The document summarizes a systematic review of modifications to the distal shoe space maintainer. It analyzes 6 studies on modified distal shoe designs. The studies showed that the modifications provided stability, adjustability, and were well-accepted by patients. However, the quality of the studies was low and conclusions about the efficacy of the modifications were inconclusive due to a lack of clear reporting on outcomes. Further high-quality research is needed to establish the effectiveness of modified distal shoe space maintainers.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
This document discusses a case study of using unilateral sagittal split ramus osteotomy (SSRO) with an interpositional iliac bone graft to correct facial asymmetry in a 27-year old female patient. The patient presented with flatness on the right side of her face and mandible. Clinical and radiographic examinations revealed a decrease in the mediolateral distance of the right mandibular ramus compared to the left. Unilateral SSRO was performed on the right side, and a cancellous iliac bone graft was interpositioned between the proximal and distal segments to restore symmetry. Rigid fixation with a bent plate was used to stabilize the graft and maintain thickness. At follow-up, the procedure had
This study compared the effectiveness of Hawley retainers and two protocols for vacuum-formed retainers (VFRs) in maintaining orthodontic treatment results. 90 patients were randomly assigned to receive either a Hawley retainer, VFRs worn for 4 months full-time then nightly, or VFRs worn for 1 week full-time then nightly. Models at debond and 4 and 8 months post-treatment showed the Hawley group had significantly greater loss of upper arch length and increased crowding compared to the VFR groups, though lower arch measurements were similar. Both VFR protocols were more effective than Hawleys in maintaining the upper arch, and 4 months full-time wear provided better lower incis
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
This document discusses a case study of using unilateral sagittal split ramus osteotomy (SSRO) with an interpositional iliac bone graft to correct facial asymmetry in a 27-year old female patient. The patient presented with flatness on the right side of her face and mandible. Clinical and radiographic examinations revealed a decrease in the mediolateral distance of the right mandibular ramus compared to the left. Unilateral SSRO was performed on the right side, and a cancellous iliac bone graft was interpositioned between the proximal and distal segments to restore symmetry. Rigid fixation with a bent plate was used to stabilize the graft and maintain thickness. At follow-up, the procedure had
This study compared the effectiveness of Hawley retainers and two protocols for vacuum-formed retainers (VFRs) in maintaining orthodontic treatment results. 90 patients were randomly assigned to receive either a Hawley retainer, VFRs worn for 4 months full-time then nightly, or VFRs worn for 1 week full-time then nightly. Models at debond and 4 and 8 months post-treatment showed the Hawley group had significantly greater loss of upper arch length and increased crowding compared to the VFR groups, though lower arch measurements were similar. Both VFR protocols were more effective than Hawleys in maintaining the upper arch, and 4 months full-time wear provided better lower incis
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Marginal and Internal Fit of Different Fixed Dental Prostheses: A Comparative...DrHeena tiwari
This study compared five methods for assessing the marginal and internal fit of fixed dental prostheses: the cross-sectional method, silicone replica technique, triple scan method, micro-computed tomography, and optical coherence tomography. Measurements of the marginal gap, axial gap, angle gap, and occlusal gap found statistically significant differences between the methods. The cross-sectional method and silicone replica technique showed the lowest mean values and were the most similar, while the triple scan method and optical coherence tomography also showed similarities. The study concluded that while fit values may fall within clinically acceptable ranges, differences between assessment methods should be considered.
Effectiveness of Low-Level Lasers subsequent to Third Molar Surgery: An Origi...DrHeena tiwari
This study assessed the effectiveness of low-level lasers in reducing postoperative pain, swelling, and trismus following third molar surgery. 32 patients who required bilateral lower wisdom tooth removal were treated, with one side receiving laser treatment and the other serving as the control. Pain was significantly lower on the laser treated side on days 6-7, though swelling and trismus did not significantly differ between sides. The results suggest low-level lasers may help reduce pain following third molar surgery when applied immediately after surgery.
"Demographic Analysis Of Palatal Fistula In A Tertiary Care Centre: A Retrosp...DrHeena tiwari
This document presents a retrospective study analyzing demographic data of patients with palatal fistulas who underwent repair at a tertiary care center between 2000-2020. The study found that in patients aged 0-6 months, fistulas were mostly located in the anterior hard palate and were predominantly less than 0.4mm in size. For patients aged 7-12 months and 13-24 months, most fistulas were also in the anterior palate but were larger in the older group. Patients over 24 months showed fistulas mainly in the anterior palate but had more intraoperative complications and postoperative infections. The results suggest certain age groups may be more prone to developing palatal fistulas in specific locations and sizes. Further prospective studies are recommended
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Malocclusion And Deleterious Oral Habits In South Indian Adolscent Population...DrHeena tiwari
This study evaluated the prevalence of malocclusion and associated oral habits in South Indian adolescents. The researchers assessed 1000 12-15 year olds using the Dental Aesthetic Index and found that 52% had some form of malocclusion. Deleterious oral habits were present in 21.2% of subjects and those with habits were more likely to have malocclusion than those without. Specific habits like tongue thrusting and mouth breathing were correlated with traits like crowding and open bite. The study concludes that malocclusion in this population is directly linked to the presence of oral habits.
