Assessment of dental, skeletal, and soft tissue changes following mandibular advancement with Invisalign in skeletal Class II.

Objective: This study evaluated the dentoskeletal and soft tissue changes for Class II malocclusion patients treated with Invisalign clear aligners with mandibular wings (IAMW). Methods: This retrospective study included 50 skeletal Class II patients treated with Invisalign clear aligner with mandibular wings. Records of 20 subjects were collected from the AAOF Legacy Collection (The Case Western Bolton Brush Growth Study) and were used as a control. The dental, skeletal, and facial soft tissue changes were assessed by digitizing and analyzing lateral cephalograms using Dolphin Imaging software (version 11.95 Premium; Dolphin Imaging & Management Solutions, Chatsworth, Calif). Paired t-tests and independent t-tests were used to assess the changes before and after and to compare between the IAMW and control groups. Results: The different measurements of the maxilla have shown that IAMW effect on the maxilla included minimal, non-significant retraction compared to the control group. The SNB and mandibular base position increased by 1.17° (±2.63) and 3.79 (±8.13), respectively. The mandible advanced significantly in the treatment group compared to the control group. Dentally, the lower incisors tipped slightly buccally, but the change was not significant (p > 0.05). The facial convexity angle decreased by 1.16° (±4.36). Conclusion: Invisalign clear aligner with mandibular advancer wings was able to correct the Class II malocclusion. This correction was mainly skeletal with some dental changes. This device can be used to address the growth modification problem in Class II malocclusion at the same time as addressing the other occlusal problems.

The Relationship between Maxillary Sinus Volume and Different Cephalometric Characteristics in Orthodontics.

Introduction: This study aimed to evaluate the maxillary sinus volume (MSV) in both genders in a Saudi sample and among different skeletal patterns. Materials and Methods: This retrospective cross-sectional study included 52 cone-beam computed tomography (CBCT) scans of 18 years or older individuals with complete dentition and healthy medical history. MSV was measured as the mean value of both sides in cubic millimeters (mm3) using OnDemand three-dimensional™ Dental. Cephalometric tracings were conducted on cephalograms obtained from CBCT scans. The beta, A × B, and Frankfort-mandibular plane angles were selected to determine the sagittal and vertical skeletal patterns of the study subjects. Descriptive statistics and other tests were conducted. The significance level was set at P < 0.05. Results: Fifty-two CBCT scans were included in this study (23 males and 29 females), with a mean age of 36 (±14) years. The mean MSV was 14887 (±5030.79) mm3. Males had statistically significantly larger MSV (16517 ± 5335 mm3) compared with females (13595 ± 4,452 mm3) (P = 0.036). There was no statistically significant difference in MSV among all other cephalometric measurements (P > 0.05). Conclusions: The MSV in the studied Saudi sample was larger among males. However, different skeletal patterns have no statistically significant differences in MSV.

Anthropometric and Cephalometric Facial Characteristics of Adult Saudi Patients with Skeletal Class III Malocclusions.

Objectives: We aimed to assess adult Saudi patients' facial anthropometry and cephalometric characteristics with skeletal Class III malocclusions compared to Class I malocclusion patients. Materials and Methods: Our cross-sectional study included a review of the orthodontic records of 108 patients: 54 patients with skeletal Class III malocclusions and 54 patients with skeletal Class I malocclusions, equally distributed between males and females. Using anthropometric landmarks, seven angular and eight linear measurements were recorded and compared between Class III and Class I patients. In addition, we compared three horizontal facial proportions and three horizontal neoclassical canons between the two groups. Finally, we used Student's t-tests to compare continuous variables and Chi-square tests for categorical variables. Results: Class III patients had significantly larger mandibular length, mandibular plane angle, mid- and lower-anterior face height, and posterior face height (P < 0.05) compared to Class I patients. Class III patients had significantly proclined upper incisors, retroclined lower incisors, and an obtuse interincisal angle (P < 0.05). The mouth: nose ratio differed significantly between skeletal Class III and I patients (P = 0.008). The orbital canon was valid in 14.8% of Class I and 9.3% of Class III patients, respectively. The orbitonasal proportion applied only to 31.5% and 20.4% of Class I and III patients, respectively. The naso-oral canon occurred in 18.5% and 1.9% of Class I and III patients, respectively. Conclusion: Saudis with Class III skeletal profiles have some distinctive Class III characteristics not observed in most other ethnic groups. The established horizontal facial proportions, neoclassical facial canons, and Class III skeletal profile did not apply to Saudis with skeletal Class I malocclusions, indicating that these proportions and characteristics may not be suitable as references when planning the surgical treatment for these patients.

