A Novel Approach for Orthodontic Extrusion Prior to Intentional Replantation: A Case Report.

AIM: This case report aimed to present a novel surgical technique involving orthodontics luxation of the offended tooth using miniscrew prior to performing intentional replantation (IR) to remove an extruded separated instrument that injured the inferior alveolar nerve (IAN). BACKGROUND: Intentional replantation is a dental procedure that involves extracting a tooth, managing the root canal, and then reinserting the tooth back into its socket. This procedure is typically used as a last resort when other treatment options have failed or are not possible. Intentional replantation can be successful in preserving the tooth and preventing tooth loss, but it is important to note that there are risks involved. Maintaining the viability of the periodontal ligament (PDL) is a pivotal step to achieve a favorable outcome. CASE DESCRIPTION: A 15-year-old female patient came to the clinic complaining of electric-like pain in the left mandibular posterior area that radiated to the left ear and sometimes caused a headache. Upon clinical and radiographic evaluation, extruded endodontic file from the mesial root of the left first molar that penetrated the IAN canal was noticed. Nonsurgical root canal retreatment was performed, which failed to retrieve the separated file. Orthodontics luxation of the offended tooth was done 2 weeks before the surgical intervention using a miniscrew to induce PDL inflammation, which increased the tooth mobility and PDL volume, facilitating the atraumatic extraction and reduced the risk of complications, such as root resorption and ankylosis. Then, IR was performed, and the extruded file was successfully retrieved. Three months follow-up showed complete recovery of the endodontics-related IAN injury symptoms. Preapical radiographic evaluation and cone-beam computed tomography scan showed complete healing of the periapical radiolucency/area of low density and complete formation of the PDL space and lamina dura around the resected roots. CONCLUSION: This novel approach using a miniscrew suggests a noninvasive technique that minimizes the damage to the offended tooth surrounding tissues as well as minimizing the morbidity of the adjacent teeth and the vital anatomical structures. CLINICAL SIGNIFICANCE: Multidisciplinary comprehensive preplanning of complicated cases is essential to maximize treatment efficiency. The orthodontic extrusion facilitates the extraction process that helps in preserving the PDL, and ultimately increases the survivability of the teeth. How to cite this article: Alharbi MA, Alghamdi BA, Alswajy WA, et al. A Novel Approach for Orthodontic Extrusion Prior to Intentional Replantation: A Case Report. J Contemp Dent Pract 2023;24(11):895-901.

Root Membrane Concept: Shield the Socket-A Case Report.

Edentulousness affects the mental health of most patients. Missing teeth in the anterior esthetic zones is a matter of concern, especially for young adults. Various replacement options such as fixed partial dentures, removable partial dentures, and dental implants are available to treat edentulousness. Dental implants have been a booming treatment option in modern-day dentistry as they more closely mimic the natural tooth. The most important criterion for placement of the implant in the esthetic zone is the conservation of alveolar bone, especially in the anterior region which is usually compromised due to tooth extraction or resorption of the ridge. The root membrane concept or the socket shield technique is a recently introduced concept in implant dentistry where a portion of the root acts as a shield to protect against alveolar bone resorption and maintain bone integrity, especially in the esthetic area. This case report describes the clinical management of fractured upper anterior teeth using a dental implant and the root membrane technique. Keywords: Anterior zone, Esthetics, Immediate implants, Implant, Missing teeth, Root membrane technique, Socket shield.

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.

Influence of photodynamic therapy and different conventional methods on conditioning of lithium di silicate ceramics bonded to metallic brackets: An assessment of bond strength.

