Publications by authors named "Om Prakash Kharbanda"

36 Publications

Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions.

BDJ Open 2021 Jan 26;7(1). Epub 2021 Jan 26.

Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Molecular diagnostics for SARS-CoV-2 infection characteristically involves the sampling of the throat or nasopharyngeal swab (NPS). However, these procedures are invasive, require necessary skills for sample collection, cause patient discomfort, and are non-conducive for extensive scale testing. Saliva is increasingly being suggested as an alternate diagnostic sample in SARS-CoV-2 infection.

Objectives: This scoping review was done with the objective of exploring the evidence on the role of saliva as an alternate diagnostic sample in SARS-CoV-2 condition.

Methods: Thorough search of the literature in major databases was undertaken in June 2020 using free text and MESH terms, followed by PRISMA to identify 17 studies for data extraction.

Results And Conclusions: Evidence was summarised for study characteristics, salivary sampling characteristics, viral load, and longevity of virus in saliva. The literature supports that saliva offers a simple sample collection method compared to technique-sensitive NPS and has the advantage of point-of-care testing for initial screening in community or hospital-based set-up. The additional highlights of this review are heterogeneity in the current literature and the gaps in methodology. Therefore, a robust study design to generate higher levels of evidence has been proposed.
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http://dx.doi.org/10.1038/s41405-021-00064-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836040PMC
January 2021

Levels of TGF-β1 in peri-miniscrew implant crevicular fluid.

J Oral Biol Craniofac Res 2020 Apr-Jun;10(2):93-98. Epub 2020 Mar 6.

Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India.

The peri-miniscrew implant crevicular fluid is analogous to gingival crevicular fluid, and its contents reflect the state of inflammation and health during the life of the miniscrews in the mouth. The stability of MSI is fundamental to its role as an anchorage. This study aimed to evaluate transforming growth factor-beta one (TGF-β1) of the peri-miniscrew implant crevicular fluid (PMICF), on implant insertion, pre- and post-loading of MSIs to find a clue to their role in the stability of MSI. Fifty-two MSIs sites were placed in the mouths of 13 patients aged 12-26 years undergoing orthodontic treatment. PMICF was collected using micro-pipettes at T1 (day 0, 1 h after MSI implantation), T2 (day 1), T3/baseline (day 21, preloading of MSI), T4 (day 21, 1 h post loading), T5 (day 22, 1 day post loading), T6 (day 43, 3 weeks post loading). The levels of TGF-β1 were estimated by enzyme-linked immunosorbent assay (ELISA). The data were subjected to statistical analysis. Of the 52 MSIs, 20 MSIs failed at T3. In the case of successful MSIs, the TGF-β1 levels were found to monotonously decrease from T1 (~1400 pg/mL) until T3 (~700 pg/mL) and saturate thereafter. In the case of failed MSIs, the levels of TGF-β1 at various time periods were approximately constant and of much lower value than corresponding time periods of successful MSIs. This study highlights the role of TGF- β1 in bone metabolism around miniscrew reflecting the state of inflammation from 1 h post-implantation.
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http://dx.doi.org/10.1016/j.jobcr.2020.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082543PMC
March 2020

Palatal volume estimation in operated unilateral and bilateral cleft lip and palate subjects using digital study models.

Orthod Craniofac Res 2020 Aug 20;23(3):284-290. Epub 2020 Feb 20.

Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Scientific Instruments Organisation, Chandigarh, India.

Objective: To quantify and compare palatal volume of operated unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) subjects.

Setting And Sample Population: This cross-sectional study was conducted on 85 study models comprising of 40 operated UCLP subjects (UG; mean age 10.33 ± 1.76 years), 25 operated BCLP subjects (BG; mean age 10.44 ± 1.92 years) and 20 non-cleft controls (C; mean age 12.90 ± 1.68 years).

Materials And Method: The study models were scanned using 3D scanner and palatal volume assessment done using 3-matic software. Kruskal-Wallis test for palatal volume and one-way ANOVA for intercanine (IC), interpremolar (IPM) and intermolar (IM) width comparison were used. Pearson correlation was done between IM, IPM, and IC width, and palatal volume for three groups. The control group sample was evaluated by two observers to evaluate the interobserver reliability.

Results: The median palatal volume of C, UG and BG groups was 5814.31 mm , 2452.34 mm and 1688.39 mm , respectively. Significantly smaller palatal volume was found in UG and BG compared to control. Significant difference was seen in IC width between three groups. The IM, IPM and IC width with palatal volume in UG and IM width with palatal volume in BG group showed significant correlation. The ICC showed excellent agreement (>0.9) between observers.

Conclusion: Palatal volume of UG and BG groups was smaller by 57.82% and 71.1%, respectively, compared to controls. Improving IPM width in UG and IM width in BG seems to have more impact in correction of palatal volume.
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http://dx.doi.org/10.1111/ocr.12368DOI Listing
August 2020

Interdisciplinary Management of an Adult Bilateral Cleft Lip and Palate Patient with Excessive Incisor Display - A Case Report.

