess the potential for development of temporomandibular disorders (TMDs) in the three groups.

MATERIALS AND METHODS

A sample of 75 cases, 25 cases in each group of Class I, Class II vertical, and Class II horizontal, were selected based on inclusion and exclusion criteria. Magnetic resonance imaging (MRI) assessments were made with a 1.5-Tesla basic system with a closed-mouth technique for evaluating articular disk position in the sagittal and transverse planes, condylar position, and joint spaces in the sagittal plane. Philips 3.0 software was used to analyze the MR images.

RESULTS

There was evidence of alterations in the temporomandibular joint (TMJ) morphology in both Class II vertical and Class II horizontal cases, with maximum discrepancy in Class II vertical cases. MRI evaluation suggested a tendency for antero-medial disk displacement with anteriorly positioned condyles in Class II vertical cases. The discrepancy was milder in the Class II horizontal group.

CONCLUSIONS

Class II vertical cases are more susceptible to the development of TMDs and should be subjected to TMJ evaluation before starting any orthodontic treatment to intercept and prevent a mild asymptomatic TMD from developing into a more severe form. Class II vertical cases should be subjected to MRI evaluation before starting any orthodontic treatment.

Physician perceptions and practice patterns regarding fertility preservation in hematopoietic cell transplant recipients

Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.

Outcome of hematopoietic stem cell transplant as salvage therapy for Hodgkin's lymphoma in adolescents and young adults at a single institution

For patients with relapsed Hodgkin's lymphoma (HL), high dose chemotherapy with stem cell rescue (HDCT-SCT) may improve survival over chemotherapy alone. We assessed the outcomes of HDCT-SCT in 37 consecutive adolescent and young adult patients with relapsed HL whose malignancy was categorized based on sensitivity to chemotherapy. We determined whether current outcomes supported the use of HDCT-SCT in all of our patients or just those patients with lower-risk characteristics such as chemosensitivity. With a median follow-up of 6.5 years, the 2-year overall survival (OS) was 89% (95% CI: 62-97%) for the chemosensitive patients (n = 21), whereas for patients with resistant disease (n = 16), OS was 53% (95% CI: 25-74%). Both autologous and allogeneic transplants were well tolerated, with 100-day treatment-related mortality under 10%. Our data show encouraging outcomes for patients with chemosensitive relapsed HL who receive hematopoietic stem cell transplant (HSCT) and support the value of the procedure even when the disease is chemoresistant.

Sigmoid sinus thrombosis presenting with posterior alexia in a patient with Behçet's disease and polycythaemia: a case report

Introduction

A 59-year-old Caucasian woman presented with an acute onset of alexia, noticed whilst driving. She described how while she could read car number plates, she had lost the ability to read and understand words on roadside advertisements and car window stickers.

Case presentation

Neurological examination was unremarkable apart from the inability to read full words or sentences. Imaging of the brain, initially computed tomography, followed by magnetic resonance venography, confirmed a diagnosis of sigmoid sinus thrombosis with associated venous infarction. The patient's past medical history revealed that she had suffered an ischemic stroke and following investigation for this, had undergone a nephrectomy for renal cell carcinoma. This was complicated by postoperative deep venous thrombosis. She had a persistent polycythaemia that was managed with venesection, and recently she had been diagnosed with Behçet's disease. Prior to this presentation, she had recently stopped her prophylactic antiplatelet medication as she was due to undergo a total knee replacement for osteoarthritis. She was managed with weight-adjusted, low molecular weight heparin followed by oral anticoagulation, and made a good recovery from her symptoms.

Conclusion

This case illustrates a classical neurological syndrome, highlights the importance of cerebral venous and sinus thrombosis as a cause of stroke, and the importance of remaining vigilant to a person's changing risk of venous thrombosis with evolving comorbidity.

Human herpesvirus-6 encephalitis following allogeneic hematopoietic stem cell transplantation

Immunosuppressive monoclonal antibodies directed to immune system cells may reduce rejection and graft versus host disease (GvHD) after allogeneic stem cell transplantation (SCT), but can increase the risks of viral infection. Here, we report human herpes virus-6 (HHV-6) encephalitis despite antiviral prophylaxis in 5 of 43 (11.6%) patients receiving alemtuzumab supported conditioning. Encephalitis occurred at 41-103 days (median 60 days) presenting with confusion in all patients, combined with amnesia (n=3) or seizures (n=2). MRI revealed non-specific white matter changes in two and a non-enhancing medial temporal lobe lesion in three patients. Cerebrospinal fluid (CSF) PCR amplification for HHV-6 was positive in all five patients, (600-2 25 000 (median 4700) copies/ml CSF), while analysis of peripheral blood revealed 100-22 500 (median 1200) viral copies/ml plasma. CSF protein was elevated in four patients, with minimal CSF pleocytosis. Intravenous foscarnet produced neurological improvement at 8-13 (median 11) days and negative plasma PCR at 30-66 (median 50) days. Four patients had complete neurological recovery, but one patient with persistent viral DNA in the CSF succumbed to progressive encephalopathy. Given this high incidence of HHV-6 and the possibility of successful outcome with prompt treatment, a high index of suspicion of this disorder is required in recipients of monoclonal antibody supported allografts.