Social Anxiety and Orthognathic Surgery Effect on Oral Health-Related Quality of Life.

OBJECTIVES: This study aimed to investigate the impact of patients' social anxiety on oral health-related quality of life (OHRQoL) in the context of orthognathic surgery. METHODS: The study involved a cohort of 70 patients who were tasked with completing a comprehensive questionnaire aimed at assessing various facets of their OHRQoL at distinct stages of treatment: pre-surgery, within one month post surgery, and more than one month post surgery. Statistical analyses were conducted in the form of t-test. RESULTS: Out of the 70 participants, 27 were male (38.57%) and 43 were female (61.43%). The sample distribution comprised 30 (43%) subjects in the pre-surgical stage, two (3%) at one month post surgery, and 38 (54%) more than one month post surgery. In relation to the t-test results, we found variations in the significance of the results for each question, with multiple results showing patients who reported experiencing discomfort significantly outnumbering those who did not (p < 0.05). CONCLUSION: Social anxiety and orthognathic surgery both demonstrate significant influences on OHRQoL. Subsequent research should delve into specific areas where patients experience the greatest impact.

Maxillary sinus volume in patients with canted occlusal plane: A cone-beam computed tomography study.

OBJECTIVES: To compare the maxillary sinus volume between both sides in adult patients with upper occlusal canting (>2 mm cant) and a control group (≤2 mm cant) using cone-beam computed tomography scans. MATERIALS AND METHODS: This retrospective study included a total of 84 scans (42 scans per group) according to predetermined selection criteria. OnDemand 3-D™ software was used for volumetric and linear measurements of the maxillary sinus. Maxillary occlusal canting was determined at the level of the maxillary first molars. It was defined as the vertical difference between right and left sides relative to the Frankfort horizontal plane. Non-parametric tests were applied. RESULTS: The median difference in the maxillary sinus volume between the sides was statistically significant between the control and cant groups (P < 0.001). Also, the median difference in the maxillary sinus craniocaudal height and apex sinus distance between the sides was statistically significant between the control and cant groups (P < 0.05 and P < 0.001, respectively). CONCLUSION: In adult patients, maxillary occlusal canting of more than 2 mm was associated with asymmetric maxillary sinus volumes. In the cant group, maxillary first molars on the canted-down side were in close proximity to the sinus floor, which suggests a limited leeway for molar intrusion.

Evaluation of Bioactive Glass and Low Viscosity Resin as Orthodontic Enamel Sealer: An In Vitro Study.

The study aimed to evaluate the effect of applying fluoride bioactive glass (FBAG) and Alpha-Glaze® (resin sealer) on the shear bond strength of orthodontic brackets to enamel bonded by Transbond XT, brushing−abrasion durability, and their protective effect against simulated cariogenic acidic attack. Materials include 135 extracted premolars that were divided into three groups­FBAG, Alpha-Glaze, and control. The shear bond strength test was measured using an Instron Universal Testing Machine. The brushing abrasion challenge took place with a tooth-brushing simulator. Transmitted light microscopy examinations were performed after the specimens were demineralized for 4 days. The results show that the shear bond strength values of the three groups did not report any statistically significant differences: FBAG (28.1 ± 5.5 Mpa), Alpha-Glaze (32.5 ± 7.4 Mpa), and control (30.7 ± 6.5 Mpa) p < 0.05. The Adhesive Remenant Index (ARI) study showed chipping of enamel in 6.6% of Alpha-Glaze and control specimens and 40% of specimens had their enamel surface covered with resin. Furthermore, 30% of the FBAG and 100% of the Alpha-Glaze sealer specimens resisted the abrasion test. In conclusion, FBAG can serve as an orthodontic-sealer capable of protecting the enamel surface surrounding orthodontic brackets. However, the Alpha-Glaze sealer did not offer the capability of protecting the enamel.

Orthodontic management of anterior disc displacement without reduction.