AIM: The aim of the current study was to assess the effect of different conditioning methods on Lithium di silicate (LDC) employing conventional and contemporary regimes bonded to metallic brackets. MATERIAL AND METHODS: 70 discs of LDC were prepared and polished to attain smooth surface. Samples were allocated into seven groups according to ceramic surface conditioning. Group 1 surface treated with Er-YAG laser and saline (S), Group 2 PDT using MBP + S, Group 3 H F + S (control), Group 3 HF (Hydrofluoric acid) + saline, Group 4 HF (Hydrofluoric acid) + ultrasonic bath (UB) + S, Group 5 sand blasting the glass ceramic surface with 120 um Al2O3, Group 6 LDC surface conditioned with SECP(Etch and Prime) and Group 7 ECL(Laser) + S on was irradiated on LDC. Both chemical and mechanical surface treatments of LDC were followed by placement of metallic brackets. Samples were arranged in universal testing machine for shear bond strength (SBS) testing. Bond failure of brackets were assessed using ARI. To assess and compare the mean and standard deviations (SD) among experimental groups analysis of variance (ANOVA) was employed. All treatment combination means were compared using the post hoc Tukey's multiple comparison test at a significance level of (p ≤ 0.05). RESULTS: SBS values of Group 2 H F acid + S displayed highest bond durability (22.28 ± 1.09 MPa). Whereas, specimens in Group 4 surface treated with 120 µm Al2O3 displayed lowest SBS scores (11.81 ± 0.55 MPa) and these bond scores were comparable to PDT using MBP + S (12.54 ± 1.09 MPa) (p > 0.05). LDC surface treated by ECL + S (21.11 ± 3.85 MPa), HF + UB + S (19.28 ± 0.52 MPa) exhibited results comparable to HF acid + S (p > 0.05). CONCLUSION: LDC conditioned with HFS still remains as gold standard. Use of PDT for surface treatment of LDC and bonded to metallic bracket is not recommended as it results in decreased bond durability. Use of ECL-S and HF + UB + S has a potential to be used alternatively to HFS for LDC conditioning.

Mandibular symphysis dimensions in different sagittal and vertical skeletal relationships.

BACKGROUND: The aim of this cross-sectional study was to compare the dimensions of mandibular symphysis (MS) between gender and the different sagittal and vertical skeletal relationships. MATERIAL AND METHODS: Pre-treatment records of orthodontic patients were divided according to gender, sagittal (Class I, II and III) and vertical (decreased, average and increased mandibular plane [MP] angle) skeletal relationships. Measurements of MS parameters were performed on lateral cephalograms using IMAGEJ software. Comparisons between MS parameters and gender and the different skeletal relationships was performed using multifactorial and one-way ANOVA, and independent sample t-tests. RESULTS: A total of 104 records (25 males and 79 females) fulfilled the inclusion criteria. Males had significantly greater MS surface area, dentoalveolar length, skeletal symphysis length, total symphysis length, vertical symphysis dimension and symphysis convexity (p < 0.05). Skeletal Class II patients had significantly greater dentoalveolar and skeletal symphysis lengths while Class III had greater chin length, vertical symphysis dimension and symphysis convexity (p < 0.05). Patients with decreased vertical dimension had greater skeletal symphysis length (p = 0.026) and those with an average vertical relationship had greater chin length (p < 0.001). CONCLUSIONS: The morphology of the mandibular symphysis is affected by gender, sagittal and vertical skeletal patterns. Males had increased mandibular symphysis surface area and linear dimensions. Class II patients had greater dentoalveolar length. Chin length was greater in patients with an average MP angle.

Scope and performance of artificial intelligence technology in orthodontic diagnosis, treatment planning, and clinical decision-making - A systematic review.

