Routine use of 3-dimensional zoom modality with 2-dimensional transesophageal echocardiography to decide the candidacy for transcatheter device closure of atrial septal defect

Background

2-dimensional transesophageal echocardiography (2D-TEE) and balloon sizing are commonly used for assessment of Ostium secundum atrial septal defect (OS-ASD) prior to device closure but complications do occur. Therefore, assessment of accurate morphology and anatomy of the defect in three-dimensional plane is essential for transcatheter device closure to be successful, which the 2D TEE fails to reveal.

Purpose

2D TEE has long been used to decide size of the device required for transcatheter closure of OS-ASD and the appropriate candidates. However, complications like inadequate closure, leaving behind residual defect or device embolization often come into picture. The reason behind this is complex anatomy of some defects in the three-dimensional plane. Purpose of this study was to see if the routine use of 3D zoom with 2D TEE can better help to select the appropriate patients for device closure than that by 2 TEE alone.

Methods

We enrolled 71 OS-ASD patients from October 2020 to December 2021. All the patients underwent transesophageal echocardiography (TEE). Assessment of quantitative (number, shape and size of defect and size of residual rims) and qualitative (aneurysm, malalignment, fenestration) parameters was done by both 2D and 3D zoom. The measurements by 2D and 3D TEE clips were done by different operators. Transcatheter device closure was done for the patients with defect morphology and residual rims amenable for the same, with acceptable pulmonary pressure. Patients found to be adequate for the device closure by 2D TEE, when further found to have an unfavorable morphology by 3D TEE, were referred for surgical management. Follow up transthoracic echo was done after 1 month.

Results

Of the 71 patients, 65% were females and mean age was 26.23±10.75 years. By 3D TEE, 66% had circular defect,19% had oval defect and 14% had complex defect. 2 patients had spiral defect. Malalignment of the septum was seen in 4 (5.6%) patients by 2D TEE whereas in 13 (18.3%) patients by 3D TEE. Septal aneurysm was seen in 1 (1.4%) by 2D TEE whereas in 3 (4.2%) patients by 3D TEE. Mean largest size obtained by 2D was 24.82±9 mm and that by 3D was 26.23±8.42. By 3D TEE, 37 patients had at least one rim deficient (<5 mm). 3D Maximal diameter strongly correlated with 2D Maximal diameter (correlation coefficient 0.860; p<0.01). 9 (12.6%) patients found adequate for the device closure by 2D TEE were further found to have an unfavorable morphology by 3D TEE. 38 (53.5%) patients underwent device closure and 20 (28.2%) patients underwent surgical patch closure. At 1 month follow up all the 38 patients had device in-situ and had no residual shunt.

Conclusions

In OS-ASD patients, routine use of 3D zoom modality can complement 2D TEE in deciding appropriate patients for transcatheter device closure and help prevent many unforeseeable complications.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Jawaharlal Institute of Postgraduate Medical Education and Research

A comparative study of conventional and Hall techniques of crown placement using finite element stress analysis

BACKGROUND

Hall technique of crown placement causes the changes in vertical occlusal dimension; the mode of settlement of which needs to be explored.

AIM

To assess and compare the changing patterns of stress distribution following placement of stainless steel crowns on primary teeth by Hall and conventional techniques using a finite element model analysis.

MATERIALS AND METHODS

The clinical crown heights of primary molars restored with Hall and conventional techniques and opposing teeth in contact, vertical dimension changes in the primary canine area were measured using intraoral digital scan. T-scan was used to measure the changes in bite force while the finite element analysis was used to assess deformative changes on the 2^nd, 5^th, 10^th, and 15^th days.

RESULTS

The Hall technique of crown placement caused more stress distribution in the tooth supporting tissues that settled in 2 weeks as compared with conventional technique of crown placement in which settlement occurred in 2 days.

CONCLUSION

The settling of vertical occlusal dimension as well as stress distribution in Hall technique probably takes place by intrusion of crowned tooth and opposing teeth in contact.

An assessment of the effectiveness of oral health education on oral health-related knowledge and attitudes of caregivers of children with hearing impairment

AIM

To assess the effectiveness of oral health education on oral health-related knowledge and attitudes of caregivers of children with hearing impairment and its impact on the oral health status of their children.

