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Cleft lip and palate are the most frequently observed congenital abnormalities affecting the maxillofacial region. They can occur isolated or together in various combinations. These deformities are also associated with features found in over 300 recognised syndromes. Additionally, there are several problems, including social limitations, such as difficulties in breastfeeding resulting in failure to grow properly, speech abnormalities, hearing loss, misalignment of teeth, significant facial abnormalities, and serious aesthetic, psychological, and psychosocial challenges. Treatment modalities involve a number of specialists, such as Maxillofacial and Plastic surgeons, Anaesthetists, Orthodontists, Restorative dentists, Paediatric dentists and Prosthodontists, who collaborate to determine the best treatment plan based on the site of the defect and the patient's age. The present case report discusses the treatment and management of a 16-year-old female patient who presented with cleft lip and palate, along with skeletal class III malocclusion, hypodontia, multiple decayed teeth and dental malformation. The patient had missing lateral incisors and canines in the maxillary arch, along with carious maxillary central incisors. The purpose of this article is to report the multidisciplinary management of a unilateral cleft lip and palate patient with class III malocclusion, utilising orthognathic surgery, as well as, incorporating endodontic and prosthodontic corrections.

Introduction: Very little is known about the hard to reach tribal communities in India and one such community is a primitive hidden and isolated tribe group of Bharia people in Patalkot. Their health problems need special attention as they have very limited access to health care. The aim of this study is to assess the oral hygiene and periodontal status in the primitive tribe group of Bharias in Patalkot, Madhya Pradesh, India. Materials and Methods: A descriptive cross-sectional study was undertaken with sample size of 462 patients. The sample was selected using simple random technique. A predefined pro forma was used to record information about oral hygiene practices and tobacco-related habits. Oral Hygiene Index-simplified (OHI-S), Community Periodontal Index (CPI), and loss of attachment (LOA) were used to assess oral hygiene and periodontal status, respectively. Results: The prevalence of periodontal disease based on CPI scores showed that 35.4 % had periodontal pocket > 6mm. It was also found that 27.9% people had attachment loss of 6-8mm. Mean Debris Index-simplified, Calculus Index-simplified, and OHI-S for the participants were 1.59 ± 0.73, 0.99 ± 0.70, and 2.56 ± 1.36, respectively. Poor oral hygiene status was found in 36.3% of Bharias. Conclusion: Higher prevalence of periodontal diseases and poor oral hygiene status in Bharia people can be attributed mainly to their difficult terrain, isolation, very low literacy level, socioeconomic status, and cultural practices.

Introduction: The present study was conducted to determine the comparative variations in dermatoglyphic patterns in patients without oral submucous fibrosis (OSMF) and leukoplakia and those having lesions, as well as to predict the occurrence of these diseases and initiate preventive measures in these high-risk patients. Materials and Methods: Dermatoglyphic patterns were collected from randomly selected 120 patients using 3M™ CSD200i. Single-digit Optical Scanner (3M™, Canada, 2015) with automatic capture mechanism was applied to capture finger prints of all the 10 fingers of patients, who were divided in control and test group with respective subgroups of leukoplakia and OSMF. Qualitative analysis of dermatoglyphic patterns in the different groups showed loops, arches, and whorls. Results: The collected data was subjected to analysis using Chi-square test for comparison between the groups; significant difference in P value was observed on comparison between dermatoglyphic patterns in patients with leukoplakia and those with adverse oral habits but without oral lesions (P = 0.00005), patients with OSMF and individuals with adverse oral habits but without oral lesions (P = 0.03), patients with OSMF and individuals without adverse oral habits and without oral lesions (P = 0.004), leukoplakia and OSMF (P = 0.007). Quantitative analysis including total finger ridge count was done by counting the number of ridges in all 10 fingers for all the patients in all the groups. Conclusion: The present study showed weak association in the loop pattern of patients with OSMF than leukoplakia, whorl pattern with adverse oral habits, without oral lesions, and arch pattern with OSMF. More controlled prospective trials are needed to affirm the association, if any, at larger homogeneous Indian sample in future to validate the finding.

Anchorage control during the correction of severely crowded dentitions has always been a source of concern during orthodontic therapy. The Nance palatal arch (NPA) has, in the past, been widely used for reinforcing anchorage in such cases. Modifications of the NPA have been reported for use as a fixed functional appliance or for molar distalization. Herein, a simple, effective modification of the conventional NPA is introduced incorporating two power arms, which can be used for unravelling of anterior crowding at the same time effectively augmenting molar anchorage.

