International Poster Journal of Dentistry and Oral Medicine, 04/2019

Aim & Objectives: The aim of this study was to determine the current status of the health workforce in India in terms of changing trends in distribution and availability of services and its influence on the development of a new bridge course for dentists to practice medicine. Methodology: The Arksey and O'Malley method for conducting a scoping review was used. The distribution of the health workforce, i.e., doctors practising allopathic medicine and dentistry in India, was analysed from previous literature of the past 10 years, from 2009- 2019, and was compared to that of the previous decade (1999- 2009) to analyse the change in trends over the past 2 decades. The various factors responsible for change in trends were postulated. Results: There is an inverse ratio of dentist to population, especially in the rural areas, of 1:50,000. While the urban areas maintain a fair ratio of 1:8000, the metropolitan cities face a crowded dentist to population ratio including the dental colleges and other tertiary facilities. It is questionable whether the proposal of the new bridge course for dentists to practice family medicine will change the current distribution pattern of health workforce given the high concentration of dentists in urban areas. Conclusion: The proper distribution of available workforce is the need of the hour, the challenges to which could probably be overcome with strong consensus and implementation through upstream approaches. Keywords: oral health workforce, allopathic doctors, india

Background: Plasma insulin is a surrogate marker for insulin resistance. Research shows a significant correlation between plasma and salivary insulin (sINS) levels. Current evidence indicates the potential use of salivary biomarkers for the diagnosis of Type 2 Diabetes Mellitus (T2DM). A family history (FHx) of T2DM and hyperinsulinemia is a predicting factor for the future occurrence of T2DM. Periodontitis is an early sign of diabetes mellitus and is a valuable risk indicator. Aims and Objectives: We aim to investigate the association between sINS with FHx of T2DM and periodontal status in a normoglycemic Malaysian population. Methodology: 54 subjects with a mean age of 35.8 years having HbA1c levels 5.6%, random blood glucose level 5.6mmol/L, BMI 27.5kg/m2, and devoid of systemic diseases were recruited. Information on FHx of T2DM and 4ml whole saliva samples were collected from subjects. Periodontal status assessment was done using the Community Periodontal Index of Treatment Needs (CPITN). The total concentration of sINS was measured by enzyme-linked immunosorbent assay (ELISA). Data were analysed using the Mann Whitney U test and Kruskal Wallis test. Results: 32 subjects had FHx of T2DM, and 22 subjects did not have a FHx (p=0.25). The mean sINS concentration was significantly higher in subjects with FHx of T2DM (n=39.51µIU/ml) compared to those without FHx (n=20.15µIU/ml) (p=0.01). Periodontal status is not significantly correlated with sINS concentration (p=0.33) and FHx of T2DM (p=0.42) Conclusion: sINs was associated with FHx of T2DM but not in periodontal disease. Thus, sINS can be further investigated as a non-invasive marker for T2DM risk that is independent of periodontal status. Keywords: Salivary insulin, non-invasive marker, family history of Type 2 Diabetes Mellitus, periodontal status

