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Xie Y, Chen Y, Hong Y, Chen Q. Effect of trapezoidal excision combined with modified embedded vertical mattress suture technique on postoperative scar formation after cesarean section. Am J Transl Res 2024; 16:3812-3821. [PMID: 39262742 PMCID: PMC11384344 DOI: 10.62347/mgkq5295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/13/2024] [Indexed: 09/13/2024]
Abstract
To study the impact of modified embedded vertical mattress suture technique in conjunction with trapezoidal resection on the formation of scars after cesarean section. This retrospective study involved 339 pregnant women who had cesarean sections at the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University from September 2020 to August 2023. Among them, 150 patients who received traditional subcutaneous fat layer discontinuous suture during September 2020 and June 2022 were assigned to the control group, and 152 patients who received improved buried vertical mattress suture technique and trapezoidal resection between July 2022 and August 2023 were assigned to the observation group. The therapeutic effect, surgical parameters and cosmetic effects in the two groups were compared. The suture time of the observation group was longer than that of the control group (t=27.858, P<0.001). The grade A healing rate (96.05%) and cosmetic satisfaction rate (94.08%) in the observation group were significantly higher than those (76.00% and 74.00%) in the control group (all P<0.001); while the incidences of suture reaction (12.05%), complication (1.96%), and hypertrophic scar (5.26%) were significantly lower than those in the control group (38.00%, 22.00%, and 27.33%, respectively) (all P<0.001). The visual analogue scale (VAS) score in the observation group was lower than that of the control group (intergroup effect: F=1434.000, P<0.001; time effect: F=91.091, P<0.001; interaction effect: F=2.409, P=0.091). The postoperative VSS score and scar width in the observation group were lower than those in the control group (all P<0.001). Multivariate analysis showed that complications (P=0.006) and suture method (P=0.016) were independent influencing factors for the occurrence of hypertrophic scars in pregnant women. Trapezoidal resection combined with improved buried vertical mattress suture technique can promote incision healing, reduce suture reaction, incision pain, adverse complications and the incidence of hyperplastic scar, and improve the cosmetic effect of surgery.
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Affiliation(s)
- Yudi Xie
- Clinical Research Center for Gynecological and Reproductive Health of Fujian Province Xiamen 361000, Fujian, China
- Clinical Medical Research Center for Obstetrics and Gynecology Diseases of Fujian Province Xiamen 361000, Fujian, China
- Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City Xiamen 361000, Fujian, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen 361000, Fujian, China
| | - Yiling Chen
- Clinical Research Center for Gynecological and Reproductive Health of Fujian Province Xiamen 361000, Fujian, China
- Clinical Medical Research Center for Obstetrics and Gynecology Diseases of Fujian Province Xiamen 361000, Fujian, China
- Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City Xiamen 361000, Fujian, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen 361000, Fujian, China
| | - Yihuang Hong
- Clinical Research Center for Gynecological and Reproductive Health of Fujian Province Xiamen 361000, Fujian, China
- Clinical Medical Research Center for Obstetrics and Gynecology Diseases of Fujian Province Xiamen 361000, Fujian, China
- Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City Xiamen 361000, Fujian, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen 361000, Fujian, China
| | - Qionghua Chen
- Clinical Research Center for Gynecological and Reproductive Health of Fujian Province Xiamen 361000, Fujian, China
- Clinical Medical Research Center for Obstetrics and Gynecology Diseases of Fujian Province Xiamen 361000, Fujian, China
- Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City Xiamen 361000, Fujian, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen 361000, Fujian, China
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Lin J, Wang X. Effects of botulinum toxin type A in the prevention and treatment of facial hypertrophic scars: A meta-analysis. Int Wound J 2024; 21:e14796. [PMID: 38494191 PMCID: PMC10944687 DOI: 10.1111/iwj.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 03/19/2024] Open
Abstract
A meta-analysis was conducted to comprehensively evaluate the prophylactic and therapeutic efficacy of botulinum toxin type A (BTX-A) in the treatment of facial hypertrophic scars. Computerised searches were performed in databases, from their inception to November 2023, including Embase, Google Scholar, Cochrane Library, Wanfang, PubMed and China National Knowledge Infrastructure databases, focusing on randomised controlled trials (RCTs) that investigated the use of BTX-A for treating facial hypertrophic scars. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Seventeen RCTs were ultimately included, involving 1605 patients who underwent facial cosmetic surgery. The analysis revealed that compared with conventional treatments, BTX-A significantly reduced visual analogue scale (VAS) scores (standardized mean difference [SMD]: -3.50, 95% confidence interval [CI]: -5.16 to -1.84, p < 0.001) and Vancouver scar scale (VSS) scores (SMD: -2.86, 95% CI: -4.03 to -1.68, p < 0.001), and narrowed scar width (SMD: -1.80, 95% CI: -2.48 to -1.13, p < 0.001), while also enhancing the overall effectiveness of the treatment. This study indicates that BTX-A is an effective modality in the prophylaxis and treatment of facial hypertrophic scars, significantly alleviating scar-related pain and preventing scar widening, and is thus worthy of broader clinical application.