MATERIALS

Study design: Non randomised pre- and post-comparison study. Fifty-six pairs of caregiver-child with sensory impairment were chosen and divided into study and control groups. Health education was provided to the caregivers of the study group for 1, 3, 6 and 12-month period and periodic assessment of their knowledge, attitudes and practices (KAP) was performed. The caregivers of the control group did not receive any oral health education during the study period. The oral health status of these children was evaluated using the WHO assessment form (2013) and modified OHI-S (oral hygiene index- simplified) at baseline, 6 month and 12-month period. The effectiveness of KAP of caregivers and the oral health status of their children was correlated at the end of the study.

STATISTICAL ANALYSIS

The mean KAP scores between caregivers' of study and control group at different time intervals was compared using repeated measures of ANOVA test. Chi square test was used to compare the presence of bleeding gums and Mann Whitney U Test was used to compare the mean DMFT, deft and OHIs scores at different time intervals between study and control groups. Pearson correlation test was used to assess the relationship between KAP scores and clinical parameters at different time intervals in study and control group of both the populations.

CONCLUSION

The oral health education given to the caregivers has shown a positive impact on the oral health status of their children. Periodic reinforcement of the oral health-related measures among caregivers of children with hearing impairment is recommended.

A clinical and radiographic comparative evaluation of custom-made zirconia crowns using CAD-CAM and stainless steel crowns in primary molars

BACKGROUND AND AIM OF STUDY

Early childhood caries is a multifactorial disease process affecting children below 71 months of age and continues to be a global health problem. Stainless steel crowns (SSCs) are widely used and are very popular in pediatric dentistry due to its superiority and durability when compared with multisurface amalgam restorations. However, one of the major disadvantages with these crowns is the poor esthetics. Parents often request for a more esthetic alternative to the SSC. Zirconia crowns are one of the tooth-colored full crown restorations currently available for use in primary teeth. These are available as both preformed and custom-made crowns and show excellent esthetics. However, these require extensive tooth preparation with a subgingival finish lines, which would cause gingival trauma and bleeding during the preparation. The present study uses intraoral scanners for making the custom-made zirconia crowns, which will avoid the conventional impressions. Currently, there are no studies available in pediatric dentistry regarding CAD-CAM crowns. Hence, there is a need for the study.

AIM

The aim of this study is to clinically evaluate the performance of preformed SSCs and custom-made zirconia crowns in primary molars. To elicit parental and patient satisfaction with respect to preformed SSCs and custom made zirconia crowns and to radiographically compare the interproximal bone height for 1 year.

METHODS

The patients were selected with purposive sampling. The tooth of interest was prepared according to the crown it would receive. The upper and the lower arch of the tooth receiving custom-made zirconia crown was scanned using an intraoral scanner. The crowns were cemented using Type 1 glass ionomer cement (GIC) (SSC) and resin modified GIC (custom-made zirconia crown). After the crown placement, the patient and the parent's satisfaction was scaled regarding the time taken, comfort, cost of crown, appearance of crown, etc., using a 5-point Likert scale. A baseline radiograph was taken after crown placement. The patient was recalled every 3 months till 1 year for evaluation (loss of retention, loss of proximal contact, gingival inflammation, opposing tooth wear, and marginal integrity). At the end of 1 year, radiographs were taken to check the interproximal bone.

RESULTS

After 1 year evaluation of custom-made zirconia crowns and preformed SSCs in primary molars, it was shown that both SSC and zirconia crowns showed good gingival scores but zirconia crown was better than SSC in improving the gingival health. SSCs showed better results with respect to the opposing tooth wear and marginal adaptability. Parents as well as patients preferred a tooth-colored crown as a treatment option.

CONCLUSION

Custom-made zirconia crowns are comparable to the preformed SSCs and they show better gingival scores and excellent color match.

A comparative evaluation of pain perception following topical application of benzocaine gel, clove-papaya based anesthetic gel and precooling of the injection site before intraoral injections in children

BACKGROUND AND AIM OF THE STUDY

The topical anesthetic property of clove remains unexplored even though it has been widely used in dentistry since ages. Hence, the aim of the study was to compare the topical anesthetic efficiency of precooling with ice, clove-papaya based topical gel and benzocaine gel in pediatric patients.

