South European Journal of Orthodontics and Dentofacial Research (SEJODR)
Hrvatsko društvo ortodonata, Hrvatski liječnički zbor
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Response to orthodontic treatment with fixed appliances in adult patients compared to adolescents. A systematic review.
Objectives: This systematic review will seek to answer whether there are differences in the response to orthodontic treatment according to age, sex, and periodontal condition. Data Sources: A qualitative systematic review was carried out between 2016 and March 2021 in the electronic databases of PubMed, EBSCO Host, ClínicalKey, and BVS, selecting studies in English and Spanish with a maximum age of 5 years. The study was carried out according to the PRISMA statement. Data Selection: All the studies based on findings of orthodontic treatments in adult and adolescent human groups, healthy and/or with some conditions that may affect orthodontic treatment (periodontitis, postmenopausal) were included. Data Extraction: Study selection and data extraction were undertaken independently and in duplicate by two reviewers. There was a high degree of inter-examiner agreement for the eligibility assessment of the included articles (κ = 0.8637). Two reviewers assessed the quality of the included studies using AMSTAR-2, Cochrane's RoB 2.0, ROBINS-I, and Tools for cross-sectional, case-control and case reports studies from The National Institutes of Health (NIH). Results: The search strategy used provided 1,350 papers of which 18 were selected for this study. Only 1 study showed a low risk of bias and 10 studies showed a high risk of bias. Adults show a late response after orthodontic activation. Periodontal conditions show improvement when periodontal and orthodontic treatment are combined. The response to orthodontic treatment does not show significant differences between adolescents and adults, or between premenopausal and postmenopausal women. Conclusions: The studies indicate that there is no difference in the response to orthodontic treatment according to age, sex, and periodontal condition, although there is great heterogeneity between the included studies and the majority present a high risk of bias, therefore the results must be carefully analyzed.
Copyright (c) 2021 South European Journal of Orthodontics and Dentofacial Research (SEJODR)
Comparative analysis of adhesive remnant index of orthodontic adhesive systems
Introduction: At the end of orthodontic treatment, enamel fractures and cracks are pointed out as potential risks related to the procedures for removing fixed appliances bonding to teeth. Aim of the study: The objective of the present study was to analyze comparatively residual adhesive index of different adhesive systems used in Orthodontics for bonding brackets on the dental surface. Materials and Methods: The present in vitro study was performed with 120 healthy human extracted premolars randomly divided into two groups to receive the bonding of steel and ceramic brackets. Then, the teeth were divided into six subgroups according to adhesive system used: G1: Orthocem®; G2: Orthocem® + Ambar universal® adhesive; G3: Orthobond Plus®; G4: Biofix®; G5: Transbond XT® and G6: Ortholink VLC®. The analysis of the residual adhesive index was performed using a microscope under 20x magnification after removing the brackets. Data were analyzed with Mann-Whitney test. The level of statistical significance was set at P < 0.05. Results and Conclusions: The score of the most prevalent adhesive index in steel brackets group was 2, while in ceramic brackets group was 3. Comparatively, Orthobond Plus®, Biofix® and Ortholink VLC® showed better performance of adhesive remnant index than Orthocem® + Ambar® in steel brackets group. For ceramic brackets, Biofix® and Transbond XT® adhesives performed better than Orthobond Plus®.
Assessment of the third finger middle phalanx maturation stages: A study of repeatability and diagnostic agreement
Data regarding the repeatability of the third finger middle phalanx maturation (MPM) method is still lacking. This study evaluated both the repeatability and diagnostic accuracy of the visual assessment of the MPM stages. Ten operators were given detailed instructions of the 5-stage MPM method and were asked to stage 80 cases, which included radiographs of equal number of all 5 MPM stages. Radiographs of the third finger were created by cropping hand-wrist radiographs of the Burlington Growth Study, ensuring the inclusion of several borderline cases. Such assessment was repeated in two sessions (T1 and T2) 4 weeks apart. For both the sessions, overall agreement and kappa coefficients were above 80% and 0.86, respectively. Most of the disagreements were seen for stages 1 and 2 with overall mean scores between the sessions being 29.7% and 39.4%, respectively. With only 4 exceptions (out of over 1,600 recordings), 1-stage apart disagreements were seen. Overall diagnostic accuracy ranged from 83.7% for MPM stage 2 (T1) to 99.3% for MPM stage 5 (T1). The MPM method has a satisfactorily level of repeatability and diagnostic agreement. About 1 case out of 5 remains misclassified, disagreement is mostly limited to 1-stage apart, with stage 2 being the most critical.