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Affiliation(s)
- Jin Lin
- Department of DermatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Xiao Wang
- Department of GeriatricsThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
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Combination of W-plasty and Botulinum Neurotoxin Type A Injection for Preventing Rhytidectomy Scar in Asians. Aesthetic Plast Surg 2023; 47:181-188. [PMID: 35697816 DOI: 10.1007/s00266-022-02970-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/21/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study was conducted to see if better scar results could be obtained by administering botulinum neurotoxin type A (BoNTA) injection and W-plasty incision for preventing rhytidectomy scar. METHODS All patients underwent extended deep-plane rhytidectomy in two groups. Group 1 had a straight incision line, and BoNTA was not given. Group 2 was injected with W-plasty and BoNTA. Photos were taken before surgery and twelve months after surgery. Two aesthetic surgeons analyzed the results using MSS, MSRS, and SBSES. Interrater reliability was measured using the intraclass correlation coefficient (ICC). RESULTS Forty-nine patients were included in the study. Group 1 (Straight incision, No BoNTA) had 26, and Group 2 (W-plasty, BoNTA) had 23 patients. The interrater reliability in Group 1 was excellent for MSS (ICC, 0.957 [0.904-0.981]), and good in two of the interrater reliability measures (ICCs, 0.897 [0.769-0.954] for MSRS, and 0.821 [0.605-0.919] for SBSES). Interrater reliability in Group 2 was good in two out of three measures (ICCs, 0.760 [0.423-0.899] for MSS, 0.746 [0.392-0.893] for MSRS, and 0.851 [0.654-0.937] for SBSES). There was a significant statistical difference between Group 1 and Group 2, showing that Group 2 has superior outcomes (MSS, 6.596 ± 1.569 vs. 5.435 ± 0.590, P = 0.001; MSRS, 4.346 ± 0.967 vs. 3.652 ± 0.510, P = 0.003; SBSES, 3.788 ± 0.695 vs. 4.261 ± 0.541, P = 0.012). CONCLUSIONS Analyzed by three dedicated scar assessments, better results were obtained through combining W-plasty and BoNTA injections, so it is expected to be a useful method for improving scars. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Xu H, Li J, Zhou Z, Bi J, Li X, Huo R. Skin Wound Tension Reduction Device Combined with Ablative Fractional Carbon Dioxide Laser to Reduce Scar Formation After Excision of Pediatric Facial Skin Lesions: A Prospective Cohort Study. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:283-292. [PMID: 35228810 PMCID: PMC8881920 DOI: 10.2147/ccid.s347065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
Abstract
Purpose To investigate the efficacy of skin wound tension reduction device (SWTRD) combined with ablative fractional carbon dioxide laser (CO2-AFL) for the prevention of scar formation following the excision of facial cutaneous lesions in children. Methods Patients undergoing surgical excision of facial cutaneous lesions in our hospital between May 2019 and April 2021 were enrolled. After the excision of facial cutaneous lesions and based on the personal intents and conditions, patients were assigned to undergo SWTRD combined with CO2-AFL. Outcome evaluations were as follows: defect size, incision width, scar width, the Vancouver Scar Scale (VSS) and University of North Carolina 4P Scar Scale (UNC4P). Results A total of 25 pediatric patients (mean age, 9.88 years) were enrolled in the study. Following the treatment of SWTRD+CO2-AFL, scar widths were relatively narrow and the appearance of the incision scars was significantly improved. A significant reduction in the patient-reported UNC4P scores at 6 months (3, 1–4) was observed when compared with that at 2 months (0, 0–1) after surgery (p<0.001). A similar reduction in the VSS scar scale was also evident (6 months: 1, 0.75–2.5 vs 2 months: 6.5–8.5; p<0.001). Conclusion Combined SWTRD and CO2-AFL treatment effectively modulates the scar formation after the incision is healed and resulting in preventing scar widening, leading to the improvement of scar appearance, reduction in wound pain and pruritus and its overall prognosis.