This article presents a novel idea for managing patients with anterior disc displacement without reduction that often develops in susceptible patients during routine orthodontic treatment. The patient was a 24-year-old male who presented with class I right molar and canine relationship and class III left molar and canine relationship on a class I skeletal base, complaining of bimaxillary crowding. The case was treated with fixed orthodontic appliance with maxillary expansion and unilateral mandibular extraction to eliminate the mandibular crowding. Due to a life crisis, the patient developed anterior disc displacement on the right joint. A maxillary occlusal splint was fabricated to reduce the symptoms and attempt to recapture the disc; however, this attempt failed. An attempt was then made to recapture the disc using occlusal pivots and elastics. The disc was eventually recaptured, and the patient resumed normal jaw function and mouth opening. This case report aims to demonstrate a new way to achieve stable occlusion in a patient who sustained disc displacement.

Comparative assessment of the cell-surface antigens and gene expression profiles of the gingival tissue biomarkers in subjects with fixed functional and removable functional orthodontic appliances.

Background: This study aimed to examine the cellular components of the gingiva during orthodontic treatment with fixed and removable appliances. The cellular and molecular cues of pathologies of the gingival tissue associated with the use of different orthodontic appliances could be studied. Materials and methods: Tissue samples of gingiva were received from healthy patients undergoing gingivectomy for aesthetic purpose and from patients with fixed and removable functional orthodontic appliances undergoing gingivectomy for gingival overgrowth. The collected samples were stored in a sterile container with phosphate-buffered saline and to carry out further processes it was transported to the laboratory. Results: Cells positive for ECAD and NCAD were found to be increased in fixed appliances where as CD90 and CD105 positive cells showed no significant difference in all the three groups. CD24 and CD146 positive cells were increased significantly in removable and fixed than normal whereas CD133 positive cells were decreased in removable and fixed than normal. CD44 positive cells showed no noticeable change in all three groups. The gene expression levels of KRT5, SOX2, NANOG, and CXCL5 were found to be significantly increased in removable and fixed appliance groups. However, KRT8, CXCL10, and TIMP1 were increased only in fixed appliance group but CXCL10 showed decreased expression in removable appliance group. KRT6A, MYC, and MMP9 were decreased in fixed appliance group whereas MYC and MMP9 were increased in removable appliance group. KRT6A, KRT8, and TIMP1 showed no significant difference in removable appliance group. Conclusion: This study demonstrated essential roles of various genes, showing their contribution in regulating cell proliferation and migration in both the removable and fixed functional appliances.

Factors influencing the orthodontic treatment plan in Class II malocclusion.

INTRODUCTION: This study aimed to investigate the influence of orthodontists' demographics and patient characteristics on the orthodontic treatment plan decision for borderline Class II Division 1 malocclusion in growing patients. METHODS: An electronic survey was distributed to orthodontists through the American Association of Orthodontists. Participating orthodontists were asked to select their preferred orthodontic treatment plan for 3 patients with borderline Class II Division 1 malocclusion. The survey also included questions about the patient-related factors contributing to the treatment decision for each patient. RESULTS: A total of 113 orthodontists completed the survey. United States-trained orthodontists were more likely to select growth modification and nonextraction relative to extraction (odds ratio, 3.50; 95% confidence interval, 1.01-12.12; odds ratio, 3.59; 95% confidence interval, 1.18-10.91, respectively). Clinicians with >15 years of experience were 72% less likely to prefer nonextraction relative to extraction in 1 patient and were 67% less likely to prefer growth modification relative to extraction in another patient. Working solely in private practice was associated with higher, but not statistically significant, odds of growth modification and nonextraction. The practice location was also associated with treatment plan decisions; however, findings were inconsistent between the patients. CONCLUSIONS: The orthodontist's experience, place of education, location, and type of practice appear to influence the preferred treatment plan for Class II malocclusion. Overall, the patient's profile and age were the most considered patient-related factors for growth modification, whereas the patient's profile, amount of crowding, and smile esthetics were the most considered factors for preferring extraction and nonextraction treatment modalities.

Combined Orthodontic and Surgical Management for Treatment of Severe Class III Malocclusion with Anterior and Posterior Crossbites.