Skeletal effects of mini-implant assisted rapid palatal expansion (MARPE) on the sagittal dimensions of the maxilla an in-vivo cone-beam computed tomography (CBCT) study
Introduction -Transverse discrepancies of the maxilla are one of the most prevalent skeletal problems. Due to drawbacks of conventional RPE and invasive surgical expansion methods alternative methods were developed such as Mini Implant-supported rapid maxillary expansion (MARPE).Haas17 , Davis and Kronman18, Akkaya et al19 and many other studies have reported the maxillary response after MARPE on the sagittal dimensions, but their results were inconclusive. Aim - This study analyzed the effects on the maxilla in the sagittal dimension after Mini Implant assisted rapid palatal expansion (MARPE) in adolescents using CBCT. Material and method -A pretreatment CBCT image (T1) was taken as a standard initial record for all patients and post treatment CBCT (T2) was taken after three months in retention. The parameters SNA angle, Frankfort horizontal plane to NA angle, A-N perpendicular, ANS –PNS were measured and calculated for evaluation of the sagittal maxillary changes. Comparisons were then made between the two treatment groups (T1, T2). Result -There was a positive increase in both angular and linear measurements from pretreatment to post treatment measurements showing significant skeletal changes in sagittal dimension. Conclusion -The study concludes that there was statistically significant forward displacement of maxilla after transverse skeletal expansion in patients with transverse problems achieved through MARPE in adolescent patients.
Management of Class II Division 1 Subdivision malocclusion using unilateral bicuspid extractions and fixed functional appliance: A Two Year Follow-Up
Introduction: Management of Class II Subdivision cases pose a clinical dilemma and require a careful diagnosis to ascertain the source of asymmetry. Various treatment modalities involving: different protocols of tooth extractions; molar distalization; fixed functional appliances or orthognathic surgery have been proposed for the same. Objective: This article reports a unique approach for management of a severe skeletal Class II with Angle’s Class II Division 1 subdivision malocclusion using unilateral bicuspid extractions in mandibular and maxillary arches and a fixed functional appliance. Results: A 13 year 1 month old male in CVMI transition stage was successfully treated. Extraction of #44 was done to alleviate crowding in the mandibular anterior region and #15 was extracted to protract #16 to achieve a Class II molar relationship. A pre-functional Class II molar and canine relationship with co-incident midlines was achieved. The functional phase consisted of a fixed functional appliance (Forsus FRD) for mandibular advancement to correct the severe skeletal Class II. Class I molar and canine relationships were achieved with reduction of facial convexity and overjet. Result remained stable 24 months after treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pre and post treatment. Conclusions: Management of Class II subdivision malocclusion requires careful planning. This paper presents a unique approach utilizing unilateral extractions and fixed functional appliance to address severe skeletal Class II discrepancy and the subdivision dilemma.
Evaluation of the effects of cotton roll-biting on debonding pain: a split-mouth study
Introduction: Debonding pain is an unpleasant sensation that is frequently encountered during debonding procedure. Aim of the study: To investigate the effectiveness of cotton roll-biting on pain caused by the debonding procedure. Materials and methods: 102 patients (61 females, 41 males) who were at the debonding stage in orthodontic treatment were included in the research. The study was planned using a split-mouth design: one side of the jaw was the study, and the other side was the control. The anxiety level of participants was measured before debonding. On the study side, debonding was performed while patients were biting a cotton roll. On the control side, debonding was implemented as a routine debonding procedure. Study and control sides were assigned differently in each successive patient. The debonding pain of each tooth was recorded using the Visual Analog Scale prepared separately for each tooth. Shapiro–Wilk and Mann–Whitney U tests were used for statistical analysis. For both gender groups, patients were sequenced according to the average amount of pain per tooth. Subsequently, statistical analysis was repeated by using 50% of patients suffering more pain. Results: In the lower second premolar tooth, a statistically significant difference was detected. Pain scores were statistically higher in the study side for this tooth. No statistically significant differences were found for all other teeth. Conclusions: Cotton roll-biting has no alleviating effect on debonding pain. When debonding is performed gently using a squeezing action without applying torsional forces, additional pain relief methods are not required.
Relationship between Obstructive Sleep Apnea(OSA) and Orthodontic malocclusion in non-obese adults
INTRODUCTION:Obstructive Sleep Apnea (OSA)represents the complete or partial obstruction of the airway.Clinically OSA manifests as sleepness during the day,heavy snoring as well as waking up during the night dues the lack of air.Obesity,gender and orthodontic malocclusion are mentioned in the literature as the etiologic factor for Obstructive Sleep Apnea. AIM: The aim of this study was to find the relationship in the analyzed studies between the Obstructive Sleep Apnea and orthodontic malocclusion at non-obese adults. MATERIAL AND METHODS:The electornic search of the database was performed,using PubMed and Googlescholar,with the aim to find the relevante articles which correlate the OSA and orthodontic malocclusion.Keyword included:obstrucitve sleep apnea,orthodontic malocclusion,cephalometric analysis,impact,association,body mass index,obesity,adults,non obesity. Inclusion criteria were:nonobesity,orthodontic malocclusion,adults,articles published from 1999 to 2019,articles in English,full articles avaiable. RESULTS:Two hundred papers included keywords.The number of articles that included the fully set criteria was nine.These nine articles were analyzed in detail. CONCLUSION:Analyzed articles showed that there is relationship between the Obstructive Sleep Apnea and orthodontic malocclusion in non-obese adults.It was also showed that orthodontic malocclusion is etiological factor for OSA in non-obese adults.