METHODOLOGY

Sixty healthy children aged 9-10 years who required local anesthetic injections for dental procedures were selected and divided into three groups with 20 patients each. In the first visit, written consent and intraoral screening of the patients were performed. In the second visit, the topical anesthetic agents were applied in the respective groups for 1 min and later local anesthetic injections were administered. Pain perception was evaluated using Sound, Eye, Motor Scale (SEM scale) and Wong Baker Faces Pain Rating Scale (WBFPRS), tabulated, and statistically analyzed. A.

RESULTS

The test results demonstrated that benzocaine group has the highest mean WBFPRS score followed by clove-papaya group and then ice cone group. The ice group showed the least mean SEM scale score, followed by the benzocaine group and then clove-papaya group. However, the mean WBFPRS score and the mean SEM scale score did not show any statistically significant difference.

INTERPRETATION AND CONCLUSION

All the three topical anesthetic agents provided similar surface anesthesia in children. The newly introduced clove-papaya based topical anesthetic gel showed encouraging results, hence can be used as a potent topical anesthetic agent.

Potential of acute phase proteins as predictor of postpartum uterine infections during transition period and its regulatory mechanism in dairy cattle

Among the various systemic reactions against infection or injury, the acute phase response is the cascade of reaction and mostly coordinated by cytokines-mediated acute phase proteins (APPs) production. Since APPs are sensitive innate immune molecules, they are useful for early detection of inflammation in bovines and believed to be better discriminators than routine hematological parameters. Therefore, the possibility of using APPs as a diagnostic and prognostic marker of inflammation in major bovine health disorders including postpartum uterine infection has been explored by many workers. In this review, we discussed specifically importance of postpartum uterine infection, the role of energy balance in uterine infections and potential of APPs as a predictor of postpartum uterine infections during the transition period and its regulatory mechanism in dairy cattle.

Assessment of the effect of probiotic curd consumption on salivary pH and streptococcus mutans counts

BACKGROUND

Antimicrobial methods of controlling dental caries that include probiotic agents can play a valuable role in establishing caries control in children at moderate to high risk for developing dental caries. Several studies have demonstrated the beneficial effects of use of various Probiotic products including curd. The objective of this study was to compare the effect of short-term consumption of probiotic curd containing Lactobacillus acidophilus and normal curd on salivary Streptococcus Mutans counts, as well as salivary pH.

MATERIALS AND METHODS

Forty, caries-free, 10-12 years old children were selected and randomly allocated to two groups. Test Group consisted of 20 children who consumed 200ml of probiotic curd daily for 30 days. Control Group consisted of 20 children who were given 200ml of regular curd for 30 days. Salivary pH and salivary Streptococcus Mutans counts were recorded at baseline and after 30 days and statistically compared using the Student's t-test.

RESULTS

Consumption of probiotic curd resulted in a statistically significant reduction in S. Mutans colony counts (P<0.001) as compared to regular curd. However, there was a slight reduction in pH (P>0.05) in both the groups.

CONCLUSION

Short-term consumption of probiotic curds can reduce oral S. Mutans counts. However, this caused a slight reduction in salivary pH.

Accidental ingestion of foreign object: Systematic review, recommendations and report of a case

One of the serious complications during a routine endodontic procedure is accidental ingestion/aspiration of the endodontic instruments, which can happen when proper isolation is not done. There are at present no clear guidelines whether foreign body ingestion in the gastrointestinal tract should be managed conservatively, endoscopically or surgically. A 5 year old boy reported to the Department of Pediatric and Preventive Dentistry, D.A. Pandu Memorial R.V. Dental College, Bangalore, India, with a complaint of pain and swelling in the lower right back teeth region. Endodontic therapy was planned for the affected tooth. During the course of treatment the child accidentally swallowed a 21 mm 15 size K file. Endoscopy was performed immediately but the instrument could not be retrieved. The instrument passed out uneventfully along with the stools 48 h after ingestion. Careful evaluation of the patient immediately after the accident helps in managing the patient effectively along with following the recommended guidelines.