Severity and Treatment Difficulty of Impacted Maxillary Canine among Orthodontic Patients in Riyadh, Saudi Arabia.

BACKGROUND: The current study aimed to evaluate the severity and treatment difficulty of impacted maxillary canines and their relationship with gender, age group, and bucco-palatal position. METHODS: A retrospective cross-sectional study was conducted from 2017 to 2021. Patients' data and panoramic radiography were obtained from the orthodontic clinic at King Saud University's Dental University Hospital in Riyadh, Saudi Arabia. The severity factors and treatment difficulty index were used to assess the impacted maxillary canines. Statistical analyses were performed utilizing a chi-square test for categorical variables and an independent t-test for numerical variables, and a p-value of ≤0.05. RESULTS: There were 171 impacted maxillary canines in total, with a female-to-male subject ratio (11:8) and a mean age (18.7 years). Overall, 77.2% of impacted upper canines were found to be palatal. The severity of canine impaction parameters showed no significant sex or age group predilection. Buccally impacted maxillary canines were characterized by a preferable angulation to the midline, compared to the palatally impacted maxillary canines (p = 0.012). The horizontal overlap of the impacted maxillary canine cusp tip revealed a significant association with the bucco-palatal position of the impacted canine (p < 0.001). Palatal impaction was located more frequently in sectors 3 and 4. Male patients were found to have a higher total score in terms of the treatment difficulty index relative to females (p = 0.046). CONCLUSION: Despite the severity parameters having revealed no significant gender predilection, males were found to have higher treatment difficulty in maxillary canine impaction than females. The severity of the palatally impacted canine is greater than that of buccal impaction in terms of angulation to the midline and horizontal overlap.

Etiology of Molar-Incisor Hypomineralization (MIH): A Cross-Sectional Study of Saudi Children.

(1) Background: Molar-incisor hypomineralization (MIH) is a common clinical condition with critical negative consequences for dental health. The etiology of MIH is still not completely understood, although several theories have been suggested. (2) Aim: To investigate the etiology of MIH defects in a sample of Saudi school children. (3) Method: A total of 893 school children in the age range of 8-10 years participated in the study. The sample was taken from Riyadh City, Saudi Arabia. The participating children were examined for MIH using the European Academy of Pediatric Dentistry Criteria. The children's parents were asked about the child's pre, peri-, and postnatal condition utilizing a structured and validated questionnaire. (4) Results: A total of 362 children (168 males and 194 females) were affected with MIH, for a prevalence of 40.5%. Among all analyzed etiological factors, only jaundice was found to be significantly associated with MIH in children (OR = 1.35, p = 0.047). Multivariate logistic regression analysis confirmed that the only significant etiological factor for MIH was newborn jaundice (p = 0.04). (5) Conclusion: Newborn jaundice was the only etiological factor that showed a significant association with MIH in the studied Saudi school children.

Fixed orthodontic appliance impact on oral health-related quality of life during initial stages of treatment.

AIMS: Our study aimed to assess the oral health-related quality of life (OHRQoL) changes during the initial stage of fixed orthodontic appliance therapy and determined the impact of various orthodontic therapy needs on the OHRQoL of Saudi patients seeking orthodontic treatment. MATERIALS AND METHODS: Forty-two patients aged 14-24 years (69% females) were recruited from the orthodontic clinics. OHRQoL was quantified by a self-administered short version of oral health impact profile (OHIP-14) questionnaire used before treatment (T0) and following bonding of fixed appliance on days 1 (T1), 7 (T2), 14 (T3), and 30 (T4). The higher the OHIP-14 score, the poorer the OHRQoL. The dental health component (DHC) of the index of orthodontic treatment needs (IOTN) was used to assess malocclusion severity. The missing, overjet, crossbite, displacement, overbite (MOCDO) hierarchical scale was used to categorize the most severe feature in each patient and determine the grade of orthodontic treatment need. Changes of OHRQoL over time were compared using the Friedman test. RESULT: Overall OHIP-14 score significantly increased following orthodontic appliance bonding at T1 and T2 compared to T0 (P < 0.001). The functional limitation domains in OHIP-14 pain and discomfort, physical disability, psychological disability, and psychological discomfort were affected at T1 compared to T0 (P < 0.05). Grade 4 IOTN-DHC (definite treatment needs) significantly influenced most OHIP-14 domains compared to other grades. CONCLUSION: With the growing therapeutic and cosmetic demands of orthodontic treatment and the focus on OHRQoL, the study findings can be used to enhance patients' cooperation, expectation, and adherence to orthodontic treatment.