Turk J Orthod 2019 Sep 1;32(3):176-181. Epub 2019 Sep 1.

Department of Orthodontics and Dentofacial Deformities, All India Institute of Medical Sciences, Centre for Dental Education and Research, New Delhi, India.

This case report shows a successful orthodontic treatment of an operated adult bilateral cleft lip and palate subject with short upper lip and excessive incisor display. The patient underwent cleft lip repair at an early age of 2.5 years, followed by palatoplasty at the age of 21 years. She presented with malaligned teeth, inability to close the lips, excessive upper incisor display, and difficulty in speech. She was treated with upper and lower arch alignment and intrusion of the upper incisors, followed by prosthetic replacement of the missing right lateral incisor and left lateral incisor and canine. Normal dental occlusion was achieved using orthodontic procedures, followed by prosthodontic rehabilitation that resulted in significant improvement in facial aesthetics and psychosocial benefit to the individual.
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http://dx.doi.org/10.5152/TurkJOrthod.2019.18054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756560PMC
September 2019

Digital possibilities in the prevention and early detection of oral cancer in the WHO South-East Asia Region.

WHO South East Asia J Public Health 2019 09;8(2):95-100

Centre for Dental Education and Research, All India Institute of Medical Sciences, World Health Organization Collaborating Centre for Oral Health Promotion, New Delhi, India

Cancers of the lip and oral cavity are the most common cancers among men in the World Health Organization (WHO) South-East Asia Region. Most cancers of the oral cavity are attributable to tobacco smoking, smokeless tobacco use and areca-nut product use, alone or in combination, and excessive consumption of alcohol. These risk factors are highly prevalent in parts of the region. This paper outlines an integrated framework for oral cancer prevention, which includes a strengthened primary health-care workforce, enhanced community engagement and a positive policy environment. Operationalizing this framework could be greatly facilitated by the application of digital technologies. Robust evidence exists for the effectiveness of using appropriately trained primary health-care workers to screen for oral cancer by oral visual examination; this can be combined with counselling for riskbehaviour modification as part of an overall strategy on noncommunicable diseases. This needs to be supported by greater overall community engagement, for example to tackle low levels of awareness of the harmful effects of smokeless tobacco and areca-nut products. A strong policy environment that supports and promotes these efforts is essential, along with the enforcement of the measures required by the WHO Framework Convention on Tobacco Control. Despite the burden of disease, oral cancer has been a neglected area of public health. This paper considers how the positively disruptive effects of digital technology may enable much-needed acceleration in prevention and control efforts.
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http://dx.doi.org/10.4103/2224-3151.264853DOI Listing
September 2019

Accidental Swallowing of a Molar Band.

Turk J Orthod 2019 Jun 21;32(2):115-118. Epub 2019 Jan 21.

Division of Orthodontics and Dentofacial Deformities Centre for Dental Education and Research, All India Institue of Medical Sciences, New Delhi, India.

Accidental ingestion or aspiration of foreign bodies is considered as a medical emergency in dentistry. Despite their rare occurrence, accidental ingestions are associated with various complications and morbidity, thereby necessitating prevention of their incidence along with early and effective management. Herein, we report a case of accidental swallowing of an orthodontic molar band in a patient with unilateral cleft lip and palate and its management.
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http://dx.doi.org/10.5152/TurkJOrthod.2019.18001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605883PMC
June 2019

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review.

Dental Press J Orthod 2019 May;24(2):40.e1-40.e22

All India Institute of Medical Sciences,Department of Biochemistry (New Delhi, India).

Objective: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement.

Methods: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search.

Results: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), β-glucuronidase (βG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude.

Conclusions: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.
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http://dx.doi.org/10.1590/2177-6709.24.2.40.e1-22.onlDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526765PMC
May 2019

The reliability of different methods of manual volumetric segmentation of pharyngeal and sinonasal subregions.

Oral Surg Oral Med Oral Pathol Oral Radiol 2017 Dec 18;124(6):577-587. Epub 2017 Sep 18.

Academy of Scientific & Innovative Research, Council of Scientific and Industrial Research-Central Scientific Instruments Organisation, Chandigarh, India.

Objectives: The purpose of the study was to test the intra and interobserver reliability of manual volumetric segmentation of pharyngeal and sinonasal airway subregions.

Study Design: Cone beam computed tomography data of 15 patients were collected from an orthodontic clinical database. Two experienced orthodontists independently performed manual segmentation of the airway subregions. Four performance measures were considered to test intra and interobserver reliability of manual segmentation: (1) volume correlation, (2) mean slice correlation, (3) percentage of volume difference, and (4) percentage of nonoverlapping voxels.