Objectives: The aim of this observational study was to evaluate decision regret after shared decision making regarding pain control for scaling and root-planing (SRP). The decision regret scale was used as the primary outcome and pain control and future choice as secondary outcomes. Methods: 159 patients with a need for SRP during anti-infective therapy or as retreatment in periodontal supportive therapy opted for pain control using a decision board during shared decision making. Pain control options were: (1) no anaesthesia (NO), (2) intrapocket gel (GEL, Oraqix, Dentsply Sirona), and (3) injected anaesthesia (INJ, articaine 4%, Ultracain D-S, Sanofi-Aventis). The decision regret scale, procedural pain (via VAS), and future choice were recorded after SRP by questionnaire. Results: 88 patients opted for anaesthesia, 73 of them for intrapocket gel, and 15 for injection. Overall, patients were satisfied with their choice (98%), reported no regret (94%), and would take the same decision for future treatments (96%). Additionally, they valued their choice as smart (97%) and not harmful (97%). These outcomes were consistent for the subgroups, showing no intragroup differences (p>.05). The distribution of anaesthesia choice was affected by treatment point (p=.000). 80% choosing INJ underwent anti-infective therapy, and 65% opting for GEL received retreatment during supportive therapy. Procedural pain during SRP was distributed equally between the groups (p>.05), with an overall mean of 20.5±23.0 and a range between 0 to 90. Future choice of pain control was not influenced by procedural pain (p=.155). Conclusion: Decision-board-supported shared decision making for pain control during SRP led to satisfaction with the anaesthesia choice, overall and in each subgroup. Patients were able to properly estimate their individual need for adequate pain control. Patients undergoing supportive periodontal therapy with a need for SRP tend to choose intrapocket gel or no anaesthesia without regretting the decision. Keywords: shared decision making, decision regret, periodontal disease, intrapocket anaesthesia

Introduction: Anterior open bite (AOB) correction is one of the most challenging malocclusion to manage because of the high chances of relapse. Although the cause of AOB is multifactorial, tongue dysfunction plays an important role in the features of the malocclusion. Therefore, correction of the tongue position and function results in stable outcomes. Recently, Bonded Shark-Tooth-like Spurs (JAWs) have been introduced for the treatment of AOB patients. Aim of Study: To evaluate the dentoalveolar effects of the central incisors following tongue-training therapy using JAWs in adult patients with AOB. Materials and Methods: 3D digital dental casts of twenty-one adult patients (mean age 23.05 4.8 years) diagnosed with AOB with severe tongue thrust habits were collected during initial examination (TO) and one month after using JAWs (T1) for tongue-training. A retrospective study was conducted to measure changes in tooth position at the incisal edges of the maxillary and mandibular central incisors using superimposed 3D digital dental casts. The amount of tooth displacement (Total change, T; Vertical, V; Anteroposterior, AP) was analysed using the T-test. The size of the JAWs and the amount of tooth displacement were compared using Pearson's correlation. Results: The measurements revealed that there was tooth displacement in V and AP direction. The amount of tooth displacement in V and AP directions were 0.18 ± 0.03 mm and 0.23 ± 0.04 mm respectively. The amount of tooth displacement in the mandibular incisors was significantly greater than that of the maxillary incisors. There was a moderate positive correlation between size of the JAWs and tooth displacement. Discussion and Conclusion: The use of JAWs is an effective therapy in adult patients with tongue-induced AOB. Correction of tongue position and function can induce dental changes in adult. The size of JAWs is one of the factors that correlated with tongue adaptation. Keywords: Tongue thrust, open bite, 3D digital dental models

Aims: To introduce an innovative device named "minimally invasive brace" (MIB) that can efficiently upright mesially impacted mandibular third molars for facilitating extraction. Materials And Methods: Twenty-four partially erupted mandibular third molars with mesioangular impaction and requiring removal were included in this prospective clinical study. The patients were randomly divided into two groups: MIB (n= 16) and control groups (n= 8). In the MIB group, an MIB and MIB smart spring were applied to upright the third molars to allow simple extraction. In the control group, no treatment was provided before the third molar removal. The rate and amount of tooth movement were assessed by pre- and post-operative panoramic radiographs. Duration of the tooth removal and patient comfort using visual analog scale (VAS) scores were compared. The stability of the anchorage provided by the MIB was determined by superimposition of pre- and post-operative intraoral scanner images. The facial swelling was evaluated by superimposition of pre- and post-operative 3-D facial scanner images. Statistical differences between two groups was evaluated using Independent T-test. Results: The MIB system can upright mesially impacted mandibular third molars before extraction with minimal changes to the dental anchorage provided by the MIB. Duration of the tooth removal, patient discomfort, and facial swelling in the MIB group were significantly less than in the control group. Conclusion: The MIB system, using posterior teeth as the anchorage unit and an MIB smart spring, offers a minimally invasive option for uprighting mandibular third molars before extraction and can reduce patient discomfort and facial swelling. Keywords: orthodontic extraction, third molar, uprighting, anchorage, bracket