Effects of Antioxidants on the Shear Bond Strength of Orthodontic Brackets Bonded to Bleached Human Teeth: An In Vitro Study.

AIM: The aim of this study was to evaluate the effects of different concentrations of sodium ascorbate (SA), green tea (GT), and chamomile (CM) on the shear bond strength (SBS) of metal orthodontic brackets bonded to teeth bleached with 40% hydrogen peroxide (HP). MATERIALS AND METHODS: Ninety-four sound premolars were divided into eight groups: group I (control + no bleaching), group II (bleaching + immediate bonding), group III (bleaching + 10% SA), group IV (bleaching + 35% SA), group V (bleaching + 0.5% GT), group VI (bleaching + 1% GT), group VII (bleaching + 0.5% CM), and group VIII (bleaching + 1% CM). In groups III-VIII, teeth were treated with the antioxidants for 10 minutes after bleaching with 40% HP, but before bonding. All the specimens were bonded with the resilience adhesive, and the SBS was tested with a universal testing machine (Instron 5965). The cross-head speed to break the bond was 1 mm/minute. The adhesive remnant index (ARI) was tested under 50× magnification. One-way analysis of variance, Tukey's post hoc, and Chi-squared tests were used for analysis (p ≤ 0.05). RESULTS: The differences in SBS among the eight tested groups were highly significant (p < 0.001). Comparison of the eight groups using Tukey's post hoc test revealed significantly lower SBS (p < 0.001) in test groups II, III, IV, and VIII than in group I. Adhesive remnant index scores showed significant intergroup differences (p = 0.005). Most groups had a failure score of 1 (<50% of the bonding material adhering to the tooth), whereas groups II and VIII showed a failure score of 0 (no material adhering to the tooth). CONCLUSION: Bond strength can be enhanced by using 0.5% or 1% GT or 0.5% CM to allow bracket bonding immediately after bleaching. CLINICAL SIGNIFICANCE: The use of antioxidants would allow clinicians to bleach teeth before orthodontic treatment without delaying bonding.

Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children.

BACKGROUND: This study aimed to determine the prevalence of sleep-disordered breathing among primary school children in Riyadh, Saudi Arabia, and to evaluate associations between sleep-disordered breathing and respiratory conditions/orofacial symptoms. METHODS: In this cross-sectional study, 1600 questionnaires were distributed to Saudi boys and girls aged 6-12 years from 16 primary schools in Riyadh. The questionnaire covered relevant demographic and personal characteristics, presence of respiratory conditions and orofacial symptoms, and the Pediatric Sleep Questionnaire. The latter was used to assess the prevalence of symptoms of sleep-disordered breathing and was completed by the participating children's parents. RESULTS: In total, 1350 completed questionnaires were returned (85% response rate). The children' mean age was 9.2 ± 1.8 years; 733 (54.3%) were boys and 617 (45.7%) girls. Overall, 21% of children were at high risk of sleep-disordered breathing. The prevalence of snoring was 14.4% and that of sleep apnea 3.4%. Boys were at higher risk of sleep-disordered breathing than girls (P = 0.040). Children with respiratory conditions or orofacial symptoms were at higher risk of sleep-disordered breathing (P < 0.0001) than children without these conditions/symptoms. CONCLUSIONS: Around 21% of Saudi children are at risk of sleep-disordered breathing. There is a strong association between sleep-disordered breathing symptoms and the presence of respiratory conditions or orofacial symptoms.

Correlation between skeletal maturation and developmental stages of canines and third molars among Saudi subjects.