This study investigated the craniofacial morphology and growth of cleft palate patients. Common findings among patients included anterior crossbite, a reduced and posteriorly positioned maxilla. Frequent orthodontic issues were deviations of the upper incisors, missing teeth in the cleft area, and asymmetries of the upper dental arch. Regarding growth, some patients had normal facial development while others exhibited a hypoplastic maxilla and middle third of the face. The study aimed to characterize the morphological features and growth patterns of cleft palate patients' craniofacial complexes to help establish appropriate treatment protocols.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
This case report describes an adult patient who presented with an anterior open bite that was associated with breathing problems. Clinical and radiographic examination revealed the open bite was due to skeletal factors including an increased lower anterior facial height and hyperdivergent skeletal planes. The patient's breathing problems acted synergistically with her skeletal pattern to cause and worsen the open bite over time as her mandible rotated counterclockwise to open and facilitate breathing. Treatment of the open bite would need to address both the skeletal and respiratory etiological factors.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
Epidemiology of Orofacial Pain in Population of Jammu City in India: An Origi...DrHeena tiwari
This study evaluated the etiology of orofacial pain among 400 patients visiting private clinics in Jammu, India. The results showed that dental caries leading to pulpitis was the most common cause of orofacial pain, affecting 96 patients. Periodontal disease and tooth sensitivity were also significant causes. Orofacial pain was more prevalent in females aged 26-35 years. The pain most commonly worsened during sleep and evenings and lasted less than 1 hour for many subjects. This study concluded that dental caries is the primary etiology of orofacial pain in this population and treatment should be tailored based on the identified cause.
“Comparative Evaluation between Physics Forceps and Conventional Extraction F...inventionjournals
:Tooth extraction procedure, although known as a minimal traumatic procedure, some sort of trauma is subjected to underlying soft and hard tissues, resulting in immediate destruction and loss of alveolar bone. Conventional extraction forceps are designed on the principle of simple machine incorporating two first-class levers, connected with a hinge. The physics forceps are the newly invented forceps. The design of physics forceps which implements a first class lever, creep, and type of force that provides a mechanical advantage, which makes it more efficient. AIM: The aim of the present study to evaluate the efficacy between the conventional extraction forceps and physics forceps in orthodontic extraction of maxillary premolars. Patients & Methods:A total of 50 healthy patients with indicated for extraction of bilateral maxillary premolar for orthodontic reasons; split mouth design (control side, test side) in a randomized manner; were included in the present study. Results:Ease of technique, buccal cortical plate fracture, fracture of tooth or root, gingival laceration, soft tissue healing was not significant. The extraction time and bleeding associated with extraction socket were significant. Post operative days 1-4 are not significant and on day 5-7 the pain on VAS score is 0. Conclusion:The results of present study suggest that, extraction using any forceps can produce predictable results and it totally depends on surgeon’s expertise in a particular technique.
Aims: This study evaluated the subjective experience of masticatory performance and masticatory efficiency in partially edentulous patients rehabilitated with three different types of removable partial dentures (RPDs). Materials and methods: This was a crossover randomized study, which was carried out at the prosthodontics clinic of the University of Ghana Dental School clinic. Sixteen patients requiring RPDs but had never worn one before were consecutively recruited for the study. Three different RPDs [i.e., cobalt chromium, acrylic, and thermoplastic resin (iFlex)] were fabricated for each patient. Masticatory efficiency was assessed using a singlesieve method after chewing raw carrots. The subjective experience of masticatory performance was also assessed using a questionnaire after 1 week of using each denture. Results: The cobalt-chromium denture recorded the highest masticatory efficiency (31.4%), and the iFlex denture recorded the lowest (27.9%).
This meta-analysis evaluates the reliability of published evidence on regenerative endodontic procedures. It summarizes clinical and radiographic findings from studies on treating non-vital immature permanent teeth using regenerative techniques. The analysis finds good success rates for tooth survival and pathology resolution, but variable results for outcomes like apex closure and root development. Regenerative procedures are improving but factors important for success remain unclear, indicating more research is needed.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Marginal and Internal Fit of Different Fixed Dental Prostheses: A Comparative...DrHeena tiwari
This study compared five methods for assessing the marginal and internal fit of fixed dental prostheses: the cross-sectional method, silicone replica technique, triple scan method, micro-computed tomography, and optical coherence tomography. Measurements of the marginal gap, axial gap, angle gap, and occlusal gap found statistically significant differences between the methods. The cross-sectional method and silicone replica technique showed the lowest mean values and were the most similar, while the triple scan method and optical coherence tomography also showed similarities. The study concluded that while fit values may fall within clinically acceptable ranges, differences between assessment methods should be considered.
Effectiveness of Low-Level Lasers subsequent to Third Molar Surgery: An Origi...DrHeena tiwari
This study assessed the effectiveness of low-level lasers in reducing postoperative pain, swelling, and trismus following third molar surgery. 32 patients who required bilateral lower wisdom tooth removal were treated, with one side receiving laser treatment and the other serving as the control. Pain was significantly lower on the laser treated side on days 6-7, though swelling and trismus did not significantly differ between sides. The results suggest low-level lasers may help reduce pain following third molar surgery when applied immediately after surgery.
"Demographic Analysis Of Palatal Fistula In A Tertiary Care Centre: A Retrosp...DrHeena tiwari
This document presents a retrospective study analyzing demographic data of patients with palatal fistulas who underwent repair at a tertiary care center between 2000-2020. The study found that in patients aged 0-6 months, fistulas were mostly located in the anterior hard palate and were predominantly less than 0.4mm in size. For patients aged 7-12 months and 13-24 months, most fistulas were also in the anterior palate but were larger in the older group. Patients over 24 months showed fistulas mainly in the anterior palate but had more intraoperative complications and postoperative infections. The results suggest certain age groups may be more prone to developing palatal fistulas in specific locations and sizes. Further prospective studies are recommended
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Malocclusion And Deleterious Oral Habits In South Indian Adolscent Population...DrHeena tiwari
This study evaluated the prevalence of malocclusion and associated oral habits in South Indian adolescents. The researchers assessed 1000 12-15 year olds using the Dental Aesthetic Index and found that 52% had some form of malocclusion. Deleterious oral habits were present in 21.2% of subjects and those with habits were more likely to have malocclusion than those without. Specific habits like tongue thrusting and mouth breathing were correlated with traits like crowding and open bite. The study concludes that malocclusion in this population is directly linked to the presence of oral habits.