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Affiliation(s)
- Haiting Xu
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jing Li
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Zifu Zhou
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Jianhai Bi
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Xiaoyang Li
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ran Huo
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Department of Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
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Zhang W, Li X, Li X. Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 24:608-618. [PMID: 32608997 DOI: 10.1177/1203475420937963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scars with poor cosmesis that develop after wound healing may affect normal life. OBJECTIVE To assess the efficacy and safety of botulinum toxin type A (BTXA) in preventing postoperative hypertrophic scars or keloids. METHODS A systematic review was performed by searching the PubMed, Cochrane Library, and EMBASE databases from their inception date up to February 2020 for randomized controlled trials (RCTs) evaluating the efficacy of BTXA in preventing hypertrophic scars or keloids. The primary outcome measures included the Vancouver Scar Scale (VSS) score, Visual Analog Scale (VAS) score, scar width, patient satisfaction, and adverse events. RESULTS Twelve RCTs involving 497 cases (372 patients) were included. The meta-analysis showed significant differences in the VAS score (weighted mean difference [WMD] = 1.31, 95% CI = 1.06 to 1.55, P < .00001), VSS score (WMD = -1.02, 95% CI = -1.72 to -0.32, P = .004), scar width (WMD = -0.18, 95% CI = -0.29 to -0.08, P = .0008), and patient satisfaction (relative risk = 1.25, 95% CI = 1.06-1.49, P = .01). Four studies reported trivial adverse events. CONCLUSIONS This meta-analysis showed that BTXA was more effective than the control treatment in preventing postoperative scars and improving the cosmetic appearance of facial scars for East Asians, and no serious adverse events were found during the follow-up period. However, there was insufficient evidence to support the use of BTXA for the prevention of scars in patients from other ethnic groups and regions or scars in non-facial areas.
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Affiliation(s)
- Wei Zhang
- 36639 Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyi Li
- 36639 Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaojing Li
- 36639 Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Guo X, Song G, Zhang D, Jin X. Efficacy of Botulinum Toxin Type A in Improving Scar Quality and Wound Healing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthet Surg J 2020; 40:NP273-NP285. [PMID: 31155638 DOI: 10.1093/asj/sjz165] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Botulinum toxin type A-induced "chemoimmobilization" has long been utilized for improved scar quality and wound healing; however, current evidence is limited to small studies, and evidence-based information is inadequate to make well-informed decisions. OBJECTIVES The purpose of this study was to evaluate the efficacy of botulinum toxin type A (BTA) to improve scars and wound healing. METHODS The authors searched databases, including Pubmed, Embase, and Cochrane Library, to identify randomized clinical trials (RCTs) that compared outcomes of surgical scars and wounds treated with BTA vs those treated with blank or placebo controls. The Visual Analog Scale, Vancouver Scar Score, scar width, and reported patient satisfaction were utilized in evaluating outcomes. Adverse events were also recorded. RESULTS Eleven RCTs involved a total of 486 cases (374 patients). Quantitative synthesis suggested that compared with the control group, patients in the BTA treatment group had significantly higher Visual Analog Scale scores (mean difference [MD] = 1.30, 95% confidence interval [CI]: 1.05 to 1.55), lower Vancouver Scar Scores (MD = -1.62, 95% CI: -2.49 to -0.75, P = 0.0003), and thinner scars (MD = -0.15, 95% CI: -0.20 to -0.11, P < 0.00001). Patient satisfaction was higher in the BTA group than in the control group (risk ratio: 1.25, 95% CI: 1.06 to 1.49, P = 0.01). Trivial adverse events were reported. CONCLUSIONS This meta-analysis of RCTs provides reliable evidence that BTA injection is superior to placebo or blank control group in improving scar quality and wound healing in the face and neck for Asians, and negative outcomes for BTA treatment in these patients include only trivial adverse events. However, inadequate evidence supports utilization of BTA in Caucasians for primary surgical scars or for scars in locations other than the face and neck. Further studies on the standardized injection regimen and technique of BTA are warranted for clinical practice. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Xiaoshuang Guo
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guodong Song
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Dong Zhang
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaolei Jin
