Decision-Making Criteria of Odontectomy or Surgical Exposure in Impacted Maxillary Canine Based on Treatment Difficulty Index Modification

Objective Canine impaction is a difficult condition to treat, and it usually necessitates a combination of surgical exposure and orthodontic traction or surgical extraction. An accurate assessment of the maxillary canine's position can help determine the severity of the impaction, the difficulty of therapy, and the treatment's prognosis. Materials and Methods A total of 55 impacted canines were studied and selected retrospectively. Difficulty indexes were used to measure the severity of impaction with pretreatment panoramic radiographs. Statistical Analysis Pearson correlation was used to test the validity of the difficulty index modification score. Regression statistical analysis was used to evaluate any correlation between total scoring from each index with surgical treatment. Results The validity test on the variable modification index score showed a valid value (p = 0.000). According to both treatment difficulty and modification index, odontectomy group showed higher mean of total scoring than surgical exposure group. Treatment difficulty and modification index showed a significant correlation with surgical treatment (p = 0.003 and p = 0.001). Conclusions The higher the severity of canine impaction, the greater is the possibility of odontectomy than surgical exposure. Both indexes can consider to be used in determining surgical treatment planning.

Post-surgical care in surgical periodontics

The patient's post-surgical management is just as critical as the surgical treatment planning and management of the patient. Patients who do not receive proper and contemporary post-surgical instructions, or who do not follow them, are at higher risk for complications such as pain, swelling, and infection, as well as the possibility of altered healing of both the oral soft tissues and supporting osseous structures. During postoperative phase, the three most important factors to consider are the patient comfort, wound stability and plaque control. These are achieved through a combination of good surgical technique and careful postoperative care of the surgical site. Thus, surgeon's professional obligation is to ensure that patients receive consistent verbal and written instructions that describe activities during the critical early healing period after the surgery. Furthermore, the surgeon must have a thorough understanding of the instructions given to the patient, as well as the reasoning behind them.

To Establish Cephalometric Floating Norms as a Guide toward Harmonious Cranial Individual Pattern among North Indian Adults

Introduction Floating norms put us at ease while diagnosing and establishing a treatment plan for an individual with abnormal skeletal pattern. It uses the variability of the associations among appropriate cephalometric variables and later on the basis of a regression model by combination of both skeletal parameters which are sagittal and vertical and construct a harmony box which make diagnosis straightforward. This study aims to establish floating cephalometric norms for the describing individual craniofacial skeletal pattern among North Indian Adults as an additional diagnostic tool for orthodontic treatment planning. Materials and Methods The study includes North Indian adults in age range of 17 to 25 years. A total of 30 patients were selected and were subjected to cephalometric evaluation. Various angular measurements viz., SNB (sella-nasion-point B), NL-NSL (maxillary line-nasion sella line), ML-NSL (mandibular line-nasion sella line), N–S–Ba (nasion-sella-basion), SNA (sella-nasion-point A), and ML-NL (mandibular line-maxillary line) were considered for designing harmony box for North Indian adults. Results The results of the study were subjected to various statistical analyses. SNB served as the independent variable and NL-NSL, NSBa, ML-NSL, ML-NL, and SNA were made the dependent variable due to lesser R2 values in multiple regression analysis. Correlation between some of the variables, such as (SNA–SNB, ML-NSL–NL-NSL, and ML-NSL–ML-NL), in the present North Indian sample showed positive correlation among each other and were statistically significant (p = 0.000). When compared with the other similar studies done previously, least variability was seen with the Segner study and maximum variability was seen with Thilander’s study. Conclusion The analysis of the individual craniofacial pattern by means of floating norms appears to provide a helpful method in determining the parameters responsible for the skeletal disharmony, thus representing a viable option for additional diagnostic tool in orthodontic and orthopaedic/surgical treatment planning.

Congenital Heart Diseases Associated With Cleft Lip and Palate and Its Impact on Surgical Treatment Planning of Patients With Cleft Lip and Palate—A Cross-Sectional Study

Objectives: The aim of this study is to know the prevalence, type of congenital heart diseases (CHDs), and its association with cleft lip and/or palate and to know the impact of CHDs on surgical treatment planning of cleft lip and palate from a craniofacial hospital specializing in orofacial clefts, head and neck cancer, and trauma management. Design: A total of 1381 patients with nonsyndromic cleft lip and palate were included in the study. This is a hospital-based retro–prospective case record analysis. The data were collected from clinical records of the patients which included clinical, chest radiographic and 2D echocardiographic findings. Total incidence of CHDs and its impact on treatment planning was evaluated using κ statistics and χ2 test. Results: There were 32 (2.32%) cleft lip and palate patients with CHDs. In 2 patients, cleft surgery was delayed by 6 to 9 months to allow the defect to decrease in size. Subacute bacterial endocarditis prophylaxis was administered in 7 patients before cleft surgery. Cardiac surgery was advised prior to cleft surgery in 3 patients. Sixteen patients with CHDs were not taken for cleft surgery considering the potential risk to the patient’s life as they had multiple cardiac anomalies. There were no intraoperative and postoperative complications in these patients. Conclusion: The results emphasize the association between clefting and CHD. The collected data suggest that there should be careful examination of children with cleft lip and palate for signs of heart disease. This could significantly reduce the morbidity/mortality of cleft lip and palate surgery making it more predictable and safer.