This study investigated the craniofacial morphology and growth of cleft palate patients. Common findings among patients included anterior crossbite, a reduced and posteriorly positioned maxilla. Frequent orthodontic issues were deviations of the upper incisors, missing teeth in the cleft area, and asymmetries of the upper dental arch. Regarding growth, some patients had normal facial development while others exhibited a hypoplastic maxilla and middle third of the face. The study aimed to characterize the morphological features and growth patterns of cleft palate patients' craniofacial complexes to help establish appropriate treatment protocols.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
This case report describes an adult patient who presented with an anterior open bite that was associated with breathing problems. Clinical and radiographic examination revealed the open bite was due to skeletal factors including an increased lower anterior facial height and hyperdivergent skeletal planes. The patient's breathing problems acted synergistically with her skeletal pattern to cause and worsen the open bite over time as her mandible rotated counterclockwise to open and facilitate breathing. Treatment of the open bite would need to address both the skeletal and respiratory etiological factors.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
Epidemiology of Orofacial Pain in Population of Jammu City in India: An Origi...DrHeena tiwari
This study evaluated the etiology of orofacial pain among 400 patients visiting private clinics in Jammu, India. The results showed that dental caries leading to pulpitis was the most common cause of orofacial pain, affecting 96 patients. Periodontal disease and tooth sensitivity were also significant causes. Orofacial pain was more prevalent in females aged 26-35 years. The pain most commonly worsened during sleep and evenings and lasted less than 1 hour for many subjects. This study concluded that dental caries is the primary etiology of orofacial pain in this population and treatment should be tailored based on the identified cause.
“Comparative Evaluation between Physics Forceps and Conventional Extraction F...inventionjournals
:Tooth extraction procedure, although known as a minimal traumatic procedure, some sort of trauma is subjected to underlying soft and hard tissues, resulting in immediate destruction and loss of alveolar bone. Conventional extraction forceps are designed on the principle of simple machine incorporating two first-class levers, connected with a hinge. The physics forceps are the newly invented forceps. The design of physics forceps which implements a first class lever, creep, and type of force that provides a mechanical advantage, which makes it more efficient. AIM: The aim of the present study to evaluate the efficacy between the conventional extraction forceps and physics forceps in orthodontic extraction of maxillary premolars. Patients & Methods:A total of 50 healthy patients with indicated for extraction of bilateral maxillary premolar for orthodontic reasons; split mouth design (control side, test side) in a randomized manner; were included in the present study. Results:Ease of technique, buccal cortical plate fracture, fracture of tooth or root, gingival laceration, soft tissue healing was not significant. The extraction time and bleeding associated with extraction socket were significant. Post operative days 1-4 are not significant and on day 5-7 the pain on VAS score is 0. Conclusion:The results of present study suggest that, extraction using any forceps can produce predictable results and it totally depends on surgeon’s expertise in a particular technique.
Aims: This study evaluated the subjective experience of masticatory performance and masticatory efficiency in partially edentulous patients rehabilitated with three different types of removable partial dentures (RPDs). Materials and methods: This was a crossover randomized study, which was carried out at the prosthodontics clinic of the University of Ghana Dental School clinic. Sixteen patients requiring RPDs but had never worn one before were consecutively recruited for the study. Three different RPDs [i.e., cobalt chromium, acrylic, and thermoplastic resin (iFlex)] were fabricated for each patient. Masticatory efficiency was assessed using a singlesieve method after chewing raw carrots. The subjective experience of masticatory performance was also assessed using a questionnaire after 1 week of using each denture. Results: The cobalt-chromium denture recorded the highest masticatory efficiency (31.4%), and the iFlex denture recorded the lowest (27.9%).
This meta-analysis evaluates the reliability of published evidence on regenerative endodontic procedures. It summarizes clinical and radiographic findings from studies on treating non-vital immature permanent teeth using regenerative techniques. The analysis finds good success rates for tooth survival and pathology resolution, but variable results for outcomes like apex closure and root development. Regenerative procedures are improving but factors important for success remain unclear, indicating more research is needed.
This document provides an overview of diagnostic aids used in orthodontics. It begins by defining diagnostic aids as clinical tools that help with diagnosis and treatment planning. It then classifies diagnostic aids as either essential or supplemental. Essential aids include case history, clinical examination, study models, and certain radiographs. Supplemental aids include specialized radiographs, electromyography, and hand-wrist radiographs. The document goes on to describe each diagnostic aid in detail and discusses recent advances such as digital radiography, MRI, and computed tomography. It aims to outline the key clinical tools orthodontists use to evaluate patients and plan treatment.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
Introduction. The differences in the supporting structure of the implant make them more susceptible to inflammation and bone
loss when plaque accumulates as compared to the teeth. Therefore, a comprehensive maintenance protocol should be followed
to ensure the longevity of the implant. Material and Method. A research to provide scientific evidence supporting the feasibility
of various implant care methods was carried out using various online resources to retrieve relevant studies published since 1985.
Results.The electronic search yielded 708 titles, out of which a total of 42 articles were considered appropriate and finally included
for the preparation of this review article. Discussion. A typicalmaintenance visit for patients with dental implants should last 1 hour
and should be scheduled every 3 months to evaluate any changes in their oral and general history. It is essential to have a proper
instrument selection to prevent damage to the implant surface and trauma to the peri-implant tissues. Conclusion. As the number
of patients opting for dental implants is increasing, it becomes increasingly essential to know the differences between natural teeth
and implant care and accept the challenges of maintaining these restorations.