BACKGROUND/PURPOSE: In the recent years artificial intelligence (AI) has revolutionized in the field of dentistry. The aim of this systematic review was to document the scope and performance of the artificial intelligence based models that have been widely used in orthodontic diagnosis, treatment planning, and predicting the prognosis. MATERIALS AND METHODS: The literature for this paper was identified and selected by performing a thorough search for articles in the electronic data bases like Pubmed, Medline, Embase, Cochrane, and Google scholar, Scopus and Web of science, Saudi digital library published over the past two decades (January 2000-February 2020). After applying the inclusion and exclusion criteria, 16 articles were read in full and critically analyzed. QUADAS-2 were adapted for quality analysis of the studies included. RESULTS: AI technology has been widely applied for identifying cephalometric landmarks, determining need for orthodontic extractions, determining the degree of maturation of the cervical vertebra, predicting the facial attractiveness after orthognathic surgery, predicting the need for orthodontic treatment, and orthodontic treatment planning. Most of these artificial intelligence models are based on either artificial neural networks (ANNs) or convolutional neural networks (CNNs). CONCLUSION: The results from these reported studies are suggesting that these automated systems have performed exceptionally well, with an accuracy and precision similar to the trained examiners. These systems can simplify the tasks and provide results in quick time which can save the dentist time and help the dentist to perform his duties more efficiently. These systems can be of great value in orthodontics.

Developments, application, and performance of artificial intelligence in dentistry - A systematic review.

BACKGROUND/PURPOSE: Artificial intelligence (AI) has made deep inroads into dentistry in the last few years. The aim of this systematic review was to identify the development of AI applications that are widely employed in dentistry and evaluate their performance in terms of diagnosis, clinical decision-making, and predicting the prognosis of the treatment. MATERIALS AND METHODS: The literature for this paper was identified and selected by performing a thorough search in the electronic data bases like PubMed, Medline, Embase, Cochrane, Google scholar, Scopus, Web of science, and Saudi digital library published over the past two decades (January 2000-March 15, 2020).After applying inclusion and exclusion criteria, 43 articles were read in full and critically analyzed. Quality analysis was performed using QUADAS-2. RESULTS: AI technologies are widely implemented in a wide range of dentistry specialties. Most of the documented work is focused on AI models that rely on convolutional neural networks (CNNs) and artificial neural networks (ANNs). These AI models have been used in detection and diagnosis of dental caries, vertical root fractures, apical lesions, salivary gland diseases, maxillary sinusitis, maxillofacial cysts, cervical lymph nodes metastasis, osteoporosis, cancerous lesions, alveolar bone loss, predicting orthodontic extractions, need for orthodontic treatments, cephalometric analysis, age and gender determination. CONCLUSION: These studies indicate that the performance of an AI based automated system is excellent. They mimic the precision and accuracy of trained specialists, in some studies it was found that these systems were even able to outmatch dental specialists in terms of performance and accuracy.

Micro-osteoperforations and Its Effect on the Rate of Tooth Movement: A Systematic Review.

Prolonged orthodontic treatments have inconvenienced patients and clinicians alike. Surgically assisted techniques for accelerating orthodontic tooth movement have shown promising results in the literature over the years. The minimally invasive nature of micro-osteoperforations (MOPs), however, for enhanced orthodontic tooth movement has recently gained momentum, with many clinical trials conducted on both animals and humans. An electronic search was performed to extract papers using PubMed, Google Scholar, Scopus, and Web of Science. The keywords that were used included "MOP," "accelerating tooth movement," "orthodontic tooth movement," and "regional acceleratory phenomenon." The studies that met our inclusion criteria were extracted and evaluated in this review. MOPs have been proven time and again, in animal and human studies alike, to increase the rate of orthodontic tooth movement. The application of perforations to cortical bone present in the pathway of teeth, which are specifically to be moved creates transient osteopenia. This reduces the density of the cortical bone, hence speeding up the rate of orthodontic tooth movement. Many techniques have been implemented and perfected to enhance orthodontic tooth movement and shorten the treatment time in the literature. MOPs have proven to be a universally applied, nontechnical, repeatable, and minimally invasive method of accelerating tooth movement, with extremely minimal consequences.

Comparison of Effectiveness of Corticotomy-assisted Accelerated Orthodontic Treatment and Conventional Orthodontic Treatment: A Systematic Review.