Results: Intra and interobserver reliability was observed to be greater than 0.96 for the entire pharyngeal and sinonasal airway sinus subregions by both observers using the volume correlation method. Mean slice correlation was found to be greater than 0.84, showing the existence of nonoverlapping voxels. Therefore, the percentage of nonoverlapping voxels was used as a reliability measure and was found to be less than 20% for both intra and interobserver markings.

Conclusions: The mean slice correlation and percentage of nonoverlapping voxels were the most reliable performance measures of segmentation correctness. Volume correlation and the percentage of volume difference were observed to be the most reliable performance measures for volume correctness.
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http://dx.doi.org/10.1016/j.oooo.2017.08.020DOI Listing
December 2017

Automatic localization of three-dimensional cephalometric landmarks on CBCT images by extracting symmetry features of the skull.

Dentomaxillofac Radiol 2018 Feb 3;47(2):20170054. Epub 2018 Jan 3.

1 Academy of Scientific & Innovative Research (AcSIR) , Chennai , India.

To propose an algorithm for automatic localization of 3D cephalometric landmarks on CBCT data, those are useful for both cephalometric and upper airway volumetric analysis. 20 landmarks were targeted for automatic detection, of which 12 landmarks exist on the mid-sagittal plane. Automatic detection of mid-sagittal plane from the volume is a challenging task. Mid-sagittal plane is detected by extraction of statistical parameters of the symmetrical features of the skull. The mid-sagittal plane is partitioned into four quadrants based on the boundary definitions extracted from the human anatomy. Template matching algorithm is applied on the mid-sagittal plane to identify the region of interest ROI, further the edge features are extracted, to form contours in the individual regions. The landmarks are automatically localized by using the extracted knowledge of anatomical definitions of the landmarks. The overall mean error for detection of 20 landmarks was 1.88 mm with a standard deviation of 1.10 mm. The cephalometric land marks on CBCT data were detected automatically with in the mean error less than 2 mm.
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http://dx.doi.org/10.1259/dmfr.20170054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965913PMC
February 2018

A pilot study for segmentation of pharyngeal and sino-nasal airway subregions by automatic contour initialization.

Int J Comput Assist Radiol Surg 2017 Nov 28;12(11):1877-1893. Epub 2017 Jul 28.

Academy of Scientific and Innovative Research (AcSIR), Chennai, India.

Purpose: The objective of the present study is to put forward a novel automatic segmentation algorithm to segment pharyngeal and sino-nasal airway subregions on 3D CBCT imaging datasets.

Methods: A fully automatic segmentation of sino-nasal and pharyngeal airway subregions was implemented in MATLAB programing environment. The novelty of the algorithm is automatic initialization of contours in upper airway subregions. The algorithm is based on boundary definitions of the human anatomy along with shape constraints with an automatic initialization of contours to develop a complete algorithm which has a potential to enhance utility at clinical level. Post-initialization; five segmentation techniques: Chan-Vese level set (CVL), localized Chan-Vese level set (LCVL), Bhattacharya distance level set (BDL), Grow Cut (GC), and Sparse Field method (SFM) were used to test the robustness of automatic initialization.

Results: Precision and F-score were found to be greater than 80% for all the regions with all five segmentation methods. High precision and low recall were observed with BDL and GC techniques indicating an under segmentation. Low precision and high recall values were observed with CVL and SFM methods indicating an over segmentation. A Larger F-score value was observed with SFM method for all the subregions. Minimum F-score value was observed for naso-ethmoidal and sphenoidal air sinus region, whereas a maximum F-score was observed in maxillary air sinuses region. The contour initialization was more accurate for maxillary air sinuses region in comparison with sphenoidal and naso-ethmoid regions.

Conclusion: The overall F-score was found to be greater than 80% for all the airway subregions using five segmentation techniques, indicating accurate contour initialization. Robustness of the algorithm needs to be further tested on severely deformed cases and on cases with different races and ethnicity for it to have global acceptance in Katradental radKatraiology workflow.
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http://dx.doi.org/10.1007/s11548-017-1650-1DOI Listing
November 2017

Authors' response.

Am J Orthod Dentofacial Orthop 2017 06;151(6):1018-1019

Chandigarh and New Delhi, India.

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http://dx.doi.org/10.1016/j.ajodo.2017.03.005DOI Listing
June 2017

Authors' response.

Am J Orthod Dentofacial Orthop 2017 02;151(2):234

New Delhi, India.

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http://dx.doi.org/10.1016/j.ajodo.2016.10.018DOI Listing
February 2017

Precision of manual landmark identification between as-received and oriented volume-rendered cone-beam computed tomography images.

Am J Orthod Dentofacial Orthop 2017 Jan;151(1):118-131

CSIR-Central Scientific Instruments Organisation (CSIO); Academy of Scientific and Innovative Research (AcSIR-CSIO), Chandigarh, India.