Comprehensive assessment of dentists knowledge and awareness about surgical ...Ajay Pacharne
Aim: Accurate treatment planning for implant which considers anatomical factors and prosthetic needs is essential to guarantee a predictable therapy. The aim of this study was to assess the current knowledge and awareness about surgical template among general dental practitioner in kanpur, India. Materials & Methods: This study was entirely attempted on a cross sectional idea. It also used the rational usage of questionnaire. However, after considering some essential aspects, this number was lastly reduced to 100. Authors completed the study by close ended questionnaire containing questions about the present knowledge and awareness about surgical template. Response was recorded and data was processed statistically to evaluate the real-time knowledge and awareness level. Results: Statistical analysis was done using statistical software ‘Statistical Package for the Social Sciences (SPSS)’. The recorded data was subjected to suitable statistical tests to obtain p values, mean, standard deviation, standard error an 95% CI. P ≤ 0.05 was considered as statistically significant. 27 practitioners were unaware of the usage of surgical template. 94 practitioners think that UG dental curriculum is inadequate regarding surgical template. 60 practitioners think that surgical template must be made mandatory for all dental institutions.
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
This systematic review compares the success rates of Endosequence bioceramic root repair material (BCRRM), mineral trioxide aggregate (MTA), and calcium hydroxide for apexification of necrotic immature permanent teeth. 9 studies met the inclusion criteria for review. The studies found that all three materials had similar success rates in terms of clinical symptoms. However, MTA and Endosequence BCRRM formed the apical barrier faster and allowed for single visit treatment, making them superior to calcium hydroxide which took 5-20 months. Further research is needed directly comparing MTA and Endosequence BCRRM.
This systematic review compared the success of Endosequence bioceramic root repair material (BCRRM), mineral trioxide aggregate (MTA), and calcium hydroxide for apexification of immature permanent teeth. 9 studies involving a total of over 400 potential studies were included. The studies found that while all three materials showed similar clinical success rates, MTA and BCRRM formed apical barriers faster than calcium hydroxide. More research is still needed directly comparing MTA and BCRRM.
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
This study compared the efficacy of fixed versus removable retainers for maintaining orthodontic treatment outcomes over 4 years. 48 participants from an original randomized controlled trial were evaluated. Those with fixed retainers had lower irregularity scores on average (0.85mm increase) compared to removable retainers (1.47mm increase). After adjusting for confounding factors, the difference in irregularity between groups was statistically significant, with removable retainers having 1.64mm more irregularity on average. No other significant differences were found between groups for other metrics like inter-canine width. Compliance with removable retainers decreased over time. Fixed retainers maintained their position better, though some required repair. In conclusion, fixed retainers appeared to
This document discusses how technology can be used to improve endodontic treatment and restorations. It describes how a dental operating microscope, cone beam computed tomography (CBCT), and CAD/CAM technology allow dentists to perform endodontic treatment and place a restoration in a single visit. The microscope enhances visibility during root canal treatment, while CBCT provides additional diagnostic information. CAD/CAM technology enables same-day fabrication of ceramic restorations with digital impressions. The document provides examples of cases where these technologies were used together from initial endodontic treatment through final restoration.
This study assessed the 5-year outcome of apical microsurgery in 170 teeth from 191 subjects who underwent the procedure. At the 5-year follow-up, 129 teeth (75.9%) were healed compared to 83.8% at 1 year. Two significant predictors of healing outcome were identified: teeth with interproximal bone loss >3 mm from the cementoenamel junction had a lower healing rate (52.9%) compared to those with ≤3 mm bone loss (78.2%); and teeth filled with ProRoot MTA had a higher healing rate (86.4%) than those filled with SuperEBA (67.3%).
2009 A novel decision making for tooth extraction or conservation.pdfKaterineRiquelme3
This document presents a decision-making chart to help clinicians determine whether to extract or retain a compromised tooth. The chart contains 6 levels of factors to consider, ranging from initial patient assessment to periodontal disease severity. Each factor is assigned a color (green, yellow, red) to indicate the likelihood of successful long-term retention. If a tooth receives mostly red or a combination of red and yellow ratings, extraction is recommended. The chart is meant to guide clinicians through an analysis of all relevant factors to make the best decision for each individual tooth and patient.
1. The study assessed the effectiveness of an orthodontic tongue crib appliance in treating 18 growing children with Class 3 malocclusion and open bite.
2. Cephalometric analysis found that after 12 months of treatment, patients had significant forward growth of the maxilla and improved maxilla-mandibular relationships.
3. The tongue crib was effective at improving the maxillary complex growth and facial esthetics in growing patients with skeletal Class 3 and open bite malocclusions.
revision de la clasificacion de las maloclusionesRESIDENTESIUNT
This document discusses a study that evaluated the consistency of orthodontists in classifying malocclusions according to Angle's classification method. Study models of patients with varying malocclusions were photographed and sent to orthodontists in a questionnaire. There was significant disagreement among respondents in classifying malocclusions that were not fully Class II or Class III. Only the ideal occlusion models elicited over 90% agreement. The results demonstrate inconsistency in applying Angle's classification to borderline cases. Many orthodontists feel a more precise classification system is needed that addresses limitations of Angle's method such as variability in molar position and missing teeth.