AIMS: The present study was designed to evaluate the efficacy of using the developmental stages of the canines and third molars to predict the timing of skeletal maturity in the Saudi population. MATERIAL AND METHODS: The lateral cephalometric radiographs and orthopantograms of 239 Saudi patients, 106 males and 133 females, aged 9 to 21 years, were collected from several dental centers. Orthopantograms were used to assess the developmental stages of the upper and lower canine teeth and third molars using two popular methods: that of Nolla and that of Demirjian. Cervical vertebral maturation (CVM) stage was assessed on the lateral cephalometric images according to the method of Baccetti et al. Trained observers with no knowledge of patient age or gender performed assessments. Data were analyzed with Spearman's rank correlation coefficient at a significance level of P ≤ .05. RESULT: Skeletal CVM stages III and IV had a stronger correlation with mandibular left canine developmental stage than with maxillary canine developmental stage in the two methods used (correlation with Nolla stage 10 and Demirjian stage H: root completely formed with apex closed), especially for male patients (r = 0.700, P < .001). In contrast, the maxillary third molars at Nolla stages 5 and 7 (crown completed to 1/3 of the root formed) showed an association with CVM stages III and IV (r = 0.540 for females and r = 0.639 for males, P ≤ .001 for both) and with Demirjian stages D, E, and F. Males had slightly higher correlation values than females (r = 0.578 and 0.5010, respectively; P ≤ .001) at CVM stages III and IV. Interestingly, canine teeth showed a stronger correlation than third molars with skeletal maturation in Saudi children. CONCLUSION: Dental developmental stages were highly correlated with CVM stages III and IV among Saudi subjects.

Association of sella turcica bridging with palatal canine impaction in skeletal Class I and Class II.

PURPOSE: Based on the evidence of the embryonic origin of the sella turcica and the teeth, this retrospective study evaluated the association between sella turcica bridging and palatal canine impaction in skeletal Class I and Class II orthodontic patients. METHODS: Sixty-two orthodontic patients with palatally impacted canines and 54 controls with erupted canines (aged 12-25 years) were classified into skeletal Class I and Class II (according to ANB angle and Wits analysis). The length, depth, and diameter of the sella turcica were measured, and the shape was described. The difference in linear dimensions between the study and control groups was calculated using two-way analysis of variance and Student's t-test. The interrelationship of the variables, subject groups, skeletal type, and age, with the linear dimensions of sella turcica, was tested using regression analyses. The association between sella turcica, bridging and palatally impacted canines was determined in skeletal type using a chi-square test. RESULTS: Highly significant differences were found in the length, diameter, and depth of the sella turcica between the study sample and the control (P<0.001, P=0.015, P<0.0001, respectively). There was a highly significant frequency of bridging in cases with palatally impacted canines (P<0.0001). An increasing incidence of bridging was found in subjects with palatally impacted canines and skeletal Class I (P<0.0001) and Class II (P=0.044) relationships. Regression analysis showed that the age was significantly related to a change in length (P=0.025), diameter (P<0.0001), and depth (P<0.0001). The normal sella turcica morphology was present in most subjects (56.4%), and no significant association was found in subjects with palatally impacted canines in terms of the shape of the sella turcica. CONCLUSION: Sella turcica bridging is frequently seen in patients with impacted canines. The findings suggest that careful monitoring of canine eruption is required in patients diagnosed with sella turcica bridging at an early age.

Pharyngeal airway dimensional changes after premolar extraction in skeletal class II and class III orthodontic patients.

OBJECTIVE: To assess and compare the changes in pharyngeal airway space dimensions following orthodontic treatment of skeletal class II and class III facial deformities with premolar extraction. MATERIALS AND METHODS: Sixty pre and posttreatment lateral cephalometric radiographs of patients who underwent fixed orthodontic treatment with premolar extraction were collected. The sample was divided into two groups - 32 patients with skeletal class II and 28 patients with skeletal class III malocclusion. Both groups were subdivided into growing patients (<16 years old) and adults (>16 years old). Nasopharyngeal, palatopharyngeal, and glossopharyngeal airway space dimensions were measured in the pretreatment (T0) and posttreatment (T1) cephalometric radiographs using Dolphin Imaging 11.7 software. Two-way, repeated-measures analysis of variance was used to assess the in-treatment changes. RESULTS: Nasopharyngeal airway dimension showed similar significant increase in class II (P = 0.042) and class III (P = 0.049) patients from T0 to T1, whereas palatopharyngeal and glossopharyngeal dimensions were insignificantly decreased in both groups. However, both malocclusions followed the same pattern of changes in relation to airway dimensions. In addition, no significant statistical difference was found in the airway spaces between growing and adult patients. CONCLUSIONS: Extraction of premolars did not affect the pharyngeal dimensions except those of the nasopharynx, which showed a significant increase after extraction in both groups.

Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh.

OBJECTIVE: To assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices. MATERIALS AND METHODS: This retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13-21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test. RESULTS: Displacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics (P=0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics (P<0.0001). CONCLUSION: Young Saudis receiving free orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics.

Relationship between head posture and anterior-posterior skeletal patterns in a group of female patients.

OBJECTIVE: To evaluate the relationship between head posture and anteroposterior skeletal patterns in female adult patients. METHODS: The study included 75 lateral cephalograms of orthodontic patients in the age range of 18-25 years. The study was conducted from May 2012 to January 2013 at the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. The lateral cephalograms were divided into 3 groups based on the anterior-posterior skeletal relationship angle: skeletal class I, II, and III. Twenty-three craniofacial morphological variables were identified and used. The Kruskal-Wallis and Mann-Whitney U tests were used to determine significant differences among the 3 skeletal classifications. The Spearman correlation coefficient between the cervical lordosis angle and the cervical curvature with the postural variables were estimated. Significance was set at the p<0.05 level. RESULTS: Significant differences were observed in the mandibular plane inclination between class I and II (p<0.04), and between class II and III (p<0.028). Cervical curvature showed a significance difference between class I and II, and between class I and III (p<0.000). In Class I, II, and III the cervical lordosis angle positively correlated with the upper and middle parts of the cervical column. Cervical curvature correlated negatively with the upper part of the cervical column in class I, while positively correlated in class II and III. The class III group showed a more forward head posture, while the class II group showed a greater head extension. CONCLUSION: No clear relationship was found between head posture and the different skeletal patterns, and it does not seem to play a significant role in the development of different anteroposterior skeletal relationships.

Orthognathic surgical norms for a sample of Saudi adults: Hard tissue measurements.

OBJECTIVE: The aim of the study is to establish hard tissue cephalometric norms for orthognathic surgery for a sample of Saudi adults. MATERIALS AND METHODS: Sixty-two lateral cephalometric radiographs for 31 females and 31 males, age range of 22-24 years, were analysed. The mean values of the hard and dental measurements were compared with those of European-American adults using Burstone analysis, as well as comparison between Saudi males and females. RESULTS: Saudi males had an increased cranial base length, the mandible lied more posterior to maxilla, increased mandibular plane angle and backward rotation of the mandible with less prominent chin, shorter maxillary length, and also less proclination of lower incisors compared to those of European Americans. Saudi females had similar cranial base length and shorter maxillary length than European Americans. In both gender; lower anterior and posterior dental heights were smaller when compared with the European-Americans' values. A significant difference between Saudi males and females was found. Saudi males showed longer cranial base length, larger vertical skeletal proportion, increased dental values, longer maxillary and mandibular length than the female group. CONCLUSION: This study may be useful in providing racially specific cephalometric norms for diagnosis and treatment planning for orthognathic surgery for a sample of Saudi adults.

An anterior tooth size comparison in unilateral and bilateral congenitally absent maxillary lateral incisors.

The purpose of this study is to compare the anterior tooth size width in patients with congenitally missing maxillary lateral incisors using the Bolton Index and divine proportion. The study sample consisted of thirty pairs of orthodontic models with unilateral (twelve patients; 7 females, 5 males) and bilateral (eighteen patients; 13 females, 5 males) absence of maxillary lateral incisors. The mean ages of the selected cases were 17.7 and 17.5 years, respectively. Descriptive statistics were used for the data analysis. The result showed the mean of the Bolton Index in cases with bilateral absence was closer to the Bolton mean than in cases with unilateral absence. In the unilateral absence cases the width of the existing lateral incisor (5.5 mm) was an average of 1.00 mm less compared to the standard mean (6.5 mm). The divine proportion showed the maxillary central incisors were small in width as indicated by the adjusted value or they were slightly larger in width than the mandibular central incisors. In cases with unilateral and bilateral absence the Bolton Index exhibited maxillary insufficiency, which was confirmed by evaluating the divine proportion of the maxillary and mandibular incisors. The result of the present study will be of great help to both the orthodontist, whether to open or close the space, and to the prosthodontist to restore the missing teeth of patients having missing maxillary lateral incisors.