Copyright (c) 2020 South European Journal of Orthodontics and Dentofacial Research (SEJODR)
Fixed Lingual Retainer Positioner: A narrative review
Retention is one of the most critical phase of Orthodontic treatment . Angle stated that "the problem involved in retention are greater than the difficulties being encountered in the treatment, and tests the utmost skill of the operator. The various retention appliances available include Removable retainers and bonded retainers. Removable retainers have their own advantages and disadvantages, but they need patient’s compliance to wear them.Fixed retainers consist of a length of orthodontic wire that is bonded on the lingual aspect of tooth .The major advantages of bonded retainers includes invisibility, no patient compliance required and long term retention. Bonding of a lingual retainer is a challenging and technique sensitive procedure because it requires long working time and has a risk of contamination from saliva and moisture, leading to bond failure as it is difficult to adaptation of the retainer wire and further stabilization of contoured retainer wire in the oral cavity during bonding. If retainer wire can be effectively stabilized over the lingual surface of tooth prior to bonding, bonding becomes a simple process. Various methods used to stabilize lingual retainer before bonding involves use of separators (Kesling and elastomeric separators), materials like resin, memosil, glue etc or use of metal Stablizers in form of W,V or use of wires . The objectives of this article is to compile the different retention techniques used to stabilize the lingual retainer wire for bonding altogether at one place. Keywords: Retainers, lingual aspect, Bonding, Stablization
Assessment of facial landmarks for bone asymmetry in geometric morphometric studies: A review
Background Anthropometrical points or landmarks are key for facial shape analysis using geometric morphometrics. In the early 1990s Fred Bookstein created a classification system with landmarks type 1., type 2., type 3. based on anatomical landmark homology. However, thirty years later, a uniform referece index of landmarks that can be used for assessing facial asymmetry still does not exist. The criteria for selecting landmark points are not fully defined, which makes classification of homology and and landmarks prone to arbitrary interpretations. A systematic review of literature indicates that authors of studies do not provide explanation for choosing exact points. Most of them also do not provide a clear definition of landmarks and landmarks classification according to homology. Objective The objective of this systematic review was to assess, in an evidence based manner, which landmarks inside the Bookstein groups of on facial hard tissues can be reccomended for facial asymmetry assessment using geometric mophometrics. Search methods An electronic search of 9 databases up to March 2020 by two reviewers was conducted to identify relevant articles. Selection criteria Prospective randomized, non-randomized controlled trials and cross sectional studies reporting on facial asymmetry using three-dimensional images and geometric morphometric methods. The reasons for assessing facial asymmetry were not considered. Data collection and analysis The 23 selected studies were categorized according to the number and specification of the research subjects, types of three-dimensional images, number of landmarks, and the craniofacial region of interest. All landmarks were extracted with the following data: name, abbreviation, and the author’s definition of the location. Results The craniofacial region is divided into neurobasic cranial part, ethmomaxillar part and the mandible. Assessment of neurobasic cranial asymmetry was conducted in 6 studies and 45 different landmarks were recorded, of which 11 were medial and 34 bilateral. Bregma and Lambda occur most frequently and according to homology both belong to type 1 landmarks. Assessment of ethmomaxillary asymmetry was conducted in 21 studies and 68 different landmarks were recorded, of which 16 were medial and 52 bilateral. Nasion and Jugale occur most frequently and according to homology Nasion belongs to type 1 landmarks and Jugale to type 2 landmarks. Conclusion The selection and definition of craniofacial hard tissue landmarks is one of the most important tasks in the design of morphometric studies, and thus for the purpose of assessing facial asymmetry. The review provides an extensive cross-section of possible landmarks with the definition of the location as well as the possible location variation. The list of these landmarks should be observed through the classification of landmarks according to their homology, as well as possible variations of the classification.
Bullying and malocclusion in adolescence: a case report
Adolescents with bad malocclusion can more often be victims of bullying and the improvement of their facial appearance through oral rehabilitation is nowadays an important issue. The aim of this case report was to describe the orthodontic treatment in a teenager with a dentoskeletal malocclusion exposed to bullying to correct his occlusal problems and improve facial esthetics and quality of life. The patient, a boy aged 13.5 years, had a class II, division 1, malocclusion with hyperdivergent pattern, mandibular asymmetry, constricted maxillary arch and molar crossbite, increased overjet, lower mild crowding and lip sucking. A two-phase approach was necessary to achieve proper occlusion, better esthetics and promote the patient's self-esteem with consequent greater serenity of his family.
Herbst Appliance palatally anchored in the treatment of dental class II malocclusion
In this case report, Authors describe the correction of a class II malocclusion using only an Herbst appliance palatally anchored with miniscrews. Before sagittal correction in the same appliance we applied a palatal screw to obtain maxillary expansion. The device were removed after 12 months of treatment. The final result included the correction of Class II malocclusion by lower dentoalveolar compensation mainly. The lip function favorite the spontaneous correction of upper frontal torque with consequent improvement of facial esthetics. After a follow up of 12 months the clinical result is satisfactory in terms of occlusion and esthetics. This clinical case showed a simple orthopedic and dentoalveolar approach to correct transversal discrepancy, dental class II malocclusion and also frontal proclination only with one appliance in a very short treatment time.