This case series describes the use of multiple dental implants to achieve aesthetic rehabilitation in two patients. For the first patient, two implants were placed to replace missing teeth 11 and 12, and a root canal was performed and crown placed on fractured tooth 21, followed by a fixed bridge. For the second patient, a single implant was placed to replace missing tooth 11 and a full ceramic crown placed. Both treatments achieved patient satisfaction. The case series demonstrates that a multidisciplinary approach using different prosthetic options can successfully achieve aesthetic rehabilitation using dental implants.
Similar to Modification of Distal Shoe- A Systematic Review & Meta Analysis (20)
Diabetes mellitus is a chronic disease characterized by high blood glucose levels due to either the body not producing enough insulin or cells not responding properly to insulin. There are different types of diabetes classified by the WHO including type 1, type 2, gestational diabetes and others. The document discusses the causes, risk factors, clinical manifestations, complications and management of diabetes as well as prevention strategies and the national diabetes control program in India.
Malaria remains a major global health issue, with 216 million cases and 445,000 deaths reported in 2016. In India, the disease disproportionately impacts the Northeast and Central regions. The presentation discusses the epidemiology, measurement, control strategies and interventions for malaria. It highlights China and Sri Lanka's success in achieving elimination through strong surveillance systems and mobile clinics. Global efforts include the NMCP, vector control measures and the RTS,S malaria vaccine to reduce disease burden.
The document discusses performance evaluation in healthcare. It defines performance evaluation as measuring organizational performance to improve quality of care. Hospitals evaluate performance to plan improvements, ensure efficient resource use, and assess health programs. Evaluation methods include regulatory inspections, consumer surveys, third-party assessments, statistical indicators, and internal assessments. Key performance indicators help facilities compare performance and identify areas for increased patient satisfaction and operational efficiency. The presentation provides examples of operational, financial, internal, public health, and quality of care metrics that are important for performance evaluation.
Evaluation of Signs and Symptoms Post Recovery in COVID Patients: A Questionn...DrHeena tiwari
This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
Oral Health & Its Effect on COVID 19: Systematic Review & Meta Analysis.DrHeena tiwari
This document summarizes a systematic review and meta-analysis on the relationship between oral health and COVID-19. The review included 13 studies. Key findings included:
1) Infection control measures like telephone screening, social distancing and PPE were discussed across many studies as important for dental practices during the pandemic.
2) Pre-procedural mouthwashes and use of rubber dams and high-volume evacuation were recommended to reduce aerosol transmission during dental procedures.
3) Guidelines varied on types of masks to use, but N95 or equivalent masks were suggested for aerosol-generating procedures by many studies.
4) Psychological impacts of COVID-19 on dental workers and appropriate waste
Radiographic Evaluation of the MB2 Canal in Permanent Maxillary Molars- An Or...DrHeena tiwari
This study evaluated the presence and location of the MB2 canal in maxillary first molars using CBCT scans. The scans of 296 patients were analyzed, showing MB2 canals in 43.8% of teeth. No significant gender difference was found. The angle between the mesiobuccal, distobuccal and palatal canals (ƒMDP) was greater in teeth with MB2 canals. A moderate positive correlation was found between ƒMDP and the angle between mesiobuccal, distobuccal and MB2 canals (ƒMDMB2). If ƒMDP was over 90.95 degrees, there was a 78% probability of finding an
EVALUATION OF BREAST CANCER AND ITS RELATION WITH PERIODONTAL DISEASES: AN OR...DrHeena tiwari
This study evaluated the association between periodontitis and breast cancer in Brazilian women. 67 cases of breast cancer were compared to 134 age-matched controls. Cases had greater clinical attachment loss than controls. Women diagnosed with periodontitis had 2-3 times higher odds of breast cancer than those without periodontitis after adjusting for covariates. This suggests a significant association between periodontitis and increased risk of breast cancer.
CLINICAL FEATURES, DIFFERENCES IN COVID FIRST, SECOND, THIRD WAVES- A DATA BA...DrHeena tiwari
This study compared the clinical features of COVID-19 in children and youth across the first three waves in multiple countries. A total of 397 patients aged 18 or younger were included. More patients were asymptomatic in the second and third waves compared to the first wave. Most illnesses were mild in all waves. A few patients presented with unusual manifestations like chilblains or multisystem inflammatory syndrome. The study found differences in symptoms and hospital length of stay across the three waves.
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapa...DrHeena tiwari
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapadu Village of Guntur District, Andhra Pradesh, India: An Original Research
Evaluation of Cardiac Complications in Pateint Undergoing COVID 19 Treatment:...DrHeena tiwari
This study evaluated cardiac complications in 45 COVID-19 patients admitted to the intensive care unit. Electrocardiography and Holter monitoring found various arrhythmias in patients, with atrial fibrillation, premature ventricular contraction, and tachycardia being most common. The mortality rate of arrhythmias in COVID-19 patients was 17.77%. Although arrhythmias are not very frequent in COVID-19, they can be fatal and have a high mortality rate. Early detection of arrhythmias can help prevent deaths.
Role of Extracorporeal Membrane Oxygenation (ECMO) in COVID 19: A Boom in Tre...DrHeena tiwari
This document discusses the role of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients. ECMO is a treatment that oxygenates a patient's blood outside of the body and can be used when other treatments have failed. There are two main types of ECMO configurations - venovenous ECMO which oxygenates blood without supporting circulation, and venoarterial ECMO which fully supports the heart and lungs. The document reviews the indications, contraindications, hazards and settings for ECMO and argues it can be beneficial for supporting recovery from severe respiratory or cardiovascular problems caused by COVID-19.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Modification of Distal Shoe- A Systematic Review & Meta Analysis
1. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8674
http://annalsofrscb.ro
Modification of Distal Shoe- A Systematic Review & Meta Analysis
Dr Mohammed Muzammil Khan,1
Dr. Rinku Adwani Nathani,2
Dr. Heena Tiwari3
,
Dr. Dantuluri Lohitha Divya Vani,4
Dr. Kumar B. Niwlikar,5
Dr.Savitri Ranjeri6
1
Specialist Pedodontist, Ministry of health, Taif, Kingdom of Saudi Arabia.