Aim: This case report proposed an alternative approach for correcting gummy smile. To demonstrate an anterior intrusion technique by using iPanda and intrusion arch in the Class II, deep bite malocclusion. To illustrate this approach on anterior and first molar teeth using finite element analysis (FEA). Material and method: A 38-year-old woman presented with maxillary anterior completed deep bite, gummy smile, maxillary and mandibular anterior teeth crowding, Class II canine, and missing four first premolars from previous orthodontic treatment. In order to improve the patient's smile, correct the deep bite and crowding, two titanium miniscrews (1.6x6mm) were placed at the midpalatal suture and iPanda was used as a maximum anchorage. The main archwire was used as a sectional for anterior and posterior teeth; also an intrusion arch (0.017x0.025 inches) was used to apply an intrusive force at the central incisors and canines on the main archwire. For FEA, under 20 gf of intrusive force on each anterior tooth, initial displacement of the individual anterior and first molar teeth in three directions was measured. Also, the von Mises stresses along the root were evaluated. Results: The results were the intrusion of 2.33 mm of the maxillary incisors. The interincisal relationship was improved. Significant reductions in overjet, maxillary incisor to palatal plane, and maxillary incisor to upper lip were observed after intrusion of the incisors. Her gummy smile, maxillary and mandibular anterior teeth crowding, and Class II canine were improved without altering the molar class I relationship. iPanda presented an effective anchorage to minimise the maxillary molar displacement. FEA illustrated that the maximum von Mises stress is evenly distributed across the central and lateral incisors and canines applied to the labial surface of the roots. Nevertheless, the first molars showed higher von Mises stress along the crown and root surface; it showed the least displacement due to iPanda anchorage. Conclusion: iPanda with intrusion arch is an alternative treatment approach to effectively intrude anterior teeth without the need of additional miniscrews. Moreover, this technique can reduce the risk of extrusion on maxillary first molars. Keywords: Anterior intrusion, finite element analysis, case report

Aim of Study: To evaluate the rate and change in angulation of canine distal movement and compare between immediate and delayed canine retraction groups. Materials and Method: A total of 40 canines which had been retracted with 50 g of force in the premolar extraction site were included in this study. The date of maxillary first premolar extraction and canine retraction of each patient were recorded and used to categorised the data into 5 groups; immediate retraction and delayed retraction of 1 week, 2 weeks, 3 weeks, and 4 weeks after premolar extraction. The 3-D digital models and lateral cephalograms were recorded before canine retraction (T0) and after completed canine retraction (T1). The amount of canine distal movement was measured from the 3-D digital models (T1-T0), and the rate of tooth movement each month was calculated. The change in canine angulation was measured from lateral cephalograms. The movement rates and change in angulation of each group were compare using one-way ANOVA and multiple comparisons. Results: The mean rate of canine movement was 0.98 + 0.28 mm/month. The mean change in angulation was 6.01 + 4.01 degree. The movement rate and amount of change in angulation of the canines that were immediately retracted and those with delayed retraction of 1 to 4 weeks were not significantly different (P > 0.05). Conclusion: Immediate canine retraction and delayed retraction of 1 to 4 weeks after premolar extraction was not significantly different in the rate and type of tooth movement. Keywords: Canine retraction