Introduction: The objective of this study was to evaluate the effect of the orientation of cone-beam computed tomography (CBCT) images on the precision and reliability of 3-dimensional cephalometric landmark identification.

Methods: Ten CBCT scans were used for manual landmark identification. Volume-rendered images were oriented by aligning the Frankfort horizontal and transorbital planes horizontally, and the midsagittal plane vertically. A total of 20 CBCT images (10 as-received and 10 oriented) were anonymized, and 3 random sets were generated for manual landmark plotting by 3 expert orthodontists. Twenty-five landmarks were identified for plotting on each anonymized image independently. Hence, a total of 60 images were marked by the orthodontists. After landmark plotting, the randomized samples were decoded and regrouped into as-received and oriented data sets for analysis and comparison. Means and standard deviations of the x-, y-, and z-axis coordinates were calculated for each landmark to measure the central tendency. Intraclass correlation coefficients were calculated to analyze the interobserver reliability of landmark plotting in the 3 axes in both situations. Paired t tests were applied on the mean Euclidean distance computed separately for each landmark to evaluate the effect of 3-dimensional image orientation.

Results: Interobserver reliability (intraclass correlation coefficient, >0.9) was excellent for all 25 landmarks for the x-, y-, and z-axes on both before and after orientation of the images. Paired t test results showed insignificant differences for the orientation of volume-rendered images for all landmarks except 3: R1 left (P = 0.0138), sella (P = 0.0490), and frontozygomatic left (P = 0.0493). Also midline structures such as Bolton and nasion were plotted more consistently or precisely than bilateral structures.

Conclusions: Orientation of the CBCT image does not enhance the precision of landmark plotting if each landmark is defined properly on multiplanar reconstruction slices and rendered images, and the clinician has sufficient training. The consistency of landmark identification is influenced by their anatomic locations on the midline, bilateral, and curved structures.
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http://dx.doi.org/10.1016/j.ajodo.2016.06.027DOI Listing
January 2017

Simultaneous correction of functional posterior cross bite and midline shift.

Contemp Clin Dent 2016 Jul-Sep;7(3):413-5

Centre for Dental Education and Research, Division of Orthodontics and Dentofacial Deformities, All India Institute of Medical Sciences, New Delhi, India.

The most frequent cause of functional posterior crossbite is the reduction in width of the maxillary dental arch. This posterior crossbite is associated with anterior crowding which is presented as an infrapositioned canine or a palatally positioned lateral incisor on one side; this leads to an upper midline shift toward the crowded side. The present case report shows the management of posterior crossbite with functional shift and upper midline shift simultaneously without adverse side effects. In this case, rapid maxillary expansion along with fixed appliance is used to correct posterior crossbite with the upper dental midline shift using reciprocal action of elastic transseptal fibers.
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http://dx.doi.org/10.4103/0976-237X.188583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004562PMC
September 2016

Quantitative and qualitative assessment of anchorage loss during en-masse retraction with indirectly loaded miniscrews in patients with bimaxillary protrusion.

Am J Orthod Dentofacial Orthop 2016 Aug;150(2):274-82

Assistant professor, Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.

Introduction: This study provides vital insight in assessing anchorage loss when miniscrews are indirectly loaded.

Methods: The study sample comprised 18 patients with bimaxillary protrusion (14 girls, 4 boys; mean age, 17.3 ± 4.6 years) selected from a database of 89 patients treated with miniscrews. All subjects who were selected required extraction of all first premolars and maximum anchorage. After initial leveling and aligning, miniscrews were placed between the first molar and the second premolar in all 4 quadrants and loaded by the indirect method at 3 weeks after placement with 200-g nickel-titanium alloy closed-coil springs for en-masse retraction. Mean treatment duration was 29.7 ± 6.8 months. Pretreatment and posttreatment lateral cephalograms were analyzed to measure the amount of anchorage loss, incisor retraction, and the incisors' angular change in reference to the pterygoid vertical reference line and were evaluated by the structural superimposition method.

Results: The ratio of incisor retraction to molar protraction was 4.2 in the maxilla and 4.7 in the mandible. The first molars showed mean extrusion of 0.20 mm in the maxilla and 0.57 mm in the mandible; these were statistically insignificant. The mean angular change of the first molars was -2.43° in the maxilla and -0.03° in the mandible. The mean anchorage loss in reference to the pterygoid vertical was 1.3 mm in the maxilla and 1.1 mm in the mandible; these were statistically significant. Structural superimpositions showed mean change in molar position of 0.83 mm in the maxilla and 0.87 mm in the mandible, and 5.77 mm in the maxillary incisor and 5.43 mm in the mandibular incisor. These results were compared with the direct anchorage method reported in the literature.

