Nevin Manimala

J Clin Pediatr Dent. 2023 Sep;47(5):103-115. doi: 10.22514/jocpd.2023.059. Epub 2023 Sep 3.

ABSTRACT

The aim of the study was to establish the normality ranges of the linear and angular measurements that can be carried out in orthopantomographies (OPGs) of a paediatric sample from Madrid, according to sex and dentition. OPGs performed in the Radiology Service of the Faculty of Dentistry of the Complutense University of Madrid (UCM) from caucasic children between 4-14 years old were selected. A total of 44 measurements were made in the OPGs, and the sex and type of dentition of each child were recorded. Panoramic Mandibular Index and Antegonial Index were also calculated. Statistical tests were performed with a confidence level of 95% (p < 0.05) and bilateral significance to analyse the differences between sex and type of dentition, and the correlation between the measurements of the right and left sides. A total sample of 160 OPGs (50% boys, 50% girls) were analysed. 16.25% of the sample was in primary dentition, 50% in first phase mixed dentition, 17.5% in second phase mixed dentition and 16.25% in permanent dentition. Statistically significant differences were found with respect to the sex of the subjects in 11 of the measurements; and 44 in relation to the dentition stages of the subjects. A strong correlation is found between the measurements on the right and left sides. The application of panoramic measurements as indicators of normality can help in the detection of craniofacial alterations in growth and development of the lower facial third.

PMID:37732443 | DOI:10.22514/jocpd.2023.059

J Clin Pediatr Dent. 2023 Sep;47(5):88-95. doi: 10.22514/jocpd.2023.057. Epub 2023 Sep 3.

ABSTRACT

The health of dental pulp tissue is critical to maintaining normal tooth function from the eruption of permanent teeth to the formation of the apex. The study evaluated the inflamed pulp response to the mineral trioxide aggregate (MTA) after direct pulp capping with the mechanical pulp exposure in rats’ incisor. Forty-eight mandibular central incisors of twenty-four Sprague-Dawley rats which were prepared with the cavities of one mm diameter, and the pulp exposures were randomly assigned into two groups: MTA group and calcium hydroxide (Ca(OH)₂) group. The direct pulp capping was performed after three days and samples histological observations conduction within eight weeks. In both MTA and Ca(OH)₂ groups, dentin -like structures were observed in the pulp tissues of some teeth. The number of teeth with reparative tissue in MTA group was statistically significantly higher than that in Ca(OH)₂ group (p = 0.041). Inflammatory cell infiltration was found in the crown pulp tissues in two groups, and no statistical difference was observed between the two groups (p = 0.243). Pulp necrosis occurred in both groups, and there was no statistical difference between the two groups (p = 0.622). The results in this paper suggest that MTA promotes direct pulp capping and hence has certain potential clinical applications value in the treatments for the preservation of inflamed pulp.

PMID:37732441 | DOI:10.22514/jocpd.2023.057

J Clin Pediatr Dent. 2023 Sep;47(5):81-87. doi: 10.22514/jocpd.2023.056. Epub 2023 Sep 3.

ABSTRACT

The aim of this cross-sectional study was to assess the prevalence and severity of dental anomalies according to age at cancer treatment and type of antineoplastic protocol using the Modified Dental Defect Index (MDDI) and to explore the association between MDDI scores and caries experience in Italian childhood cancer survivors (CCS). A total of 88 CCSs (age range 6-20 years) treated with chemotherapy and/or radiotherapy for malignant diseases and in remission from at least 2 years were consecutively recruited from March 2019 to July 2022. All participants were examined for dental caries and enamel defects in the permanent dentition according to the decayed-missing-filled teeth (DMFT) index and the Aine rating scale. Dental abnormalities were diagnosed using panoramic radiographs and graded for severity according to the MDDI. The MDDI values were categorized as normal (MDDI, 0), moderately abnormal (1 ≤ MDDI < 16), and severely abnormal (MDDI ≥16). None of the enrolled children had normal MDDI score. MDDI and DMFT values were higher in CCSs submitted to cancer treatment before 5 years of age, while no statistically significant association was found with anticancer protocols. A significant positive correlation emerged between DMFT and MDDI values (p < 0.001). CCSs with moderately abnormal disturbances had statistically significant lower DMFT scores (p < 0.001) than those with severe dental abnormalities. These findings suggest that children in remission from malignant diseases with MDDI values ≥16 have poorer dental health and should be strictly monitored by dental specialists.

PMID:37732440 | DOI:10.22514/jocpd.2023.056

J Clin Pediatr Dent. 2023 Sep;47(5):65-72. doi: 10.22514/jocpd.2023.054. Epub 2023 Sep 3.