Severe class III malocclusion can be a great challenge, especially in adult patients. This case report describes an adult patient with severe skeletal class III malocclusion and with an obvious maxillary deficiency and mandibular excess causing both anterior and posterior crossbites in addition to a shift in the upper and lower midlines to the left concerning the facial midline. This was complicated by compensatory mechanisms such as the proclination of upper incisors and retroclination of lower incisors. Decompensation of the upper and lower arches was performed combined with upper arch expansion to relieve crowding in the upper arch and correct the posterior crossbite. This was followed by double jaw surgeries, including Le Fort I osteotomy in the maxilla and bilateral sagittal split osteotomy (BSSO) in the mandible. Orthodontic finishing procedures were then used to correct any other dental discrepancies. Remarkable esthetic and functional results were achieved with high patient satisfaction.

Morphological features of Class I, II and III malocclusions of Saudi adolescents.

AIMS: This cross-sectional study compared and contrasted the morphological characteristics of Class I, II and III malocclusions in an adolescent Saudi population. METHODS: Adolescent Saudis with Angle's Class I, II and III malocclusions were selected from orthodontic patients' records. Angular and linear measurements were compared between the three groups. Cephalometric analysis was performed using the VistadentOC® software. Multifactorial ANOVA for angular and linear measurements between and within groups. RESULTS: Orthodontic records of 300 patients were included. There was no significant difference between and within groups in age and distribution of Angle's classification, p > 0.05. Multifactorial ANOVA showed that there were significant interactions between gender and malocclusions in skeletal, dental and soft tissue measurements, p < 0.05. There were significant differences in the sagittal and vertical skeletal measurements between groups, p < 0.05. The dental measurements were also significantly different in most of the measurements (p < 0.05). Moreover, there were significantly different readings among the groups in the soft tissue analysis. CONCLUSION: Morphological characteristics of adolescent Saudis show unique differences between gender and malocclusions, more so in Class III malocclusions. Class II and III malocclusions also show skeletal differences amongst the groups.

Anatomical consideration for optimal position of orthodontic miniscrews in the maxilla: a CBCT appraisal.

BACKGROUND: Orthodontic miniscrews are commonly used as temporary anchorage devices. Bone thickness and bone depth are important factors when placing miniscrews. There are no studies to assess the maxillary bone thickness for optimum miniscrew placement in a Saudi population. OBJECTIVE: Assess the proximity of the maxillary sinus and nasal cavity in areas where miniscrews are usually inserted using cone beam computed tomography (CBCT). DESIGN: Retrospective, cross-sectional. SETTING: Department of maxillofacial radiology in a Saudi dental school. PATIENTS AND METHODS: Using CBCT images, we measured the distance between the maxillary sinus and nasal cavity to the palatal bone, buccal intra-radicular and infrazygomatic crest areas. Mean values (SD) were compared at various locations, including by gender, and correlation with age was calculated. MAIN OUTCOME MEASURE: Mean bone thickness at commonly used sites for orthodontic miniscrew placements in the maxilla. Secondary outcome was the insertion angle in the infrazygomatic crest area. SAMPLE SIZE: CBCT images of 100 patients (50 males and 50 females). RESULTS: The mean (standard deviation) age for the sample was 25.4 (6.5) years with no significant difference between males and females. In the palate, the distance to the nasal cavity and maxillary sinus was greater anteriorly and decreased significantly posteriorly (P<.001). Buccally, the interdental bone depth was significantly greater between the second premolar and first molar (11.96 mm) compared to between the central and lateral incisors (7.53 mm, P<.001). The mean bone thickness of the infrazygomatic crest area at a 45° insertion angle was 4.94 mm compared to 3.90 at a 70° insertion angle (P<.001). No correlation was found between age and bone thickness. CONCLUSION: The distance to the nasal cavity and maxillary sinus was greater in the anterior than posterior areas. There is minimal risk of injuring the maxillary sinus or nasal cavity using the buccal approach. Caution is needed when placing miniscrews in the infrazygomatic crest area. LIMITATIONS: Cross-sectional study from one center; hence, findings cannot be generalized to other populations. CONFLICT OF INTEREST: None.

Effect of lactic Acid etching on bonding effectiveness of orthodontic bracket after water storage.