Conclusions: Indirect miniscrew anchorage can be a viable alternative to direct anchorage.
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http://dx.doi.org/10.1016/j.ajodo.2016.02.014DOI Listing
August 2016

Letter to editor on "Efficiency of bimaxillary advancement surgery in increasing the volume of the upper airways: a systematic review of observational studies and meta-analysis".

Eur Arch Otorhinolaryngol 2017 01 3;274(1):585. Epub 2016 Jun 3.

Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s00405-016-4118-yDOI Listing
January 2017

Successful treatment of Class II malocclusion with bidental protrusion using standard edgewise prescription.

Contemp Clin Dent 2016 Jan-Mar;7(1):75-8

Chief, Centre for Dental Education and Research, Professor and Head, Division of Orthodontics and Dentofacial Deformities, All India Institute of Medical Science, New Delhi, India.

This case report deals with the successful orthodontic treatment of a 14-year-old female patient having Class II malocclusion with bidental protrusion using standard edgewise prescription. She reported with forwardly placed upper front teeth and difficulty in closing lips. She had prognathic maxilla, retrognathic mandible, and full cusp Class II molar and canine relation bilaterally with overjet of 7 mm. She was in cervical vertebrae maturation indicator Stage IV. The case was treated by fixed extraction mechanotherapy. Interarch Class II mechanics was used to retract the upper incisor and to mesialize the lower molars. Simultaneously, Class I mechanics was used to upright lower incisors. Tip back bend, curve of Spee, and extra palatal root torque were incorporated in upper archwire to maintain molars in upright position and prevent extrusion and deepening of bite, respectively. There was satisfactory improvement in facial profile at the end of 24 months. After a follow-up of 6 months, occlusion was stable.
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http://dx.doi.org/10.4103/0976-237X.177111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792061PMC
April 2016

Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies.

Sleep Med Rev 2017 02 30;31:79-90. Epub 2016 Jan 30.

Academy of Scientific & Innovative Research (AcSIR), India; CSIR-Central Scientific Instruments Organisation, Chandigarh, 160030, India.

Obstructive sleep apnea (OSA) is one of the common sleep breathing disorders in adults, characterised by frequent episodes of upper airway collapse during sleep. Craniofacial disharmony is an important risk factor for OSA. Overnight polysomnography (PSG) study is considered to be the most reliable confirmatory investigation for OSA diagnosis, whereas the precise localization of site of obstruction to the airflow cannot be detected. Identifying the cause of OSA in a particular ethnic population/individual subject helps to understand the etiological factors and effective management of OSA. The objective of the meta-analysis is to elucidate altered craniofacial anatomy on lateral cephalograms in adult subjects with established OSA. Significant weighted mean difference with insignificant heterogeneity was found for the following parameters: anterior lower facial height (ALFH: 2.48 mm), position of hyoid bone (Go-H: 5.45 mm, S-H: 6.89 mm, GoGn-H: 11.84°, GoGn-H: 7.22 mm, N-S-H: 2.14°), and pharyngeal airway space (PNS-Phw: -1.55 mm, pharyngeal space: -495.74 mm and oro-pharyngeal area: -151.15 mm). Significant weighted mean difference with significant heterogeneity was found for the following parameters: cranial base (SN: -2.25 mm, S-N-Ba: -1.45°), position and length of mandible (SNB: -1.49° and Go-Me: -5.66 mm) respectively, maxillary length (ANS-PNS: -1.76 mm), tongue area (T: 366.51 mm), soft palate area (UV: 125.02 mm), and upper airway length (UAL: 5.39 mm). This meta-analysis supports the relationship between craniofacial disharmony and obstructive sleep apnea. There is a strong evidence for reduced pharyngeal airway space, inferiorly placed hyoid bone and increased anterior facial heights in adult OSA patients compared to control subjects. The cephalometric analysis provides insight into anatomical basis of the etiology of OSA that can influence making a choice of appropriate therapy.
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http://dx.doi.org/10.1016/j.smrv.2016.01.007DOI Listing
February 2017

Management of a Horizontally Impacted and Dilacerated Central Incisor in the Early Mixed Dentition.

J Dent Child (Chic) 2015 Sep-Dec;82(3):163-7

Centre for Dental Education and Research, Division of Orthodontics, All India Institute of Medical Sciences, New Delhi, India.

An impacted maxillary incisor in the early mixed dentition can pose a clinical challenge for orthodontists and pediatric dentists. Clinical observations supported with a 3-D imaging technique can help not only in assessing the precise location of the impacted tooth and its relation with neighboring teeth but also in correctly executing a treatment plan. The purpose of this paper is to describe the management of a severely rotated and horizontally impacted central incisor using intrabony rotation and simultaneous orthodontically-guided eruption. Timely intervention avoided disturbance in arch integrity and meticulous management helped to produce an excellent outcome in terms of function, esthetics, and stability of occlusion during two years of follow-up.
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October 2016

Accuracy of 3D cephalometric measurements based on an automatic knowledge-based landmark detection algorithm.