Objective: To determine the prevalence and counts of Streptococcus mutans and Candida species in orthodontic fixed appliance therapy patients and comparison of the efficiency of manual and electronic toothbrushes on minimizing plaque by reducing S. mutans and Candida species in above-mentioned patients. Materials and Methods: The study was carried out on total number of sixty patients scheduled for orthodontic treatment (age group: 13–18). Plaque samples were collected to determine oral carriage of S. mutans and Candida of these patients, and readings were noted at T0 (before appliance placement), 2nd and 3rd month after the placement of appliances (T1 and T2). Counts of S. mutans were determined using Dentocult SM kit. Candida was cultured on Sabouraud's dextrose agar. The participants in the study group (orthodontic patients) were then divided into two groups each of 30: Group 1 (manual toothbrush), Group 2 (electronic toothbrush), and plaque samples were taken at the end of 1st, 2nd, and 3rd month to determine the efficacy of manual versus electronic toothbrushes. Results: After orthodontic treatment, colonization of S. mutans and Candida increased dramatically. Results for S. mutans counts and Candida clearly showed superiority of electronic tooth brushing over manual tooth brushing during orthodontic treatment. Conclusion: Results clearly showed that orthodontic appliances increase colonization of S. mutans and Candida albicans in oral cavity over the period of treatment time which can be controlled with proper timely brushing. The study also concludes superiority of electronic tooth brushing over manual tooth brushing.

Aim: The purpose of present study was to investigate the scanning electron microscopic alterations produced on scaled and root planed dentin surfaces after application of different etching modalities namely citric acid, tetracycline hydrochloride and ethylenediaminetetraacetic acid (EDTA). Materials and Methods: Eighty specimens of teeth were collected and categorized into four groups. In group 1, control group specimens were treated with normal saline for 3 min, group 2 specimens were treated with citric acid, group 3 specimens were treated with tetracycline hydrochloride for 3 min and group 4 specimens were treated with 15% EDTA. Results: Opening of dentinal tubules was seen in all specimens except for control group that was treated with normal saline. The total number of tubules seen was highest in citric acid group as compared to tetracycline hydrochloride and EDTA Group. The total number of patent tubule opening was highest in citric acid as compared to EDTA and tetracycline. The diameter of patent dentinal tubules in citric acid group was more than EDTA and tetracycline. Conclusion: The study showed that all the three agents were effective in removing the smear layer however number of patent and wider diameter dentinal tubules was seen in vitro best in citric acid than EDTA and then in tetracycline hydrochloride. Hence, citric acid group is more efficient than EDTA and tetracycline HCl group in removing the smear layer and in opening of number of patent dentinal tubules.

Introduction: The restoration of normal jaw function, optimal facial aesthetics and long term stability are the goals of any orthognathic surgical procedures. During the last two decades, several cephalometric investigations have been reported on the skeletal changes following maxillary surgical procedures. The stability following LeFort I osteotomy and maxillary superior repositioning of the maxilla has not been studied extensively. Aim: This study was aimed at determining the surgical changes brought about by superior repositioning of the maxilla by Le Fort I osteotomy and evaluate the stability of the surgical procedure one year following surgery. Materials and Methods: Presurgical and postsurgical and one year post surgical lateral cephalograms of 10 adult patients (age group - 17 to 40 years, with a mean age of 22.2 years) who had been treated successfully by maxillary Le-Fort I osteotomy and impaction were obtained. The lateral cephalograms were grouped into three categories: T1- Presurgical, T2- Postsurgical, T3- One year postsurgical. Comparisons were made between T1-T2 and T2-T3 to assess the changes following surgery and to evaluate the stability, one year following the surgery using 5 horizontal, 5 vertical linear and 2 angular measurement. Statistical analysis was done with SPSS ( Version 17). Results were expressed as mean±standard deviation. A paired t-test was used to analyze the paired observations. Results: The difference between T1 and T2 values of vertical changes showed that they were statistically highly significant whereas from T2 to T3 they were insignificant. The difference between T1 and T2 values of all the horizontal changes showed that they were statistically significant whereas True Vertical Line (TVL) to point Anterior Nasal Spine (ANS) was not statistically significant. The horizontal changes from T2 to T3 were statistically not significant whereas TVL to point Incisal edge of upper incisor (Is) was statistically significant. The angular changes from T1 to T2, T2 to T3 were statistically not significant. Conclusion: There was a significant reduction in the facial height and significant anterior movement of maxilla after surgery. Even after one year of surgery, negligible amount of relapse was recorded except at the incisors.

Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion in Class II division 1 malocclusions with functional mandibular retrusion. Appearance of bilateral severe posterior open bite in some cases subsequent to completion of active phase of Twin block therapy poses a challenge to an orthodontist. Closure of posterior open bites of large magnitude is difficult to achieve with conventional upper anterior inclined plane used during support phase of Twin-block therapy. A simple yet effective modification of upper anterior inclined plane is proposed, which is an effective and invaluable adjunctive aid in correction of posterior open bite.

Obstructive Sleep Apnea (OSA) is a chronic, progressive, multifactorial, life-threatening disorder that causes significant impact on patient’s life. Patients with OSA [Apnea/Hypopnea Index (AHI)>30] who cannot tolerate Continuous Positive Airway Pressure (CPAP) therapy or are not surgical candidates may benefit from oral appliances. This paper describes interim appliance devised from existing Hawley’s retainer in patients with OSA. A 38-year-old man of athletic built with history of orthodontic treatment six months back due to esthetic concerns and wearing upper Hawley’s retainer, reported with chief complaint of frequent nocturnal awakening along with excessive daytime somnolence. Based on diagnostic aids, he was diagnosed with Class II Division 1 malocclusion with severe mandibular retrusion. Sleep test revealed AHI score of 34, suggestive of severe OSA. With ENT and Oral surgeon concurrence, mandibular advancement of 7mm with Bilateral Sagital Split Osteotomy (BSSO) with distraction was contemplated as a viable functional and curative stable treatment plan. Because of non-adherence and non-compliance with CPAP therapy and on request of patient, an interim anterior positioning appliance was devised to facilitate comfortable sound sleep till the time surgery is impending. After three months of wearing this customized appliance, improved quality of sleep was discernible; both subjectively as reported by patient and objectively using sleep test (AHI=9.8).

Introduction: With increasing use of Indian made orthodontic materials, need was felt to know nickel and chromium release from these material. Materials and Methods: This study was conducted on simulated appliances consisting of brackets (022’’Roth, Modern orthodontics, Ludhiana, India), from second premolar to central incisor, buccal tube and 0.019×0.025- inch SS arch wires secured with SS ligatures. Immersion was done in artificial saliva. Samples were analysed to using Atomic Absorption Photospectrometer (GVC ScientificEquipment Pvt. Ltd Australia) at AES Laboratories (P) Ltd., Noida India on 1st, 7th, 14th and 28th day. Results: SPSS (ver 17, Inc., Chicago, Illinois, USA) was used toperform the statistical analysis. Descriptive statistics i.e. median and 25 and75 percentiles were used. Peak nickel release was on 7th day and subsequently declined over 14th and 28th day. The peak level of chromium concentration was on 14th day, which declined thereafter. Conclusion: Average daily release of nickel and chromium over a period of one month was 97.368 μg/day and 47.664 μg/day respectively. The estimated release rates were approximately 32% and 16% of the reported average daily dietary.

Background: Newer available composite resin adhesives have chromatic agents that change their color during setting from pink to colorless. It has an advantage of easy flash removal thus reducing the amount of plaque accumulation and helping patients to maintain better hygiene. Aim: The aim of the present study was to compare shear bond strengths of light-cure orthodontic bonding agents, namely glass ionomer (FujiOrthoLC, GC Orthodontics), conventional composite resin (Transbond XT, 3M Unitek), and color-changing composite resin (Transbond Plus, 3M Unitek) with conventional etch and self-etch primer (Transbond PlusSEP, 3M Unitek). Materials and Methods: Maxillary premolars (n=300) were bonded on the facial surface in five groups. The INSTRON machine was used for shear bond strength testing. Statistical Analysis: Comparison of the mean rank among the groups was done by Kruskal-Wallis one-way analysis of variance (ANOVA). To determine the mean difference among groups, the Mann-Whitney test with Bon Ferroni adjustment was applied. Observations: It was observed that light-cure conventional composite resin with the conventional etchant group had the highest and glass ionomer resin adhesive had the lowest shear bond strength. There was no statistically significant difference between conventional composite used with conventional etchant and color-changing composite resin used with conventional etchant or with self-etch primer. Conclusion: Considering the advantages of a color-changing composite and self-etch primer especially in patients having high DMFT scores or physically and mentally compromised patients unable to maintain their hygiene properly, it was concluded in the present study that it would be the most suitable material for direct bonding.