ABSTRACT

This prospective cohort study aimed to evaluate the clinical outcomes of vital pulp therapy (VPT) with the use of iRoot BP Plus (Innovative Bioceramics, Vancouver, Canada) for immature permanent teeth of patients aged from 6 to 10 years with pulp exposure resulting from dental caries and determine the impact of preoperative factors on VPT. Forty-six immature permanent teeth with dental caries underwent pulpotomy using iRoot BP Plus following a standardized protocol. Postoperative follow-ups were conducted on the first 3, 6 and 12 months post-surgery, then annually afterward. Successful treatment outcomes were defined based on clinical and radiographic evaluations. Statistical analysis was performed using the Fisher exact test, with p < 0.05 considered for statistical significance. Forty-four patients included in this study were 8.48 ± 1.49 years old and were followed up for 6 to 36 months. The overall success rate of pulpotomy was found to be 90.9% (40/44). None of the physical examination findings and symptoms significantly affected VPT prognosis (p > 0.05). Immature permanent teeth with caries-induced pulp exposed in patients aged 6 to 10 years can be effectively treated with pulpotomy using iRoot sBP Plus.

PMID:37732438 | DOI:10.22514/jocpd.2023.054

J Clin Pediatr Dent. 2023 Sep;47(5):57-64. doi: 10.22514/jocpd.2023.053. Epub 2023 Sep 3.

ABSTRACT

In this in vitro study, fracture resistance was evaluated according to the post-diameter and -length in zirconia crown restorations on three-dimensional printed primary incisors undergone pulpectomy. One hundred-and-sixty primary incisor abutments were used which were artificially fabricated through 3D-printing. Each group was divided into two subgroups based on the zirconia post-diameter (1.5 mm and 2.0 mm) employed for post setting after pulpectomy. Furthermore, each group was divided into four subgroups based on the zirconia post-height (3.0, 4.0, 5.0 and 6.0 mm). Zirconia post setting was made by applying flowable resin after filling the pulp cavity with calcium hydroxide up to 3.0 mm below cemento-enamel junction (CEJ). Finally, a preformed zirconia crown of size #1 was cemented to the abutment through resin cement. A compressive load was applied to the middle palatal surface of incisors restored with zirconia crowns by using a universal testing machine at 145° angle which is the normal interincisal angle of children. The root fracture specimens were excluded and the samples fractured within crown and core parts were included in the final fracture resistance analysis. The group with 1.5-mm post-diameter and 5.0-mm post-height had the highest fracture resistance strength (130.63 ± 55.75 N) under masticatory pressure condition. Fracture resistance was statistically greater in 5.0-mm than in 4.0-mm and 3.0-mm post-height groups for 1.5-mm post-diameter subgroup. Moreover, 5.0-mm post-height subgroup had a statistically greater fracture resistance than that of 3.0-mm post-height subgroup for 2.0-mm post-diameter group. The 2.0-mm post-diameter subgroup had a statistically greater fracture resistance than that of 1.5-mm post-diameter subgroup for 3.0-mm and 4.0-mm post-heights. If zirconia post incorporation is required for deciduous incisor restoration, a post-length equal to facial CEJ level is recommended for gaining additional retention against masticatory pressure.

PMID:37732437 | DOI:10.22514/jocpd.2023.053

J Clin Pediatr Dent. 2023 Sep;47(5):51-56. doi: 10.22514/jocpd.2023.045. Epub 2023 Sep 3.

ABSTRACT

In this study, we investigated dental arch forms in a representative sample of children with mixed dentition. Twenty-four pairs of study models, belonging to twenty-four youngsters (twelve boys and twelve girls aged 8 to 9 years) with acceptable occlusion, were scanned and assessed by Ortho analyzer software. Three transversal and three vertical measurements were acquired to evaluate the lengths and widths of dental arches, and the ratios between these measurements were standardized. Next, the mean standardized parameters were used to define the dental arch form. Unpaired t-tests were used to analyze gender differences for all measures. Subsequently, frequencies and percentages were determined for each arch shape in both jaws and genders, and Pearson’s Chi-squared test was used to evaluate differences between genders. Males exhibited higher mean values for all measurements, but without statistical significance. The most prevalent dental arch was the mid form (83.3%) for both jaws and genders.

PMID:37732436 | DOI:10.22514/jocpd.2023.045

J Clin Pediatr Dent. 2023 Sep;47(5):37-42. doi: 10.22514/jocpd.2023.052. Epub 2023 Sep 3.