AIM: To systematically review the comparative differences in the performance and timeliness of conventional orthodontic treatment with that of corticotomy-assisted accelerated orthodontic treatment. DATA SOURCES: The electronic databases PubMed and Google Scholar were searched from January 2007 to January 2018 in English, with manual searches of reference lists and gray literature. Thirty-six articles were included in the study with inclusion criteria as prospective clinical studies of patients treated with fixed conventional appliance and the intervention was the corticotomy-assisted accelerated orthodontic treatment method. STUDY SELECTION: Two reviewers assessed independently the eligibility of the included articles. One investigator abstracted study design information, intervention details, and harms data from all included studies into a standardized evidence table. The accuracy of these data was checked by the second investigator. We resolved any disagreements through discussion with other authors. RESULTS: Different aspects of the corticotomy-assisted accelerated orthodontics treatment method were investigated including risk factors, advantages, and disadvantages as compared to that of conventional orthodontic treatment. CONCLUSION: There is limited available evidence about effectiveness of corticotomy-assisted accelerated orthodontics. Although the current review indicates that the corticotomy-assisted accelerated orthodontic treatment method can fasten the treatment duration by 2.2-3 folds compared to conventional orthodontic treatment, furthermore, the level of evidence needs well-conducted prospective research with big sample size to draw valid conclusions. CLINICAL SIGNIFICANCE: Orthodontic treatment is a time-consuming process and due to noncompliance of patients, research has found different methods to accelerate the treatment, thus reducing the total treatment duration. Use of accelerated orthodontic techniques is expected to help clinicians in better treatment decisions for noncompliant patients.

Impact of Dental Visits on Oral Health Awareness in Saudi Arabia.

AIM: The aim of this study is to assess the impact of dental visits on oral health awareness among the Saudi population. MATERIALS AND METHODS: A cross-sectional survey was conducted in Saudi Arabia. An online self-administered questionnaire was distributed from January 2011 to June 2013. The questionnaire consisted of 21 multiple choice questions which was categorized into four: demographic data, dental care status, oral hygiene behavior, and oral health knowledge (OHK). Responses to the questions in the OHK category were grouped and scored according to their percentage of correct answers: 1 = very poor (0 to <25% correct), 2 = poor (25% to <50% correct), 3 = acceptable (50 to <75% correct), and 4 = good (75-100% correct). The sample was divided based on dental visit behavior into poor, average, and good dental visitors. Descriptive statistics, group comparisons, correlations, and linear regressions were conducted using SPSS (V16.0). A significance was set at p < 0.05. RESULTS: A total of 845 participants were included: 73.4% were females, 85.1% were older than 19 years, 76.9% had a college-level education, and 75.3% were from western Saudi Arabia. A total of 14.1% were poor dental visitors, 67.5% were average dental visitors, and 18.5% were good dental visitors. The good dental visitor group showed significantly better results than the other two groups in terms of dental services received, brushing habits, interdental cleansing habits, use of miswak, and OHK (p < 0.05). The best predictors with significant but weak effects on dental visit habits were brushing habits, interdental cleansing habits, use of miswak, and OHK (F(8,836) = 7.212, R2 = 0.065, p < 0.0001). CONCLUSION: Dental visits were significantly correlated with OHK. However, the impact of dental visits on oral health awareness was found to be weak. CLINICAL SIGNIFICANCE: Well-designed preventive and educational dental visit programs need to be widely implemented as part of the governmental oral health plans.

Significance of Cephalometric Radiograph in Orthodontic Treatment Plan Decision.