Human mitochondrial voltage-dependent anion channel 2 (hVDAC-2), the most predominant isoform seen in brain mitochondria, is not only crucial for cell survival but is also implicated in Alzheimer disease. The abundance of cysteines in this isoform is particularly fascinating, as hVDAC-1 cysteines have no associated functional role. We report a detailed biophysical examination of a Cys-less mutant of hVDAC-2, and its behavioral comparison with the wild type protein. Our findings suggest that cysteine mutation results in the formation of a better barrel at the expense of weakened protein-lipid interactions. Thewild type protein displays stronger lipid association, despite being less structured. A reversal in behavior of both proteins is observed in the case of chemical denaturation, with the Cys-less mutant exhibiting lowered unfolding free energies. In bicellar systems comprising 14-C phosphocholines, we observe that protein-lipid interactions are weakened in both constructs, resulting in barrel structure destabilization. Our biochemical and biophysical studies together reveal key structural roles for the cysteine residues.We find that minor conformational variations in local residues are sufficient to define the membrane protein dynamics in hVDAC-2. Such subtle sequence variations contribute to differential stability of VDACs and may have implications in their in vivo regulation and recycling. [ABSTRACT FROM AUTHOR]

Delineating the kinetic and thermodynamic factors which contribute to the stability of transmembrane β-barrels is critical to gain an in-depth understanding of membrane protein behavior. Human mitochondrial voltage-dependent anion channel isoform 2 (hVDAC-2), one of the key anti-apoptotic eukaryotic β-barrel proteins, is of paramount importance, owing to its indispensable role in cell survival. We demonstrate here that the stability of hVDAC-2 bears a strong kinetic contribution that is dependent on the absolute micellar concentration used for barrel folding. The refolding efficiency and ensuing stability is sensitive to the lipid-to-protein (LPR) ratio, and displays a non-linear relationship, with both low and high micellar amounts being detrimental to hVDAC-2 structure. Unfolding and aggregation process are sequential events and show strong temperature dependence. We demonstrate that an optimal lipid-to-protein ratio of 2600∶1 - 13,000∶1 offers the highest protection against thermal denaturation. Activation energies derived only for lower LPRs are ∼17 kcal mol(-1) for full-length hVDAC-2 and ∼23 kcal mol(-1) for the Cys-less mutant, suggesting that the nine cysteine residues of hVDAC-2 impart additional malleability to the barrel scaffold. Our studies reveal that cysteine residues play a key role in the kinetic stability of the protein, determine barrel rigidity and thereby give rise to strong micellar association of hVDAC-2. Non-linearity of the Arrhenius plot at high LPRs coupled with observation of protein aggregation upon thermal denaturation indicates that contributions from both kinetic and thermodynamic components stabilize the 19-stranded β-barrel. Lipid-protein interaction and the linked kinetic contribution to free energy of the folded protein are together expected to play a key role in hVDAC-2 recycling and the functional switch at the onset of apoptosis.

The anti-apoptotic 19-stranded transmembrane human voltage dependent anion channel isoform 2 (hVDAC-2) β-barrel stability is crucial for anion transport in mitochondria. The role of the unusually high number of cysteine residues in this isoform is poorly understood. Using a Cys-less construct of hVDAC-2, we have investigated the contribution of cysteines to channel function, barrel stability and its influence on the strength of protein-micelle interactions. We observe that despite the overall preservation in barrel structure upon cysteine mutation, subtle local variations in the mode of interaction of the barrel with its refolded micellar environment arise, which may manifest itself in the channel activity of both the proteins.Fluorescence measurements of the Trp residues in hVDAC-2 point to possible differences in the association of the barrel with lauryldimethylamine oxide (LDAO) micelles. Upon replacement of cysteines in hVDAC-2, our data suggests greater barrel rigidity by way of intra-protein interactions. This, in turn, lowers the equilibrium barrel thermodynamic parameters in LDAOby perturbing the stability of the protein-micelle complex. In addition to this, we also find a difference in the cooperativity of unfolding upon increasing the LDAO concentration, implying the importance of micelle concentration and micelle-protein ratios on the stability of this barrel. Our results indicate that the nine cysteine residues of hVDAC-2 are the key in establishing strong(er) barrel interactions with its environment and also impart additional malleability to the barrel scaffold.