mdmuzammil.khan8@gmail.com
2
Associate professor, Dept.of Orthodontics and Dentofacial Orthopaedics, VYWS Dental
College and Hospital, Camp Amravati, Maharashtra. drrinkuadwani@gmail.com
3
BDS, PGDHHM, MPH Student, Parul Univeristy, Limda, Waghodia, Vadodara, Gujrat,
India. drheenatiwari@gmail.com
4
Intern, Gitam dental college and hospital, Visakhapatnam, Andhra Pradesh.
lohithadivyavanidantuluri2821@gmail.com
5
Reader, Department of Orthodontics and Dentofacial Orthopaedics, Nanded Rural Dental
College and Research Center, Nanded, Maharashtra. kumarniwalikar9@gmail.com
6
Consultant Pedodontist & Preventive Dentist, Bidar 585401, Karnataka.
savitri.rao09@gmail.com
Corresponding Author:Dr Mohammed Muzammil Khan, Specialist Pedodontist, Ministry of
health, Taif, Kingdom of Saudi Arabia. mdmuzammil.khan8@gmail.com
Abstract
Introduction: In the pediatric patients the premature loss of second primary molar will culminate
in malocclusion of the permanent teeth by the space loss. This space has to be guarded with the
help of the appliance that can prevent the permanent first molar from migration into the free
space. The Distal Shoe Space Maintainer is indicated in such situation to avoid space loss. But
there may be situations that will require some modifications in the conventional design. Hence in
our study we intend to review the various modifications in the Distal Shoe Space Maintainer and
their functional implications.
Materials and Methods: We conducted the search for the data from the online sources like the
“EMBASE”, “Pubmed”, “Scopus” and other sources. The articles for the past 20 years were
searched for the parameters Distal Shoe Space Maintainer, modified Distal Shoe Space
Maintainer, space maintainers, space loss. The primary outcome variable was the effectiveness
of the modified distal shoe space for the space maintenance after the eruption of lower first
permanent molar in the oral cavity. The gingival responses and patient compliance were taken as
the secondary outcomes. The data extraction was based on the PICOS guidelines. We also
assessed the quality of the study using the quality assessment score.
Results: Out of the 27 articles only 6 articles were finalized. Inadequate data is available from
these 6 articles. The efficiency of these modifications, gingival responses were inconclusive.
Three studies only stated the patient compliance.
Conclusion: The success of the distal shoe and its gingival response is inconclusive. There were
many clinical aspects that were not thoroughly described in the studies about these
modifications. We can propose that further well designed studies be conducted to establish the
performance of these modifications in the distal shoe and help clinicians with its application.
2. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8675
http://annalsofrscb.ro
Keywords: Space Management, Modified Distal Shoe Space Maintainer, Pediatric patients
Introduction
For a pedodontists it is of great significance to maintain the primary teeth in their positions till
the permanent teeth erupt. Nevertheless they may be extracted in some children if there is
extensive or rapid caries.1,2
In particular the loss of the primary molars will lead to malocclusion
There could be the reduction of the arch length if there is a loss of the primary teeth
prematurely.3,4
This may lead to the improper guidance to the erupting permanent molars and the
premolars. To overcome this, the space maintainers are used. Various space maintainers can be
given to the children, subject to the cooperation, age, missing teeth, patient’s dental arch, stage of
dental development, and dentition. Among the primary teeth the premature loss of the primary
second molars is a challenge to the pedodontists. In such patients the careful selection will help
in the proper guidance while maintaining the space to the permanent teeth.5-7
The Distal Shoe
(DS) Space Maintainer is indicated in such situation to avoid space loss. But there may be
situations that will require some modifications in the conventional design. This appliance can be
fixed and is patient friendly. There are some indications and contraindications for the use of the
DS. The indications are extensive root resorption/ ankylosis of the second primary molar, loss of
the second primary molars, caries of second primary molars, bone loss periapically. However if
there are no adequate abutments, systemic health conditions, uncooperative children.8-10
The
choice of the space maintainer depends on the condition of the patient, the experience of the
pedodontists also plays an important role. The choice depends on the first permanent molar
position if that has erupted or not. The conditions that will preclude the use of the conventional
distal shoe are premature loss of multiple primary molars. In such conditions the modified distal
shoe can be used. Hence in our study we intend to review the various modifications in the Distal
Shoe Space Maintainer and their functional applications.
Materials and methods
We conducted the search for the data from the online sources like the “EMBASE”, “Pubmed”,
“Scopus” and other sources. The articles for the past 20 years were searched for the parameters
Distal Shoe Space Maintainer, modified Distal Shoe Space Maintainer, space maintainers, space
loss. The primary outcome variable was the effectiveness of the modified distal shoe space for
the space maintenance after the eruption of lower first permanent molar in the oral cavity. The
gingival responses and patient compliance were taken as the secondary outcomes. The data
extraction was based on the PICO structure. We intended to assess if the distal shoe appliance
modifications may act as an effective and safe technique for space maintenance where lower
second primary molars are indicated for extraction before eruption of lower first permanent
molars in children. We also assessed the quality of the study using the Quality assessment score.
We excluded the studies where the removable appliance were used, those articles that were not in
English, animal research, duplicate studies. Only those studies where the distal shoes were used
among the children of 4-6 years with indication to extraction of the lower second primary molar
before the permanent molar eruption. Distal shoe space maintainer with modifications was used.