Relationship between the position of maxilla and rapid maxillary expansion failure
Introduction: The palatal expansion may be a challenging treatment in late adolescents who has passed the peak of skeletal growth. The success rate of palatal expansion in these patients decreases due to decreased growth potential. Aim: It was aimed to determine any clinical/radiological indicator to be used as a predictor in the failure of rapid maxillary expansion (RME) in late adolescence. Materials and methods: The records of the patients who had undergone RME therapy between the years 2013-2019 were evaluated. The patients were allocated into two groups according to expansion success: successful (S-RME) and failed (F-RME) RME groups. Fifty systemically healthy patients in the cervical vertebral maturation stage 5/6 were enrolled (35 females, 15 males). Eleven patients were (10 females, one male) in the F-RME group, and 39 patients were (25 females, 14 males) in the S-RME group. Five cephalometric (related to maxillary position) and three clinical variables (age, gender, and CVMS) were evaluated. Variables were subjected to multiple logistic regression analysis for setting a prediction model and detecting predictors. Results: Patients with CVMS-6 had a 16.8-fold higher risk of palatal expansion failure than CVMS-5. 1 mm anterior position of PNS increased the risk of failure 2.9 times. 1 mm reduction in the distance between the PNS and cranial base in the vertical direction increased 60% the risk of RME failure. Conclusion: The CVM stage of the patient, along with the vertical and sagittal position of the PNS, were found to be the possible predictors of RME success in late adolescence.
RETENTION OF MINI SCREWS IN ORTHODONTICS – A COMPARATIVE IN VITRO STUDY ON THE VARIABLES
Objectives: To correlate between the different lengths, angles of insertion and the mini-implant material and find out the most retentive combination. Materials and methods: 48 mini-implants (24 Titanium and 24 stainless steel) of lengths 6mm, 8mm and 1.5 mm diameter were inserted into humerus bone of goat at two different angulations, 600 and 900. To insert the mini-implant in the respective angulations, custom made template was made and the angles were confirmed with digital radiographs. Force was applied on to the mini-implants with a universal testing machine and the compressive load to failure was measured. Results: Results revealed that stability of the implant was positively correlating with the length of implant. A perpendicular angulation produced more stability. Moreover, titanium mini-implants had more resistance to compressive load than stainless steel mini-implants. Conclusion: Length of mini-implant, its angulation in the bone and the material of mini-implant were factors affecting its stability. In this study, titanium mini-implant of 8mm length angulated at 900 were stable than their counterparts.
Evaluation of long-term sagittal lip changes using Burstone line: Pilot Study
Objective Lip position has become one of the most important soft tissue analyses as it influences the occlusion, tooth stability and facial aesthetic. Hence, the objective of this study was to compare the short-term and long-term sagittal lip positions/changes using the Burstone line (B-line). Methods The sample consisted of 18 Caucasoid females only (14 extractions, 4 non-extractions) who were successfully treated with edgewise appliances. All the patients were evaluated before treatment (T1),at the end of active treatment (T2), and at a long-term follow-up observation (T3). The mean age at commencement was 13.2 years with the range of 10.5-19 years. The linear distance between the tip of the lips and the B-line were measured. Results T1-T2 time intervals showed the upper lip underwent a mean change of 1.272 mm relative to the B-line (-32.8%) which was statistically significant. The lower lip showed a mean change of 1.549 mm (-22.2%), but these changes were not statistically significant. Lip protrusion relative to the B-line continued to reduce during the long term follow up period. The upper lip showed slight changes (-9.2%), whereas the lower lip demonstrated greater change (-53.8%). Conclusion Using B-line, the sagittal soft tissue lip positions were more retrusive on the long-term follow-up records for both extraction and non-extraction cases, their values were not very different from the normal values of the untreated cases. Although the differences were not statistically significant, upper lips were retrusive post treatment from T1-T2, while were statistically significant the lower lips were retrusive from T1-T2.