Background: The face is a key to human physical attractiveness. Facial attractiveness is a main motive for encouraging patients to seek oral care. Orthodontic treatment can influence facial aesthetics in many ways, such as by providing well-aligned teeth, an attractive smile, and a pleasing facial profile. Purpose: The purpose of this study was to compare preferred facial profiles of subjects with bimaxillary protrusion produced by a 3-D facial light scanner between male and female laypersons. Materials and Methods: Lateral cephalograms and digital 3-D facial images were recorded for 40 Thai subjects aged 17-39 years with skeletal Class I or mild skeletal Class II jaw relationships, bimaxillary dental protrusion, and no previous orthodontic treatment. The 3-D images were modified to retrocline the maxillary central incisors 30° and retrude them 3 mm. The 3-D images were captured at 0%, 25%, 50%, 75%, and 100% of profile change. The mandibular central incisors were correspondingly retroclined and retruded in harmony with the maxillary central incisors by maintaining normal overjet and overbite. Twenty-one male and 24 female laypersons viewed all images of the subjects and ranked the facial profile of each subject as most to least preferred. The position of the upper and lower lips in relation to the E-line was measured on the most preferred images. The data were collected and compared between male and female laypersons. Results: The majority of laypersons chose the images at 50% of profile change, -2.01 mm for the upper lip to E-line, and -1.57 mm for the lower lip to E-line as the most esthetic preferences. There were no significant differences in preferred facial profiles or lip position between male and female laypersons. Conclusions: The male and female laypersons preferred the same facial profiles and slightly retruded upper and lower lip to E-line positions. Keywords: Bimaxillary protrusion, three-dimensional scanner, facial esthetics

Crown lengthening is a commonly performed surgical procedure in dental practice. Surgical guides assist clinicians to establish appropriate soft and hard tissue architecture. Herein, a new classification of surgical guides for crown lengthening is introduced in the present study. According to the features of the length indicator unit (LIU), the surgical guides are classified as three types. Type I, LIU indicates the planed gingival margin at the tissue level. Type II, LIU indicates both the planed gingival margin and alveolar crest at the tissue level. Type III, LIU indicates the planed gingival margin at the tissue level and the alveolar crest at the bone level, respectively. Keywords: Dental esthetics, crown lengthening, gingivectomy, alveolectomy

Objectives: Removal of subgingival hard deposits is a prerequisite for successful periodontitis therapy. This can be challenging and the advantages of a dental endoscope (PE) seem obvious, but they have not yet been investigated in detail. Moreover, the influence of the operators' experience and training with such a device on treatment results is unclear. Therefore, we investigated in an in-vitro study the use of PE for scaling and root planing (SRP), influenced by the operators' experience and training. Material and Methods: A sonic device and mini-Gracey curettes were used by eleven operators (six dentists, five dental hygienists) in periodontitis manikin heads (28 maxillary/mandibular teeth with artificial subgingival hard deposits and a mean attachment loss of 5.86mm ±2.12mm SD). The time required for treatment and the proportion of simulated hard deposits removed by SRP were measured. Significant differences were tested with the Kolmogorov-Smirnov, Shapiro-Wilk, or Chi Square test, and possible associations with Pearson correlation and Spearman's rank correlation (all tests double sided; p≤0.05). Results: Using PE led to a significant difference in the removal of simulated hard deposits [%] (mean±SD) irrespective of the operators' experience (PE: 90.78±12.10% [range: 58.80-100%]; nPE: 79.98±22.15% [range:38.10-100%]; p0.001)). Sub-analyses for different tooth types only demonstrated a significant difference in favour of PE for the front teeth (p0.001) and in the upper jaw independent of the tooth type (p0.001). The comparison of the treatment times with and without PE showed a significantly longer treatment time with PE (54.73±13.12min [range: 40-80min]) vs. nPE (33.00±11.33min [range: 20-53min] p0.001). Conclusions: Within the present pilot study, the use of PE led to more removal of simulated hard deposits but concomitantly more time effort. PE may provide additional benefits for removal of hard deposits compared to traditional SRP; however, a higher effort (time/costs) and the requirement of intensive training are necessary. Keywords: Scaling and root planing, non-surgical periodontal therapy, experimental design, subgingival hard deposits, periodontal endoscopy