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Bi M, Sun P, Li D, Dong Z, Chen Z. Intralesional Injection of Botulinum Toxin Type A Compared with Intralesional Injection of Corticosteroid for the Treatment of Hypertrophic Scar and Keloid: A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:2950-2958. [PMID: 31006769 PMCID: PMC6489528 DOI: 10.12659/msm.916305] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal treatment for hypertrophic scar and keloid remains controversial. Therefore, the aim of this systematic review and meta-analysis was to compare the effectiveness of intralesional injection of botulinum toxin type A compared with placebo and intralesional injection of corticosteroid compared with placebo in patients with hypertrophic scar and keloid. MATERIAL AND METHODS Six databases were searched using Medical Subject Headings (MeSH) keywords and included Web of Science, PubMed, EMBASE, the Cochrane Library, WanFang, and CNKI from their inception to March 1 2019, without language restriction. Randomized controlled trials (RCTs) and prospective controlled trials (PCTs) were identified that compared intralesional injection of botulinum toxin type A with placebo and corticosteroid with placebo in hypertrophic scar and keloid. The quality of controlled trials was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS Comparison of intralesional botulinum toxin type A and corticosteroid showed significant differences in the Visual Analog Scale (VAS) (P<0.001) (WMD, -4.30; 95% CI, -4.44 to -4.16) and effective rate (P=0.012) (RR=0.82; 95% CI, 0.70-0.96). Intralesional injection of botulinum toxin type A compared with placebo showed significant differences in the VAS (P<0.001) (WMD, 1.41; 95% CI, 1.21-1.62), the width of scar (P=0.00) (WMD, -0.15; 95% CI, -0.19 to -0.10) and Vancouver Scar Scale (VSS) (P=0.003) (WMD, -0.69; 95% CI, -1.14 to -0.23). CONCLUSIONS Systematic review and meta-analysis showed that injection of intralesional botulinum toxin type A was more effective in the treatment of hypertrophic scar and keloid than injection of intralesional corticosteroid or placebo.
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Kattimani V, Tiwari RVC, Gufran K, Wasan B, Shilpa PH, Khader AA. Botulinum Toxin Application in Facial Esthetics and Recent Treatment Indications (2013-2018). J Int Soc Prev Community Dent 2019; 9:99-105. [PMID: 31058058 PMCID: PMC6489509 DOI: 10.4103/jispcd.jispcd_430_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 01/10/2023] Open
Abstract
Background Ever-changing perception of beauty from childhood to old age is changing with the revolution in cosmeceuticals science. Esthetics is an individual's perception since time immemorial. Standards of beauty have changed through centuries with increased awareness about esthetics. The face remains main source of information for identification and discrimination. It constitutes a structural ground for many nonverbal messages including the emotional state of a person, so the proverb "Face is an index of mind" holds good. The wrinkles and laxity are considered to be one of the factors for aging. Hence, escalating demand for cosmetic treatment to reduce facial wrinkles and laxity has stimulated us to search for published literature for nonsurgical techniques for enhancement of facial beauty. The review analyzed the published data to provide narrative basic review in a concise way to the beginners, clinicians, and students. Materials and Methods We have adopted search criteria using keywords: Botox, Botulinum toxin, incobotulinumtoxinA, esthetics, face, uses of Botox, with various Boolean operators and or in title, and abstract using PubMed search engine. The database search limited to PubMed only from January 2013 to June 2018. Results Various search results have been appended as annexures at the end of the article for further reference for the readers. Finally, 17 references were selected to write narrative review to meet our objectives. Conclusion The advancing front in the use of toxins is an emerging science for the beautification of a face. Botox exploded in to market because of efficacy, tolerability, and minimally invasive nature. The present review gives brief about the history of Botulinum toxin, types, mechanism of action, clinical indications, preparations, storage, and technique for various uses with a brief note on patient selection, contraindications, and complications.
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Affiliation(s)
- Vivekanand Kattimani
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Rahul Vinay Chandra Tiwari
- Department of Oral and Maxillofacial Surgery and Dentistry, Jubilee Mission Medical College Hospital and Research Center, Thrissur, India
| | - Khalid Gufran
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdul Aziz University, Alkharj, Riyadh, Kingdom of Saudi Arabia
| | - Bharti Wasan
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - P H Shilpa
- Department of Pediatric Dentistry, Faculty of Dentistry, AIMST University, Bedong, Malaysia
| | - Anas Abdul Khader
- Department of Periodontics, Azeezia Dental College, Kollam, Kerala, India
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