Int J Comput Assist Radiol Surg 2016 Jul 24;11(7):1297-309. Epub 2015 Dec 24.

Academy of Scientific & Innovative Research (AcSIR), New Delhi, India.

Purpose: To evaluate the accuracy of three-dimensional cephalometric measurements obtained through an automatic landmark detection algorithm compared to those obtained through manual identification.

Methods: The study demonstrates a comparison of 51 cephalometric measurements (28 linear, 16 angles and 7 ratios) on 30 CBCT (cone beam computed tomography) images. The analysis was performed to compare measurements based on 21 cephalometric landmarks detected automatically and those identified manually by three observers.

Results: Inter-observer ICC for each landmark was found to be excellent ([Formula: see text]) among three observers. The unpaired t-test revealed that there was no statistically significant difference in the measurements based on automatically detected and manually identified landmarks. The difference between the manual and automatic observation for each measurement was reported as an error. The highest mean error in the linear and angular measurements was found to be 2.63 mm ([Formula: see text] distance) and [Formula: see text] ([Formula: see text]-Me angle), respectively. The highest mean error in the group of distance ratios was 0.03 (for N-Me/N-ANS and [Formula: see text]).

Conclusion: Cephalometric measurements computed from automatic detection of landmarks on 3D CBCT image were as accurate as those computed from manual identification.
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http://dx.doi.org/10.1007/s11548-015-1334-7DOI Listing
July 2016

Authors' response.

Am J Orthod Dentofacial Orthop 2015 Sep;148(3):362-3

New Delhi, India.

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http://dx.doi.org/10.1016/j.ajodo.2015.07.005DOI Listing
September 2015

The extraction of maxillary lateral incisors for the treatment of a Class II crowded malocclusion: a case report.

Aust Orthod J 2015 May;31(1):107-15

Background: The extraction of an upper lateral incisor for orthodontic purposes is rare and must be adequately justified.

Aim: The present case report describes the management of a skeletal Class II crowded malocclusion that was facilitated by the extraction of upper lateral incisors and lower first premolars.

Methods: A 14-year-old male patient presented with a skeletal Class II crowded malocclusion with associated speech and chewing difficulties. Phase I of treatment involved the extraction of the upper lateral incisors and functional appliance therapy. Phase II included the extraction of lower first premolars and mechanotherapy using full fixed appliances.

Results: An improvement in aesthetics and sagittal relations was achieved during phase I therapy as the mandible was advanced over a period of eight months. Mandibular skeletal change was 6.5 mm observed at pogonion. During phase II therapy, the maxillary canines were substituted for lateral incisors and a functional occlusion was achieved. The skeletal correction and occlusion were stable one year after debonding.

Conclusion: The present case indicated that the timely extraction of palatally-placed maxillary lateral incisors facilitated functional appliance therapy in the management of a skeletal Class II problem. The crowding of the lower anterior teeth was relieved and alignment of the upper arch was achieved with full fixed appliance therapy, resulting in improved aesthetics and a stable occlusion at one year review.
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May 2015

A knowledge-based algorithm for automatic detection of cephalometric landmarks on CBCT images.

Int J Comput Assist Radiol Surg 2015 Nov 7;10(11):1737-52. Epub 2015 Apr 7.

Academy of Scientific and Innovative Research (AcSIR), New Delhi, India.

Purpose: Cone-beam computed tomography (CBCT) is now an established component for 3D evaluation and treatment planning of patients with severe malocclusion and craniofacial deformities. Precision landmark plotting on 3D images for cephalometric analysis requires considerable effort and time, notwithstanding the experience of landmark plotting, which raises a need to automate the process of 3D landmark plotting. Therefore, knowledge-based algorithm for automatic detection of landmarks on 3D CBCT images has been developed and tested.

Methods: A knowledge-based algorithm was developed in the MATLAB programming environment to detect 20 cephalometric landmarks. For the automatic detection, landmarks that are physically adjacent to each other were clustered into groups and were extracted through a volume of interest (VOI). Relevant contours were detected in the VOI and landmarks were detected using corresponding mathematical entities. The standard data for validation were generated using manual marking carried out by three orthodontists on a dataset of 30 CBCT images as a reference.

Results: Inter-observer ICC for manual landmark identification was found to be excellent (>0.9) amongst three observers. Euclidean distances between the coordinates of manual identification and automatic detection through the proposed algorithm of each landmark were calculated. The overall mean error for the proposed method was 2.01 mm with a standard deviation of 1.23 mm for all the 20 landmarks. The overall landmark detection accuracy was recorded at 64.67, 82.67 and 90.33 % within 2-, 3- and 4-mm error range of manual marking, respectively.