AIM: The lateral cephalometric radiograph is a standard component of clinical records taken for orthodontic diagnosis and treatment planning. The present study was conducted to assess the utility of cephalometric radiography and analysis in modern orthodontic diagnosis and treatment planning. MATERIALS AND METHODS: A research survey was conducted at Jacksonville University School of Orthodontics. Thirty-one residents and faculty were the participants. The survey sample was collected from the university patients' pool. A survey was given to participants at two time points. At the first time point (T1), the participants were given full records without lateral cephalogram. At the second time point (T2), they were given full records with lateral cephalogram. Two measures were analyzed: (1) a change in orthodontic treatment decision and (2) a change in the orthodontic treatment plan. A traditional McNemar's test was used on paired binary data. We used the conditional logistic regression model with robust variance at a participant level to adjust for a participant-level clustering effect to test the difference in treatment decision before and after. A statistical significance was determined at p = 0.05. RESULTS: It was found that 93.6% of the treatment decisions and 70% of the extraction decisions were consistent after the introduction of lateral cephalograms. There was no statistically significant association observed between two outcome measures and the use of cephalograms (p = 0.80). CONCLUSION: Sufficient evidence does not exist to warrant lateral cephalometric radiographs be taken as a part of standard diagnostic records on every individual seeking orthodontic treatment. CLINICAL SIGNIFICANCE: Evidenced-based selection criteria for prescribing lateral cephalometric radiographs should be developed to reduce the amount of radiation exposure to the general public.

Dental Caries and Risk Factors in Swedish Adolescents about to Start Orthodontic Treatment with Fixed Appliances.

AIM: The aim of this study is to investigate the caries situation in a group of Swedish adolescents, who were scheduled for orthodontic treatment with fixed appliances. MATERIALS AND METHODS: An age- and gender-matched control group was selected from the same city (Malmö, Sweden). Caries and fillings on smooth surfaces and fillings on occlusal surfaces were diagnosed clinically and caries and fillings on approximal surfaces by bitewings. Numbers of mutans streptococci (MS) and lactobacilli (LB) were analyzed in saliva. RESULTS: There were no significant differences regarding manifest caries lesions and fillings on smooth surfaces. Numbers of occlusal-filled surfaces (FS) and approximal decayed and filled surfaces were around 10%, but did not differ between the groups. However, 53% had approximal enamel caries lesions in the test group and 46% in the control group. The prevalence of approximal decayed surfaces (DS) and FS was low in both groups, 0.57 ± 1.41 in the test group and 0.65 ± 1.38 in the control group (p > 0.05), i.e., somewhat more DS in the control group (p < 0.05). Most individuals had low/medium counts of cariogenic bacteria in their saliva and less than 10% high counts in both groups. CONCLUSION: Most Swedish adolescents who have been scheduled for treatment with fixed appliances appear to have a low-to-medium caries risk nowadays. However, around 10% of all approximal tooth surfaces of premolars/molars had enamel caries and one-third of the individuals had medium/high counts of cariogenic bacteria in their saliva, which may be risk factors for future caries during orthodontic treatment. CLINICAL SIGNIFICANCE: Bitewing radiographs are important before starting orthodontic treatment and approximal caries and many cariogenic bacteria may be risk factors for orthodontic treatment.

Use of Interarch Width Ratio to measure Transverse Relationship: A New Method to measure and assess Interarch Discrepancy.

AIM: The purpose of this study was to assess the arch width, transverse discrepancy, and transverse interarch ratio for class I malocclusion sample, with and without crossbite, in permanent dentition stage. MATERIALS AND METHODS: Records of class I malocclusion patients with minimal crowding and spacing with and without posterior crossbite were selected. Each group consisted of 40 pairs of dental casts (20 males and 20 females). Arch widths were measured for the canine, first, and second premolars, and first permanent molars using the buccal approach. Means and standard deviations (SDs) of dental arch widths were measured for the maxillary and mandibular arches, and the interarch width ratio was calculated. RESULTS: There was a highly significant difference between the noncrossbite and crossbite groups regarding the maxillary width, p < 0.001. However, no differences were found between groups for the mandibular widths, p > 0.01. There were also significant differences between both groups for the intercanine, first and second premolars, and first molar ratios, p < 0.001. CONCLUSION: This new simple method showed that a transverse maxillary-mandibular ratio of 1:1.1 is ideal. A ratio less than 1:0.9 will indicate the presence of crossbite. CLINICAL SIGNIFICANCE: The interarch ratio significantly aids in orthodontic treatment planning in patients requiring maxillary expansion and/or surgical cases.

Radiographic evaluation of dental age maturity in 3-17-years-old saudi children as an indicator of chronological age.