Comparison of Transversal Effects of Different Expansion Protocols: Alt-RAMEC versus RME
Abstract Objectives The aim of this study is evaluate the transversal effects of the Alt-RAMEC(Alternate Rapid Maxillary Expansion and Constriction) protocol on both craniofacial and dentoalveolar structures and to compare the transversal effects of the RME(Rapid Maxillary Expansion) protocol. Materials and Methods In our archive, selected patients were divided into two groups. Group 1 included 22 patients(12boys,10girls, mean age 11.61±2.11years) who had been treated with 5 weeks of Alt-RAMEC. Group 2 comprised 21 patients(11boys,10girls, mean age 11.66±1.23years) who had been treated with 1 week of RME. Transversal measurements were also performed on the study models pre-(T0) and post-treatment(T1) with digital caliper. Internasal, interzygomatic, interjugular and intergonial width measurements were made on posteroanterior radiographs. The initial measurements and the mean changes within the groups were analysed using a student’s t test. Results According to the results of the study, there was no statistically significant difference between the groups in terms of chronological age, gender distribution and initial values. The expansion protocols showed a statistically significant increase in the widths of intercanine, interpremolar, intermolar and alveolar base widths in the maxilla(p<0.05). No statistically significant changes were observed in both groups(p>0.05) in mandible. The changes in maxillary intercanine, interpremolar widths between the two groups were statistically significant(p<0.05). In the posteroanterior measurements, only statistically significant difference was found between the groups in internasal width(p<0.05). Conclusions Alt-RAMEC and RME protocols are effective treatment protocols for correction of transverse deficiency in growing patients. 5-weeks Alt-RAMEC protocol significantly increased intercanine and interpremolar widths compared to 1-week RME. Clinical Relevance Since there are no studies in the literature comparing the effects of two different expansion protocols in the transverse direction, this is both the first. Most importantly, clinicians will see which of these two protocols is more singular in the treatment of transversal problems. Keywords: RME, Alt-RAMEC, tranversal measurements
COMPARISON OF CEPHALOMETRIC CRANIOFACIAL FEATURES AND FACIAL PHOTOGRAPHIC FEATURES FOR TWO GENERATIONS OF PATIENTS
Objective: To estimate the correlation and variant heritability values of craniofacial variables between parents and their offspring. Materials and Methods: The sample comprised 20 Indian families; each family consisted of father, mother, son, and daughter. Lateral cephalometric radiographs and facial photographs were taken for each family member.Fifty -three angular, linear, and proportional cephalometric variables were measured and photographic analysis was done. Interfamilial correlations and heritability (h2) values were estimated among father-son, father-daughter,mother-son, and mother-daughter pairings. Results: The most similar angular measurements between parents and offspring were as follows:SNA0,SNB0 ,ANB0 ,FMA0, MP-FH0 , LI-NB0, Op-FH0 ,UI-NA0 , OP-SN0, LI-NB0 and The most similar linear measurements were as follows: Co-Pt.A,Co-Gn, N- ANS, , UI-A, Me-Me’,LI-A.Pog, Mx 1 exposure. Both the correlation coefficients and the heritable values were stronger in the father-offspring than the mother-offspring pairings. Conclusions: The overall correlation and h2 mean values for the three types of measurements showed stronger values in the father-offspring than the mother-offspring groups, with the father –son pairings more significant than the father-daughter groups. KEY WORDS: Cephalometrics; Heritability; Facial photographs; Craniofacial features; Offspring.
Choice of the Retention Method After an Orthodontic Treatment-Rewiev
Retention is a phase of orthodontic treatment devised to keep the teeth in a correct position once the orthodontic treatment has been completed. There are three main characteristics that each ideal retainer is required to have: to keep the teeth in the correct position after orthodontic therapy, to be long lasting and resistant to mechanical damage, and to have no adverse long-term effects on periodontal tissue. Through a computer-based browsing through a number of databases (such as, e.g. PubMed and Google Scholar) we have found and analysed various articles used in this research. The inclusion criteria to be met were: an overall availability of a research paper, the requirement that these research papers are published in English, that these research papers were published in the period 2007-2019, the requirement that the research papers should involve clinically randomized studies and that their titles contain one of the predefined keywords. The database browsing that is based on the said keywords and carried out within the above time frame has resulted in finding 165 relevant articles. A complete set of the inclusion criteria were met by 8 published research papers, but 7 articles were analysed in the end. The selected articles have compared different types of fixed and mobile retainers, different times of wearing the retainers, the impact that the retainers had on the periodontium, and the acceptability of different retention protocols for patients. The conclusion of this research paper is that bonded retainers prove to be most effective in stabilising the position of the incisors, particularly the lower ones, but that their disadvantages include the reopening of the extraction space and the retention of plaque due to difficulties in maintaining oral hygiene. Vacuum-formed retainers appear to be more effective than Hawley retainers in retaining the position of the incisors, and patients have indicated that they are more acceptable to wear. Hawley retainers prove to be most effective in preserving a closed extraction space, but they do now show solid results with regard to other segments. Changes in the overbite, overjet, arch length, and anterior and posterior widths did not show any significant statistical differences in the different types of retainers. Keywords: orthodontics, retention, stability, impact
StaTips Part VIII: Confidence interval for the sample mean
When conducting research on a given type of patients, it is impossible to examine all the existing subjects of that type (population) to derive the true mean of the parameter of interest. More realistically, by the investigation of a small group of subjects (sample) from the whole population, researchers can estimate an interval into which the true mean of the population lies. In statistics, such interval is referred to as confidence interval (CI). The calculation of the CI from a sample mean is simple and gives important information, not only regarding the true mean of the population, but also on the statistical significance of the difference between groups being compared. For these reasons, the reporting of the CIs is preferred over the p value alone.