Breast movement during normal and deep breathing, respiratory training and set up errors: implications for external beam partial breast irradiation

This study was designed to evaluate interfraction and intrafraction breast movement and to study the effect of respiratory training on respiratory indices. Five patients were immobilized in supine position in a vacuum bag and three-dimensional set up errors, respiratory movement of the breast during normal and deep breathing, tidal volume and breath hold time were recorded. All patients underwent respiratory training and all the respiratory indices were re-evaluated at the end of training. Cumulative maximum movement error (CMME) was calculated by adding directional maximum set up error and maximum post training movement during normal breathing. The mean set up deviation was 1.3 mm (SD +/- 0.5 mm), 1.3 mm (SD +/- 0.3 mm) and 4.4 mm (SD +/- 2.6 mm) in the mediolateral, superoinferior and anteroposterior dimensions. Pre-training mean of the maximum marker movement during normal breathing was 1.07 mm, 1.94 mm and 1.86 mm in the mediolateral, superoinferior and anteroposterior dimensions. During deep breathing these values were 2 mm, 5.5 mm and 4.8 mm. While respiratory training had negligible effect on breast movement during normal breathing, it resulted in a modest reduction during deep breathing (p = 0.2). The mean CMME recorded for these patients was 3.4 mm, 4.5 mm and 7.1 mm in the mediolateral, superoinferior and anteroposterior dimension. Respiratory training also resulted in an increase in breath hold time from a mean of 31 s to 44 s (p = 0.04) and tidal volume from a mean of 560 cm(3) to 1160 cm(3) (p = 0.04). With patients immobilized in the vacuum bag the CMMEs are relatively less. Individualized directional margins may aid in reduction of planning target volume (PTV).

Expression of the vascular endothelial growth factor receptors 1 and 2 in acute myeloid leukemia: incidence and feasibility of immunohistochemical staining

Vascular endothelial growth factor (VEGF) and its receptor tyrosine kinases, VEGFR-1 and VEGFR-2, are important therapeutic targets for various cancers including AML. Paraffin-embedded bone marrow samples (PE-BM) are, in most cases, the only tissue accessible to perform retrospective analyses of novel targets such as VEGF and/or its receptors. As a result, it limits our options to immunohistochemistry (IHS), or more expensive and less practical techniques such as enzyme-linked immunosorbent assay (ELISA) or fluorescence in situ hybridization (FISH). We analyzed the feasibility of IHS to measure VEGFR-1 and VEGFR-2 expression in 28 AML samples using monoclonal antibodies (moAbs) against Flt-1 (VEGFR-1) and KDR/Flk-1 (VEGFR-2). Medical records were reviewed for relevant clinical information. Expression of VEGFR-1 (+) and VEGFR-2 (+) were seen in 25% (7/28) and 43% (12/28) respectively. Forty-six percent (13/28) were dual-negatives for VEGFR-1 and VEGFR-2; 14% (4/28) were dual-positives for VEGFR-1 and VEGFR-2. An inferior survival was observed in patients whose myeloblasts express either VEGFR-1 (+) or VEGFR-2 (+), or both. Determination of expression of VEGF receptors (1 and 2) by IHS in PE-BM tissue is feasible. Prospective comparison of IHC to flow cytometry or other molecular techniques, and assessment of the prognostic significance of VEGF receptors in AML patients is warranted.

Malignant pleural effusion of multiple myeloma: prognostic factors and outcome

Malignant pleural effusion (MPE) in multiple myeloma (MM) is rare. Approximately 80 cases have been reported. To delineate optimal treatment and prognostic variables in these patients, we reviewed 11 MM patients with MPE. MPE developed at median of 12 months from diagnosis of MM. All the patients had high-risk disease based on complex karyotypic abnormalities including deletions of chromosome-13 (n=9), elevated beta-2 microglobulin (B2M) (n=9), high C-reactive protein (CRP) (n=8), high plasma cell labeling index (n=5) or high LDH (n=5). A significant increase in B2M, LDH, and CRP was observed at the onset of MPE. The initial diagnosis of MPE was based on positive cytology (n=9), pleural fluid cIg/DNA (n=9) or pleural fluid cytogenetics (n=4). Pleural tissue infiltration was found on pleural biopsy and autopsy in one patient each. Systemic chemotherapy comprising dexamethasone, cyclophosphamide, etoposide and cisplatin (DCEP) (n=7) and pleurodesis (n=7) were effective in resolving MPE but survival was short. High dose chemotherapy with peripheral blood stem cell support for MPE in six patients conferred no clear survival advantage. These patients died at median of four months from onset of MPE. Patients with bone marrow complex karyotypic abnormalities including deletion-13 (n=9) had a shorter (median--18 months) overall survival compared to patients with normal cytogenetics (median--38 months). MPE in patients with MM is often associated with high-risk disease including deletion 13 chromosomal abnormality and heralds a poor prognosis despite aggressive local and systemic treatment.