Objective. To determine the effect of lactic acid at various concentrations on the shear bond strength of orthodontic brackets bonded with the resin adhesive system before and after water storage. Materials and Methods. Hundred extracted human premolars were divided into 5 treatment groups and etched for 30 seconds with one of the following agents: lactic acid solution with (A) 10%, (B) 20%, (C) 30%, and (D) 50%; group E, 37% phosphoric acid (control). Metal brackets were bonded using a Transbond XT. Bonding effectiveness was assessed by shear bond strength after 24 hours and 6 months of water storage at 37°C. The data were analyzed with 2-way analysis of variance and Tukey's Honestly Significant Difference (HSD) test (α = .001). Results. Lactic acid concentration and water storage resulted in significant differences for brackets bond strength (P < .001). 20% lactic acid had significantly higher mean bond strength values (SD) for all conditions: 24 hours [12.2 (.7) MPa] and 6 months [10.1 (.6) MPa] of water storage. 37% phosphoric acid had intermediate bond strength values for all conditions: 24 hours [8.2 (.6) MPa] and 6 months [6.2 (.6) MPa] of water storage. Also, there were differences in bond strength between storage time, with a reduction in values from 24 hours and 6 months for all experimental groups (P < .001). Conclusion. Lactic acid could be used in place of phosphoric acid as an enamel etchant for bonding of orthodontic brackets.

Surgical Orthodontic Treatment of Severe Skeletal Class II.

This paper describes an adult Saudi male patient who presented with a severe skeletal class II deformity. The case was managed with a combination of presurgical orthodontic treatment followed by a double jaw orthognathic surgery and then another phase of orthodontic treatment for final occlusal detailing. Extraction of the four first premolars was done during the presurgical orthodontic phase of treatment to decompensate upper and lower incisors and to give room for surgical setback of the maxillary anterior segment. Double jaw surgery was performed: bilateral sagittal split ramus osteotomy for 8 mm mandibular advancement combined with three-piece Le Fort I maxillary osteotomy, 6 mm setback of the anterior segment, 8 mm impaction of the maxilla, and 5 mm advancement genioplasty. Although the anteroposterior discrepancy and the facial convexity were so severe, highly acceptable results were obtained, both esthetically as well as occlusally.

Incisors' proportions in smile esthetics.

AIMS: To determine whether alteration of the maxillary central and lateral incisors' length and width, respectively, would affect perceived smile esthetics and to validate the most esthetic length and width, respectively, for the central and lateral incisors. MATERIALS AND METHODS: Photographic manipulation was undertaken to produce two sets of photographs, each set of four photographs showing the altered width of the lateral incisor and length of the central length. The eight produced photographs were assessed by laypeople, dentists and orthodontists. RESULTS: Alteration in the incisors' proportion affected the relative smile attractiveness for laypeople (n=124), dentists (n=115) and orthodontists (n=68); dentists and orthodontists did not accept lateral width reduction of more than 0.5 mm (P<0.01), which suggests that the lateral to central incisor width ratio ranges from 54% to 62%. However, laypeople did not accept lateral width reduction of more than 1 mm (P<0.01), widening the range to be from 48% to 62%. All groups had zero tolerance for changes in central crown length (P<0.01). CONCLUSION: All participants recognized that the central incisors' length changes. For lateral incisors, laypeople were more tolerant than dentists and orthodontists. This suggests that changing incisors' proportions affects the relative smile attractiveness.

Bacteria induce osteoclastogenesis via an osteoblast-independent pathway.

Bacteria or their products may cause chronic inflammation and subsequent bone loss. This inflammation and bone loss may be associated with significant morbidity in chronic otitis media, periodontitis, endodontic lesions, and loosening of orthopedic implants caused by lipopolysaccharide (LPS)-contaminated implant particles. Currently, it is not clear how bacteria or endotoxin-induced bone resorption occurs and what cell types are involved. Here we report that Porphyromonas gingivalis, a periodontal pathogen, and Escherichia coli LPS induce osteoclastic cell formation from murine leukocytes in the absence of osteoblasts. In contrast, stimulation with parathyroid hormone had no effect. These multinucleated, tartrate-resistant acid phosphatase-positive cells were positive for receptor activator of NF-kappaB (RANK), the receptor for osteoprotegerin ligand (OPGL), also known as RANK ligand (RANKL). Blocking antibodies demonstrated that their formation was dependent upon expression of OPGL and, to a lesser extent, on tumor necrosis factor alpha. Mononuclear cells represented a significant source of OPGL production. In vivo, P. gingivalis injection stimulated OPGL expression in both mononuclear leukocytes and osteoblastic cells. Thus, these findings describe a pathway by which bacteria could enhance osteolysis independently of osteoblasts and suggest that the mix of cells that participate in inflammatory and physiologic bone resorption may be different. This may give insight into new targets of therapeutic intervention.