Experimental evaluation of strength degradation of orthodontic chain elastics exposed to cigarette combustion smoke
Introduction: Effects of cigars in the performance of dental restorative materials have been largely investigated; however, no information about the role of smoking cigars in strength degradation of orthodontic elastics has been revealed. Aim of the study: evaluate the effect of smoke derived from cigarette combustion on the strength degradation of orthodontic chain elastics. Materials and methods: Four distinct elastics from two different manufacturers were evaluated: Maximum Power Chain Pearl (OTP) (OrthoTechnology); Maximum Power Chain Pearl Tone Blue (OTPB) (OrthoTechnology); Orthodontic Elastic Chain Gray (MG) (Morelli); Orthodontic Elastic Chain Crystal (MC) (Morelli). Elastic segments were distended and exposed for eight minutes, twice a day with interval of 12 hours to cigarette combustion smoke. Elastic tension was evaluated at baseline, 7, 14 and 21 days. Results: the findings have shown that all elastics presented progressive tension reduction over the period evaluated. Statistically significant differences were evidenced from the baseline to 7 days and from 14 to 21 days period. The OTP and OTPB elastics presented greater initial tension when compared to the MG and MC elastics. This pattern was reproduced throughout the study periods. When test groups were compared to the control in the period of 21 days, it was observed that cigars combustion smoke reduced in a statistically significant manner the elastic strength in all groups tested. Relative comparisons between the tested samples and control in the period of 21 days indicated that smoke exposure promoted strength loss that varied from 7% (OTP) to 12% (OTPB). Conclusion: experimental exposure to cigarettes combustion smoke contributed for the strength degradation of orthodontic chain elastics in the period of 21 days.
Maxillary premolars extraction or molar distalization with or without TADs: cephalometric evaluation of soft tissue changes in Class II treatment
Introduction: Problem solving in Class II malocclusion treatment performed with premolars extractions or distalizing techniques in relation to the profile modification. Aim: To cephalometrically compare soft tissue changes produced either by maxillary premolar extraction, tooth-borne Pendulum appliance or bone-borne MGBM appliance. Materials and Methods: Both pre- (T1) and post-treatment (T2) lateral cephalograms of 89 skeletal Class II patients (36 M, 53 F), treated during pubertal growth spurt, were retrospectively selected. Three groups were formed based on the therapy performed: 30 patients had been treated with maxillary first premolars extraction (U4), 31 patients with a conventional tooth-borne distalizing with Pendulum appliance (PA), and 28 patients with a skeletally anchored distalizing appliance (MGBM). Soft tissue was analyzed comparing upper (UL) and lower (LL) lip’s points with regard to True Vertical Line (TVL) and Esthetic plane (E-plane). Skeletal and dental values have been recorded in order to cephalometrically compare ΔT2-T1 changes among groups and to correlate dental and skeletal changes to profile modifications. One-way ANOVA was employed to compare groups at T1. Paired sample t-tests were employed to assess significant intra- and intergroup differences between T2 and T1. Significance level was set at 0.05 Results: UL and LL showed a slight but not significant retrusion relative to TVL in all three groups. UL and LL distances to E-plane were not statistically significant among U4, PA, and MGBM groups. Independently of the treatment, UL was tangent to TVL in all groups. No statistically significant differences have been shown in skeletal records. Significant differences were recorded in Overjet among U4 than PA and MGBM groups. Conclusions: Class II malocclusion treatment with maxillary first premolar extraction, conventional or skeletal distalization did not significantly affect the profile producing similar changes in the soft tissue.
Often researchers have the need to show graphically the behaviour of ordinal data or continuous data with great asymmetrical distribution. In all of these situations, a boxplot may be an appropriate way of data presentation. Because of its non-parametric nature, this kind of diagram is particularly useful when dealing with asymmetrical distribution. The different components of the most common variant of boxplot are herein detailed.
Maxillary distalization by a rearrangement of the Leaf Expander® screw combined with palatal miniscrews: A case report on the MaXimo Appliance
Introduction: This case report describes the treatment of a crowded dental Class II malocclusion in 13 years, 2 months female patient. Maxillary distalization was achieved by a novel compliance-free appliance referred to as MaXimo, which was built by a rearrangement of the Leaf Expander® screw having palatal miniscrews as the anchorage core. Case Presentation: Pre-treatment, post-treatment and 1-year follow-up records are shown. No side effects, breakage of the appliance or loss of miniscrews was encountered. The active distalization phase lasted 14 months, while the whole treatment, including the use of multibrackets appliance, lasted 25 months. A significant spontaneous distal drifting of the premolars and canines was seen. The treatment outcomes proved to be stable at the follow-up with acceptable aesthetic and functional results. Conclusion: The MaXimo appliance proved to be efficient and of easy management, and its use may be recommended when distalization of the maxillary dentition is required. Being mostly assembled by the manufactured, the MaXimo appliance is also cheap and of easy construction.