We took care the outcomes were well defined. Two independent reviewers studied the full
articles and the disputes were settled. The information thus obtain was tabulated and compared.
We assessed the quality, considering the various parameters that were studied in the included
articles.
3. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8676
http://annalsofrscb.ro
Results
The total number of the articles that were identified is 27. Among these only 6 articles were
finalized for the study. The flow chart describing the finalization of the articles is presented in
Figure 1.
The quality of the selected 6 studies were evaluated with the quality assessment scores by taking
the following variables into consideration like the Keywords identified, Addressed question,
Clear aims and objectives, Clarity of the technique, Clear outcome, Standard method of
measurement, Clear data collection methods , Clarity of the case, Practicality of the results,
Justified conclusions from the observations. All the 6 studies were evaluated and the score of 2/3
was obtained. This shows a very low quality of the study. (Table 1)
It was observed in our review that in all the studies the primary output was implicit results were
only given, there were no thorough follow up or clear design. In these studies only one study
mentioned the secondary variable and the others didn’t regarding the gingival responses after the
appliance was given. We also observed the good tolerance to the appliance was reported in 3
studies. (Table 2)
Figure 1. Flow-chart showing the selection of the articles.
TABLE 1: Quality assessment of the finalised articles
Study
(reference)
Keywords
identified
Addressed
question
Clear
aims
and
objecti
ves
Clarity of
the
technique
Clear
outcome
Standard
method of
measurem
ent
Clear data
collection
methods
Clarity
of the
case
Practica
lity of
the
results
Justified
conclusions
from the
observation
s
QA
S
4. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8677
http://annalsofrscb.ro
13 Yes No No No No No No yes No No 2/10
12 Yes No Yes No No No No Yes No No 2/10
8 Yes No Yes Yes No No No No No no 3/10
9 Yes No No No No No No Yes No No 2/10
11 Yes No No No No No No Yes No No 2/10
10 Yes No Yes No No No No Yes No No 3/10
Table 2: Characteristics of studies included in the systematic review
Authors and
year
Dhull et al,
2011
Gujjar et al,
2012
Dhindsa and
Pandit, 2008
Bhat et al,
2014
Agarwal et al, 2014 Brill ,
2002
Nation Canada India India India India USA
Aim Evaluate the
modification
of the distal
shoe-DS
.
Clinical
management
of the
extensive
mandibular
caries with the
Modified DS
Study the
Modified DS
application in
bilateral loss
of molars
Study the
Modified DS
application in
multiple
molars loss.
Study Modified DS
application in
maxillary molars
followed by a
functional band and
bar space maintainer
until the eruption of
the underlying
second premolar
Chair
side
fabricati
on and
applicat
ion of
the
Modifie
d DS.
Problem to
be addressed
space loss space loss Bilateral
space loss
space loss Space and functional
loss
space
loss
Study design All are Case reports
Average
Age
5 year No report 4 year 10
month
4 year 5
month
5 year 4 months No
report
Abutment
teeth
mandibular
left D
Mandibular
left D and
mandibular
right C.
mandibular
right C and D
and on
mandibular
left C
mandibular
right C &
mandibular
left E
maxillary right D Mandib
ular Ds
or
mandib
ular Cs.
5. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8678
http://annalsofrscb.ro
Fabrication Laboratory Laboratory Laboratory Laboratory laboratory Chair-
side
Retention Crown Band Band Band Band Band
Prohibiting
occlusal
interference
with
opposing
tooth
Yes No No No yes No
Allow
adjustments
Yes No No No No Yes
Follow up
and
intervals
1.5 years
Every 2
months
2 months
Every month
7 months
Every 2
months
10 months
Every 2
months
Not reported Every 2
months
Not
reported
Every 2
month
Outcome Implicit
-DS guides
first molar in
correct
position
Implicit
- DS guides
first molar in
correct
position
Implicit
- DS guides
first molar in
correct
position
Implicit
- DS guides
first molar in
correct
position
Implicit
DS guides first molar
in correct position
Implicit
Success
rate of
the
chair
side
fabricat
ed
Distal
shoe
applian
ce
Findings
The proposed
design
provided
stability and
adjustability
to the
appliance.
The modified
distal shoe
appliance was
stable and
showed
acceptability
by the patient.
The modified
distal shoe
(Willet)
appliance is
more stable
and better
accepted by
the patient
than the
conventional
The modified
distal shoe
appliance is
time efficient,
more stable
and strong
than
conventional
design, better
accepted by
The trial of an
innovative design of
a functional distal
shoe space
maintainer showed
that it is well
accepted by the child
No
conclusi
on
6. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8679
http://annalsofrscb.ro
design the child,
require less
cooperation
and chair side
time and
meets all the
criteria for
proper space
maintainer.
permanent
molar
Acceptance Patients
tolerance to
the appliance
Patients
tolerance to
the appliance
Patients
tolerance to
the appliance
- - -
Discussion
In the pediatric patients the premature loss of second primary molar will culminate in
malocclusion of the permanent teeth by the space loss.11-13
This space has to be guarded with the
help of the appliance that can prevent the permanent first molar from migration into the free
space. In the current review we evaluated the efficacy of the modified distal molar in the space
maintenance. The modification has been presented in several studies. However we considered
only those studies that satisfied our criteria. A total of 6 studies were finalized for the review.