Conclusions: The proposed knowledge-based algorithm for automatic detection of landmarks on 3D images was able to achieve relatively accurate results than the currently available algorithm.
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http://dx.doi.org/10.1007/s11548-015-1173-6DOI Listing
November 2015

Surface deterioration and elemental composition of retrieved orthodontic miniscrews.

Am J Orthod Dentofacial Orthop 2015 Apr;147(4 Suppl):S88-100

Assistant professor, Centre for Biomedical Engineering, Indian Institute of Technology, Delhi; assistant professor, Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India.

Introduction: This study provides insight into surface and elemental analyses of orthodontic retrieved miniscrew implants (MSIs). The sole purpose was to investigate the behavior of MSIs while they are in contact with bone and soft tissues, fluids, and food in the oral cavity. The information thus gathered may help to understand the underlying process of success or failure of MSIs and can be helpful in improving their material composition and design.

Methods: The study was carried out on 28 titanium-alloy MSIs (all from the same manufacturer) split into 3 groups: 18 MSIs were retrieved after successful orthodontic treatment, 5 were failed MSIs, and 5 were as-received MSIs serving as the controls. All MSIs were subjected to energy dispersive x-ray microanalysis to investigate the changes in surface elemental composition and to scanning electron microscopy to analyze their surface topography. Data thus obtained were subjected to suitable statistical analyses.

Results: Scanning electron microscope analysis showed surface manufacturing imperfections of the as-received MSIs in the form of stripes. Their elemental composition was confirmed to the specifications of the American Society for Testing of Materials for surgical implants. Retrieved MSIs exhibited generalized surface dullness; variable corrosion; craters in the head, neck, body, and tip regions; and blunting on tips and threads. Energy dispersive x-ray analyses showed deposition of additional elements: calcium had greater significance in its proportion in the body region by 0.056 weight percent; iron was seen in greater proportion in the failed retrieved MSIs compared with the successful miniscrews; cerium was seen in greater proportions in the head region by 0.128 weight percent and in the neck region by 0.147 weight percent than in the body and tip regions of retrieved MSIs.

Conclusions: Retrieved MSIs showed considerable surface and structural alterations such as dullness, corrosion, and blunting of threads and tips. Their surfaces showed interactions and adsorption of several elements, such as calcium, at the body region. A high content of iron was found on the failed MSIs, and cerium was seen in the head and neck regions of retrieved MSIs.
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http://dx.doi.org/10.1016/j.ajodo.2014.10.034DOI Listing
April 2015

Effect of orthodontic forces on cytokine and receptor levels in gingival crevicular fluid: a systematic review.

Prog Orthod 2014 Dec 9;15:65. Epub 2014 Dec 9.

Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.

This systematic review aimed to generate evidence on role of potent markers of inflammation [cytokines, chemokines, their associated receptors and antagonists] following the application of orthodontic forces. Subsequent to registration with PROSPERO, literature search followed a predetermined search strategy to key databases along with hand search (HS). Seventy-seven articles from PubMed (P), 637 from Scopus (S), 51 from Embase (E), and 3 from hand search (HS) were identified. A total of 39 articles were shortlisted that met strict inclusion and exclusion criteria and quality assessment. Each study was evaluated for participant characteristics, study design, oral hygiene regimen, and gingival crevicular fluid (GCF) handling. Among these studies, biomarkers in the order of frequency were interleukin (IL)-1β (N=21), tumor necrosis factor (TNF)-α (N=10), IL-8,IL-6(N=8), receptor activator of nuclear factor kappa-B ligand (RANKL) (N=7), monocyte chemoattractant protein (MCP)-1 (N=3), IL-2 (N=4), IL-4, IL-10, RANTES (N=2), IL-1, IL-5, IL-1α, IP-10, osteopontin (OPN) (N=1) and receptors and their antagonists in the order of osteoprotegerin (OPG) (N=8), IL-1RA (N=5), and RANK (N=1). Results revealed an immediate release of inflammatory bone-resorptive mediators, IL-1β and TNF-α, where IL-1β increased as early as 1 min to 1 h reaching peak at 24 h while TNF-α increased at 1 h or 1 day. This was accompanied by a fall in bone-protective mediator (OPG) levels at 1 h and 24 h after orthodontic force application. Continuous forces were accompanied by a decrease in mediator levels after attaining peak levels (most commonly at 24 h) while repeated activations in interrupted force upregulated their secretion. Significant correlations of IL-1β levels with pain intensity, rate of orthodontic tooth movement (OTM) and of activity index (AI) (IL-1β/IL-1RA) with velocity of tooth movement and growth status of individuals have also been deduced. A greater AI and RANKL/OPG ratio was seen in juveniles as compared to adults or non-growers that were associated with faster rate of OTM in juveniles. None of the studies addressed the effect of estrous cycle in female subjects. Lack of homogeneity in several parameters calls for a better controlled research on the biology of OTM.
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http://dx.doi.org/10.1186/s40510-014-0065-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259981PMC
December 2014

Alginate base to evade lingual trimming of the mandibular cast.