Reasons for seeking orthodontic treatment in Lahore population: A cross-sectional survey in a low-income country
Introduction: Poor esthetics, dysfunction and discomfort are the key reasons for seeking orthodontic treatment across the world as reported by many researchers. This paper presents the causative factor for seeking orthodontic treatment in the patients who are visiting Punjab Dental Hospital of a populous city Lahore (de' Montmorency College of Dentistry) in local settings and associating these reasons with demographic characteristics. Objective: Aim of this cross-sectional survey was to explore the reasons for seeking orthodontic treatment among individuals who are visiting PDH. Materials and methods: This study was carried out in Punjab Dental Hospital (PDH) after the approval of the Institutional Review Board (IRB) on a sample of 98 individuals having malocclusion assessed with Angle's classification of the malocclusion. We chose simple random sampling. A self-structure questionnaire was designed to get data by the principal investigator after taking verbal and written consent. Descriptive statistics were calculated using SPSS 21. Chi-square test of association was applied to associate reasons with different demographic variables. P-value <0.05 was taken as significant. Results: Female respondents were more in number than males. Around one-third of respondents (30.6 %) had a monthly income of less than 25000 PKR ($ 170). Esthetics was the primary reason for seeking orthodontic treatment. The most common type of malocclusion was the Class II malocclusion. Statistically significant factors that emerged in this study that turned into reasons for seeking orthodontic treatment were hurdles in marriage, referral by a general dentist, motivation by parents, self-esteem and speech problems. Conclusion: In conclusion, patients seek orthodontic treatment mainly to enhance facial esthetics and self-confidence, motivation by the parents, and social acceptability.
Effects of fixed labial and lingual orthodontic appliances on speech sound production: A comparative in vivo study
Introduction: The eventual esthetic solution for patients who do not want visible orthodontic appliance is the lingual orthodontic appliance. The result produced by the lingual orthodontic appliance is parallel to those produced by the labial orthodontic appliance. However, there is an articulation problem due to the position of the lingual brackets as there is a modification of the lingual surface of the teeth. Speech problems with each appliance are studied individually and extensively, but the comparison of both appliances regarding speech is very scanty. Aim: The aim of this study is to evaluate the effect of fixed labial and lingual orthodontic appliance on speech sound production at a different time interval. Materials and methods: A total number of 30 patients were included in this study, 15 patients were bonded with the fixed labial appliance (Group 1) and 15 patients were bonded with the fixed self-ligating lingual appliance (Group 2). Based on four types of errors (E1, E2, E3, E4), a total of nine groups of sounds (S1, S2, S3, S4, S5, S6, S7, S8, S9) were evaluated for each audiovisual sample at four different time intervals (T1, T2, T3, T4) by two different speech therapist individually in each group. Results: A high degree of agreement was found between the two observers in both groups regarding the type of sound effected and the type of error during sound production. The total number of patients with effected speech is more in the lingual group compared to the labial group on the same day of bonding until six months in treatment. Conclusion: The results of the present study demonstrated the following, the total number of patients with lingual appliance had more errors in speech compared to the labial appliance at the beginning of the treatment. Patients with lingual appliance required more time for adaptation concerning speech. A similar group of sounds was effected in both types of an appliance with a similar type of error. Patients with labial appliance showed more comfort and easier adaptation with the appliance. The anatomical location of the appliance plays an important role in speech alteration and adaptation. These findings should be considered before selecting an appliance for a particular patient.
Surgery-first orthognathic treatment of an adult patient with unilateral cleft lip-palate and multiple missing teeth: a case report
Introduction: The comprehensive treatment approach and outcomes of a patient with cleft lip and palate was presented in this casereport. Case presentation: A 31-year-old man with unilateral cleft lip and palate(UCLP) had a chief complaint of his mandibular prognathism andasymmetric smile. His clinical and radiographic evaluation showed a Class III skeletal relationship, multiple missing teeth, mandibularanterior occlusal canting, 6 mm of negative overjet and 16 mm overbite. "Surgery first orthognathic approach" was planned including,short-term orthodontic treatment, maxillary advancement and segmental mandibular subapical osteotomy. Conclusion: At the end of the treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved.
Evaluating the change in Streptococcus mutans in plaque around orthodontic brackets using fluoride toothpaste, probiotic curd, and recaldent - A comparative in-vivo study
Introduction: Enamel demineralization is still a problem associated with orthodontic treatment, leading to the formation of white spot lesions;this is a grave concern to orthodontists and patients. Various methods are now employed to reduce the incidences of demineralization. Aim: To evaluate and compare the effects of Fluoride toothpaste, Probiotic curd, and Recaldent on Streptococcus mutans colonies inplaque around orthodontic brackets in different groups of patients. Further, the three agents were compared and assessed for regular useby orthodontic patients for reduction of decalcification. Materials and methods: This study consisted of 60 randomly selected patients having orthodontic treatment in the Department oforthodontics and dentofacial orthopaedics. The study protocol was approved by the institutional Ethics committee of MCE Society,Azam Campus, Pune. Group A: The patients were given fluoride containing toothpaste (ParodontaxTM Daily Fluoride toothpasteGlaxoSmithKline). Group B: The patients were asked to brush twice daily with recaldent containing tooth mousse (Dentsply ToothMousse- GC). Group C: Patients were given probiotic curd(Nestle Acti Plus). Samples were collected twice, once initially, seven days afterbonding at the start of the study and secondly, after 30 days. After DNA extraction PCR analysis was done to evaluate the colonies ofS. mutans as colony forming units per milliliter (CFU/ml) in the plaque specimens. RealPlex software programme was used to plot theresults of the colonies detected in the sample. Results: Streptococcus mutans colonies around the brackets after 30 days post use of Fluoride toothpaste, probiotic curd and Recaldentwas reduced by 44.5 %, 0.86 % and 41.8% respectively. Conclusion: The regular use of fluoride toothpaste and Recaldent will help in reducing decalcification during orthodontic treatment.Further research is needed to establish the advantages of probiotic curd in reducing white spot lesions.