ABSTRACT

The term Molar-Incisor Hypomineralisation (MIH) is used to describe hypomineralised defects of systemic origin that affect at least one of the first permanent molars and often involves the permanent incisors. Antibiotic therapy during amelogenesis may be associated with enamel hypomineralisation. By examining children with Sickle Cell Disease (SCD), who take prophylactic antibiotics daily from birth until age five, it may be possible to determine if there is an increased prevalence of MIH in this population. The aim of this study was to determine the effect of long-term antibiotic use on the prevalence and severity of MIH in children with SCD. In a prospective cohort pilot study over a period of seven months, children aged 7-17 years, with SCD at Boston Children’s Hospital (n = 18) were examined for MIH. Information regarding peri-natal concerns, incidence of illness and antibiotic use were also collected. The results were compared to a group of control patients (n = 63) for prevalence and severity of MIH using Fisher’s exact test. The patients with SCD, 4/18 (22%) taking daily antibiotics did not show a statistically significant greater prevalence of MIH compared to the control group, 24/63 (38%). There was no correlation between MIH and pneumonia, asthma, fever, flu, otitis media, breastfeeding, gender and birth weight. However, an association was noted between premature birth and MIH (p ≤ 0.05). No correlation was found between long-term antibiotic use and higher prevalence of MIH in the SCD group compared to the control group. However, MIH may be more severe in those with a history of long-term antibiotics.

PMID:37732434 | DOI:10.22514/jocpd.2023.052

J Dev Orig Health Dis. 2023 Sep 21:1-11. doi: 10.1017/S2040174423000247. Online ahead of print.

ABSTRACT

The deleterious effects of adversity are likely intergenerational, such that one generation’s adverse experiences can affect the next. Epidemiological studies link maternal adversity to offspring depression and anxiety, possibly via transmission mechanisms that influence offspring fronto-limbic connectivity. However, studies have not thoroughly disassociated postnatal exposure effects nor considered the role of offspring sex. We utilized infant neuroimaging to test the hypothesis that maternal childhood maltreatment (CM) would be associated with increased fronto-limbic connectivity in infancy and tested brain-behavior associations in childhood. Ninety-two dyads participated (32 mothers with CM, 60 without; 52 infant females, 40 infant males). Women reported on their experiences of CM and non-sedated sleeping infants underwent MRIs at 2.44 ± 2.74 weeks. Brain volumes were estimated via structural MRI and white matter structural connectivity (fiber counts) via diffusion MRI with probabilistic tractography. A subset of parents (n = 36) reported on children’s behaviors at age 5.17 ± 1.73 years. Males in the maltreatment group demonstrated greater intra-hemispheric fronto-limbic connectivity (b = 0.96, p= 0.008, [95%CI 0.25, 1.66]), no differences emerged for females. Fronto-limbic connectivity was related to somatic complaints in childhood only for males (r = 0.673, p = 0.006). Our findings suggest that CM could have intergenerational associations to offspring brain development, yet mechanistic studies are needed.

PMID:37732425 | DOI:10.1017/S2040174423000247

Stat Med. 2023 Sep 21. doi: 10.1002/sim.9900. Online ahead of print.

ABSTRACT

When multiple candidate subgroups are considered in clinical trials, we often need to make statistical inference on the subgroups simultaneously. Classical multiple testing procedures might not lead to an interpretable and efficient inference on the subgroups as they often fail to take subgroup size and subgroup effect relationship into account. In this paper, built on the selective traversed accumulation rules (STAR), we propose a data-adaptive and interactive multiple testing procedure for subgroups which can take subgroup size and subgroup effect relationship into account under prespecified tree structure. The proposed method is easy-to-implement and can lead to a more interpretable and efficient inference on prespecified tree-structured subgroups. Possible accommodations to post hoc identified tree-structure subgroups are also discussed in the paper. We demonstrate the merit of our proposed method by re-analyzing the panitumumab trial with the proposed method.

PMID:37732390 | DOI:10.1002/sim.9900

Sci Rep. 2023 Sep 20;13(1):15562. doi: 10.1038/s41598-023-42657-2.

ABSTRACT

Unsupervised clustering of intensive care unit (ICU) medications may identify unique medication clusters (i.e., pharmacophenotypes) in critically ill adults. We performed an unsupervised analysis with Restricted Boltzmann Machine of 991 medications profiles of patients managed in the ICU to explore pharmacophenotypes that correlated with ICU complications (e.g., mechanical ventilation) and patient-centered outcomes (e.g., length of stay, mortality). Six unique pharmacophenotypes were observed, with unique medication profiles and clinically relevant differences in ICU complications and patient-centered outcomes. While pharmacophenotypes 2 and 4 had no statistically significant difference in ICU length of stay, duration of mechanical ventilation, or duration of vasopressor use, their mortality differed significantly (9.0% vs. 21.9%, p < 0.0001). Pharmacophenotype 4 had a mortality rate of 21.9%, compared with the rest of the pharmacophenotypes ranging from 2.5 to 9%. Phenotyping approaches have shown promise in classifying the heterogenous syndromes of critical illness to predict treatment response and guide clinical decision support systems but have never included comprehensive medication information. This first-ever machine learning approach revealed differences among empirically-derived subgroups of ICU patients that are not typically revealed by traditional classifiers. Identification of pharmacophenotypes may enable enhanced decision making to optimize treatment decisions.

PMID:37730817 | DOI:10.1038/s41598-023-42657-2