Contemp Clin Dent 2014 Oct;5(4):527

Department of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/0976-237X.142824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229765PMC
October 2014

Innovative biomechanics for orthodontic correction of torsiversion of maxillary central incisor caused by twin mesiodens.

Contemp Clin Dent 2014 Apr;5(2):275-7

Department of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.

Mesiodens is the most common type of supernumerary teeth found in the premaxilla between the two central incisors. Early and proper diagnosis and appropriate treatment plan is critical in eluding the extent of treatment needed. This case report presents the successful orthodontic and esthetic management of an unusual case of Indian origin with twin mesiodens in the maxillary arch causing torsiversion and attrition of mandibular incisors due to occlusal trauma.
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http://dx.doi.org/10.4103/0976-237X.132360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067801PMC
April 2014

A study of interleukin 1β levels in peri-miniscrew crevicular fluid (PMCF).

Prog Orthod 2014 Apr 1;15(1):30. Epub 2014 Apr 1.

Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.

Background: This study provides a vital insight in assessing the clinical and biochemical changes in interleukin (IL)-1β levels in peri-miniscrew crevicular fluid (PMCF) during the course of orthodontic tooth movement.

Methods: The study comprised the analysis of IL-1β in peri-miniscrew crevicular fluid obtained from crevices around the miniscrews inserted in 11 patients (eight females and three males, mean age 17.3 ± 4.64 years) with all first premolar extraction and maximum anchorage requirement using miniscrew-supported anchorage. Miniscrews were loaded at 3 weeks after placement by 200-g nitinol closed coil springs of 9-mm length for en masse retraction. Peri-miniscrew crevicular fluid was collected at miniscrew placement (T1), at 3 weeks (T2/baseline) and on loading at 0 (T3) and 1 day (T4), 21 (T5), 72 (T6), 120 (T7), 180 (T8) and 300 (T9) days. IL-1β levels were estimated by enzyme-linked immunosorbent assay (ELISA). Peri-miniscrew tissue was examined for signs of inflammation, and also, miniscrew mobility was assessed with Periotest and handles of two mouth mirrors.

Results: IL-1β levels in all miniscrews were significantly higher at T1 and peaked again at T4 showing a bimodal peak. However, there was a gradual and statistically significant decrease in IL-1β till T5, while further changes till the end of the study were statistically not significant.

Conclusions: The changing levels of IL-1β levels in PMCF over a duration of 300 days are suggestive of the underlying inflammatory process. IL-1β levels in PMCF show a significant rise during miniscrew insertion and on immediate loading. The trend of gradually reducing IL-1β levels around the miniscrew over the period after loading towards baseline is suggestive of adaptive bone response to stimulus.
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http://dx.doi.org/10.1186/s40510-014-0030-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047786PMC
April 2014

Bone density and miniscrew stability in orthodontic patients.

Aust Orthod J 2012 Nov;28(2):204-12

Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.

Objectives: The purpose of this study was to evaluate bone density in buccal inter-radicular bone between second premolars and first permanent molars and its association with the clinical stability of miniscrews used for en masse retraction of anterior teeth in extraction cases.

Materials And Methods: Thirty-eight miniscrews were placed in ten patients (8 females, 2 males: mean age, 18.9 +/- 4.12 years) to provide indirect orthodontic anchorage. Twenty miniscrews were placed in the maxilla and eighteen were inserted in the mandible. All of the miniscrews were placed in the buccal inter-radicular bone between the second premolar and the first permanent molar. Bone density at each miniscrew site was recorded by computed tomography and recorded in Hounsfield units (HU) before miniscrew placement. Nickel-titanium closed-coil springs were used to apply an orthodonticforce of 2N within one week following placement.

Results: Cortical bone density values ranged from 506.7- 1705.6 HU (Mean, 929.27 +/- 322.12 HU) in the maxilla and 503.8 - 1544.8 HU (Mean, 1116.2 +/- 298.33 HU) in the mandible. Cancellous bone density values ranged from 185.9 - 930.8 HU (Mean, 450.09 +/- 205.66 HU) in the maxilla and 197.3 - 803.6 HU (Mean, 561.87 +/- 170.83 HU) in the mandible. There was no statistically significant difference between right and left sides. A bone density comparison between the maxilla and mandible revealed statistically significant higher values in mandibular cortical bone (p = 0.008), while no significant difference was found in cancellous bone values (p = 0.097). Clinically, the success rate of miniscrews in the maxilla was 100% but only 77.8% in the mandible. Miniscrew failures were associated with peri-implant inflammation and miniscrew proximity to dental roots. No relation was found between bone density and miniscrew stability.

Conclusion: The present study determined that no definitive association could be established between miniscrew success and bone density.
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November 2012