A determination of the standards of morphometrics variables of the stomatognathic system of a fetus
Introduction: Many factors affect the growth and development of the mandible. The most common one is micrognathia; this can poseand neonatal emergency. Early recognition of mandibular and other face anomalies could provide immediate care for these infants,and presence of neonatologist or other doctors in the delivery room. The aim: Aim of this study was to develop normal ranges of the facial markers: mandibular length, jaw index and the facial angle inthe fetus using 3D ultrasound. Material and methods: The research was conducted as a cross-sectional study in the second trimester of pregnancy. Fetuses (femalen=23 and male n=27) from singleton pregnancy between 29-37 week of gestation were examined by ultrasound. All images wereacquired transabdominally, using Voluson E16. Ultrasound was performed by an experienced operator (SM) and measured thevalues of head circumference, abdominal circumference, biparietal diameter, femur length, body mass. For mandibular length,inferior facial angle, and the jaw index was calculated (Jaw Index =AP mandibular diameter / BPD * 100), the profile images wereused (only images in the exact midsagittal plane were used). The characteristics of the fetal profiles were determined by the Schwartzand Ricketts profile analysis using soft tissue landmarks and analysis of the profile photographs. Results: The results show that the jaw index ranged from 25.33 and 34.06 with an average of 26.00 for all examined fetuses. Conclusion: The physiological position of the mandible is retrognathic and that the average physiological length of the mandible inthe third trimester is 2.31cm. There is no difference in mandibular length between genders.
A very common situation in medical research, including orthodontics, is when a researcher has to verify the association between 2variables, best referred to as bivariate correlation. Bivariate correlation is an analysis that measures the strength of relationship between twovariables through the calculation of different correlation coefficients. The most common correlation coefficients are: Pearson (r), Kendall(rho), Spearman (rho) and the point-biserial (rpb). The choice of the correct coefficient is based on the type of data to be analysed and, forsome of them, the existence of assumptions for using parametrical tests. Indications on how to choose the correct coefficient and abouttheir interpretation are provided.
StaTips Part V: The adjustment of the P value in the context of multiple comparisons
Very often researchers face the problem of multiple comparisons using the same data sets. When performing multiple comparisons,it happens that some P values below the desired cut-off level will be retrieved by chance, thus leading the researcher to havefalse positives. To reduce the risk of making wrong conclusions, statistical adjustment of the P values in the context of multiplecomparisons has been proposed over the last decades. This article will deal with two simple procedures, Bonferroni and Holm,commonly used in dental literature to adjust the P values in case of multiple comparisons.
Evaluating the sterility of orthodontic materials as received from the manufacturer and that exposed to clinic environment - in vitro study
Introduction: Sterilization in orthodontics has been discussed and stressed over times in the dental literature. Sterility of orthodonticmaterials should be of prime interest to the orthodontist as a health care professional and he should take appropriate measures toprevent the risk of cross infection. Aim: To evaluate the sterility of orthodontic materials as received from the manufacturer and that exposed to clinic environment for 6 months. Materials and methods: The sterility of orthodontic materials "as received" from the manufacturer and "clinically exposed" (unused materialsstored in the clinic environment for a period of 6 months) was microbiologically evaluated (universal & conventional PCR). The materialswhich were included in this study were the sealed and unsealed orthodontic archwires, molar bands, elastomeric module, stainless steelbracket, coil spring and tungsten carbide burs of various brands (American Orthodontics, 3M Unitek, Ormco, Orthosystems, G&H,Modern Orthodontics, SS white etc). Results: After universal and conventional PCR, the detection of micro-organisms in all materials was significantly higher in the clinicallyexposed samples compared to as received samples from manufacturers (P <0.001). The detection of micro-organisms in all orthodonticwires is significantly higher in the unsealed samples compared to sealed samples (P <0.001). In universal PCR, the detection of microorganismsin all materials (Coil spring, E-chain, Elastomeric, Molar brands, Tungsten carbide) except for SS brackets is significantly higherin both as received and clinically exposed samples. Conclusion: After universal and conventional PCR, we conclude that bacteria were present on almost all orthodontic materials "as receivedfrom the manufacturers" and that exposed to a clinical environment. Therefore all materials should be sterilized before use in patients.