Among these 4 studies were from India and 1 each from Canada and USA. The conventional
design can be used only for the unilateral loss of the second deciduous molar. In special
conditions like the bilateral loss of these, then a modification of the conventional design is
required. This problem was addressed by Dhindsa and Pandit12
, where they proposed a lingual
holding arch for the bilateral conditions. The drawback was the permanent incisors might be
hindered in their eruption path. Hence their design was later modified. In the design proposed by
Gujjar et al., they proposed to place the lingual arch far lingually. This prevented the hindrance
to the incisor eruption paths.13
The presence of the lingual arch in both these designs is very
useful lower arch integrity when there are multiple molar losses.2,12,13
The primary outcome that
is the effectiveness of the modified distal shoe space for the space maintenance after the eruption
of lower first permanent molar in the oral cavity was implicitly met in all the 6 studies. The
quality of the studies was poor as they didn’t fulfill the criteria put by the quality assessment
score. The scores of all the studies were 2/3 of 10. This poor quality is a hindrance to the correct
explicit outcomes that can be applied in clinical practices. The second variable that was studied
was the gingival response. Only in the study of Brill et al9
though they mentioned the the
appliance typically didn’t cause gingival inflammation. Only the clinical photographs were used
to describe the gingival condition, without any scientific records. As the conventional designs
were fabricated from the cast metals the minor adjustments of the vertical arm can’t be made.
This new modifications given by Brill et al9
and Croll et al15
would help in minor adjustments be
made in the distal shoe during the adaptations. Some authors have placed the loop modification
in the designs that helped in the precise placement of the distal shoe. This not only helped in the
placement but also prevented the supra eruption of the opposite tooth and the adjacent tooth’s
7. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8680
http://annalsofrscb.ro
tipping mesially. But the drawback with this appliance was the time, the compliance of the child
and the excessive cost of the appliance. The patient compliance was noted in only three studies
in our review. Gegenheimer and Donly gave a special modification in which the distal loop was
made and cemented.6
This helped as a space maintainer if the permanent molar erupted and the
gingival extension be removed. A very different modification was given by Dhull et al14
where
they included buccal and lingual arms that provided better stability. In all these deigns and
modifications there were some cautions to be employed as there is literature stating the trauma to
the successor tooth due to the gingival extension’s wrong placements.
It can be said from our review that the success of the modification, the gingival response and
acceptance were not thoroughly described. This could be due to the poor quality of the study
designs. None of the techniques described was able to fulfill all the clinical criteria suggested.
Conclusion
The dentist should constantly evaluate the space when there is succession from the primary to
permanent teeth. Hence the space maintenance is of great significance. The following
conclusions can be drawn from our review. The success of the distal shoe and its gingival
response is inconclusive. There is insufficient data to help clinicians with choosing these
modifications. There is inadequate evidence to depict the level of tolerance of these
modifications when given in children. There were many clinical aspects that were not thoroughly
described in the studies about these modifications of the distal shoe. We can propose that further
well designed studies be conducted to establish the performance of these modifications in the
distal shoe.
References
1. An SY, Shim YS, Park SY. Aesthetic rehabilitation in maxillary anterior tooth with early
childhood caries using ZIRKIZ® Crown: Long-term follow-up. Indian Journal of Science and
Technology. 2015 Oct; 1-5.
2. Kupietzky A. Clinical technique: Removable appliance therapy for space maintenance
following early loss of primary molars. European Archives of Paediatric Dentistry. 2007;
8(1):30-4.
3. Pinkham JR, Casamassimo PS, Tigue MDJ, Fields HW, Nowak AJ. Pediatric dentistry:
Infancy through adolescence. Elsevier Saunders. 2005; 63146.
4. Dean JA, Avery DR, Donald MRE. Dentistry for the child and adolescent. Riverport Lane.
2016; 3251.
5. Cochrane Handbook for Systematic Reviews of Interventions. 2014. Available from:
http://handbook.cochrane. org/index.htm#0_2_how_to_cite_the_handbook.htm
6. Gegenheimer R, Donly KJ. Distal shoe: A cost-effective maintainer for primary second
molars. Pediatric Dentistry. 1992; 14(4):268-9.
7. Kirshenblatt S, Kulkarni GV. Complications of surgical extraction of ankylosed primary teeth
and distal shoe space maintainers. Journal of Dentric Childist (Children ). 2011; 78(1):57-61.
8. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 8674 - 8681
Received 05 March 2021; Accepted 01 April 2021.
8681
http://annalsofrscb.ro
8. Nouri MR, Kennedy DB. Optimal fit of chairside-fabricated distal shoe space maintainer.
European Academy of Paediatric Dentistry. 2013;14(5):351-4. 9.
9. Brill WA. The distal shoe space maintainer chairside fabrication and clinical performance.
Pediatric Dentistry. 2002; 24(6):561-5.
10. Bhat PK, Idris M, Christopher P, Rai N. Modified distal shoe appliance for premature loss of
multiple deciduous molars: A case report. Journal of Clinical Diagnostic Research. 2014;
8(8):43-5.
11. Agarwal R, Chaudhry K, Yeluri R, Singh C, Munshi AK. Alternative approach to
management of early loss of second primary molar: A clinical case report. Journal of California
Dental Association . 2014; 42(5):327-30.
12. Dhindsa A, Pandit IK. Modified Willet’s appliance for bilateral loss of multiple deciduous
molars: A case report. Journal of Indian Social Pedodtric Prevention Dental. 2008; 26(3):132-5.
13. Gujjar KR, Indushekar KR, Amith HV, Sharma SL. Modified distal shoe appliance-
fabrication and clinical performance. Journal of Dentric Childist. 2012; 79(3):185-8.
14. Dhull KS, Bhojraj N, Yadav S, Prabhakaran SD. Modified distal shoe appliance for the loss
of a primary second molar: A case report. Quintessence Int. 2011; 42(10):829-33.
15. Croll TP, Sexton TC. Distal extension space maintenance: A new technique. Quintessence
Int 1981;10:1075-80.