OBJECTIVE: This study was aimed to evaluate the dental age in Saudi children from panoramic radiographs using the Demirjian method to estimate their chronological age. MATERIALS AND METHODS: This retrospective cross-sectional study consisted of 1902 panoramic radiographs of 955 boys and 947 girls between the ages of 3-17 years. All children were placed in the age group closest to their chronological age. The dental age was scored on all seven left mandibular teeth by calibrated examiners. Bivariate analyses using the t-test and Pearson correlation were performed. RESULTS: There was significant difference in both boys and girls in all the age groups between their chronological age and dental age. Even though there was a slight overestimation in boys in some age groups and slight underestimation in girls in some groups, correlation analysis showed that there was a highly significant correlation between the chronological age and dental age for both boys (r2 = 0.96, P < 0.001) and girls (r2 = 0.98, P < 0.001). Moreover, correlation analyses for each age group showed a significant correlation between the chronological age and the dental age, using the Demirjian method, in most age groups (P < 0.01). When comparing the maturation score between boys and girls, the Student's t-test showed that there were no statistical differences between boys and girls in most age groups. CONCLUSION: Saudi boys and girls living in the western region of Saudi Arabia exhibited similar pattern of dental development when compared to the Demirjian method. Hence, the Demirjian method could be used as reference in children from the western region of Saudi Arabia.

Prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population.

OBJECTIVES: This study was aimed to investigate the prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population. MATERIALS AND METHODS: The records of the 1066 patients seeking orthodontic treatment were screened for maxillary lateral incisor agenesis (MLIA). The following data were recorded for each subject: age; gender; unilateral or bilateral agenesis of MLI and side. The lateral cephalogram of each subject with MLIA was digitally traced. The data were compared to age-matched control orthodontic patients with skeletal Class I. RESULTS: The prevalence of maxillary lateral incisor agenesis was 4.9% (52 patients) in which 63.5% were females. There was a significant difference between MLIA patients and controls in sagittal relationships (ANB, Wits, AB plane, angle of convexity and Co-A/Co-Gn differential analyses) p < 0.05. CONCLUSIONS: Patients with maxillary lateral incisor agenesis showed a significant tendency for skeletal Class III compared with the Class I control. This could be attributed to maxillary hypoplasia/retrognathia.

Effect of fluoridated chewing sticks (Miswaks) on white spot lesions in postorthodontic patients.

INTRODUCTION: This article illustrates a new treatment method and evaluates the effect of the frequent use of fluoridated chewing sticks (miswaks) on the remineralization of white spot lesions (WSLs) diagnosed at debonding. METHODS: Thirty-seven orthodontic patients (mean age, 17.2 years), with a minimum of 4 WSLs on the buccal surfaces of the maxillary incisors, canines, premolars, and first molars after orthodontic therapy, were enrolled in a double-blind, randomized, longitudinal trial lasting 6 weeks. The subjects were divided into 2 groups using fluoridated miswaks impregnated in 0.5% sodium fluoride (test group, n = 19) and nonfluoridated miswaks (control group, n = 18). A custom-made mouth tray, covering half of the maxillary dentition, was used while brushing with the miswaks 5 times per day. The WSLs were scored by using a DIAGNOdent pen (KaVo, Biberach, Germany) and with the International Caries Detection and Assessment System (ICDAS II) index, at baseline and 2, 4, and 6 weeks after debonding. RESULTS: Both the DIAGNOdent readings and the ICDAS II index of the WSLs decreased in the test group on the uncovered side of the dentition but not on the covered side during the 6-week trial (P <0.0001). There was also a slight improvement in the control group (not significant). There was a strong correlation between the DIAGNOdent values and the ICDAS II index when all the data were pooled (P <0.001). CONCLUSIONS: The frequent use of fluoridated miswaks had a remineralizing effect on WSLs. The DIAGNOdent pen might be a useful tool for diagnosing and monitoring changes of WSLs over a relatively short period of time.