Stress distribution and displacement with four different types of MARPE on craniofacial complex: A three-dimensional finite element analysis.

BACKGROUND: Various designs of mini-implants assisted rapid palatal expander (MARPE) appliances can impact treatment effectiveness through their biomechanical effects. The purpose of the study was to study the stress distribution and displacement with four different designs of the MARPE appliance on the craniofacial complex. METHODS: A 3D finite element model of the craniofacial complex was created from CBCT DICOM data, comprising four distinct groups. Each group consisted of one 4-hole expansion screw positioned between the second premolar and first molar in all models. Group 1 used four single-cortical mini-implants (1.5×8mm) engaging only the palatal cortex. Group 2 employed four mini-implants (1.5×11mm) engaging both the palatal and nasal cortices. Group 3 had monocortical implants on the palatal slopes, while Group 4 was similar to group 3 with implants in the acrylic wings. Comparisons between groups were made for anchorage (groups 1 and 2), mini-implant position (groups 1 and 3) and surface effect (groups 3 and 4). Von Mises stresses and displacements at various skeletal and dental points were evaluated using ANSYS software. RESULTS: The highest stresses were observed in the maxillary, pterygoid and zygomatic bones, as well as in the mid- palatal suture in all four groups. Downward and forward rotation of the craniofacial complex was noted. Group 2 showed greater skeletal expansion than group 1. Among groups 1 and 3, group 3 showed a better stress distribution. Group 4 showed less dentoalveolar rotation than group 3. CONCLUSIONS: The MARPE appliances had an impact on the craniofacial complex with stresses on the mid-palatal suture, maxillary bone, pterygoid bones and anterior teeth. Clockwise rotation of the maxilla, zygomatic bones and dentition was noted, while the pterygoid bones and pterygoid suture were displaced backwards. MARPE with bicortical anchorage produces better skeletal expansion. Placing implants on the palatal slopes with acrylic wings results in better skeletal expansion with less clockwise rotation of the dentition.

Association, diagnostic accuracy and optimal threshold of salivary IGF-1 and vitamin DBP levels for estimation of pubertal growth spurt: A cross sectional study.

AIM: To determine the association of salivary IGF-1 and vitamin D Binding Protein with cervical vertebral maturation index (CVMI) across the pubertal stages and to determine the diagnostic accuracy and optimal threshold of these biomarkers for estimation of pubertal growth. DESIGN: Cross-sectional observational study. SETTING: Material and methods. All patients in the age group of 8-23 years from the Outpatient Department of Orthodontics and Dentofacial orthopaedics, between the period of July 2020 to December 2020 meeting the eligibility criteria were included. Lateral cephalograms obtained from the patients were divided into pre pubertal, pubertal & post pubertal groups based on CVMI by Baccetti et al. Unstimulated whole saliva was collected by a swab-based method & analyzed with ELISA. RESULTS: Ninety-four participants were divided in three stages: prebubertal (30), pubertal (33), post pubertal (31). A significant difference was observed in the salivary IGF-1 & DBP across the three stages. Post-hoc test revealed significantly higher mean salivary IGF-1 & DBP in pubertal group than in pre & post-pubertal group. Receiver operator characteristic curve revealed excellent diagnostic accuracy for salivary IGF-1with areas under the curve (AUC) of 0.962, satisfactory for vitamin DBP with AUC of 0.831 and poor diagnostic accuracy for age with AUC of 0.536. Youden index revealed the optimal threshold to be 3.96ng/ml and 124.13pg/ml for salivary IGF-1 and vitamin DBP respectively. CONCLUSION: The levels of Salivary IGF-1 and Vitamin DBP increased during C3 and C4 stages. Compared to vitamin DBP diagnostic accuracy of salivary IGF-1 was excellent and an optimal threshold of 3.96ng/ml can be utilized to distinguish pubertal & non-pubertal participants.

Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis.

INTRODUCTION: The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. OBJECTIVE: This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. METHODS: A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. RESULTS: The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. CONCLUSIONS: The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.

Serum biomarkers associated with radiographic skeletal maturity indicators: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the relevant scientific literature to determine the association between different serum biomarker levels and radiographic skeletal maturity indicators. DATA SEARCH, SCREENING AND ELIGIBILITY: A literature search was carried out on PubMed, Cochrane Library, Google Scholar, Semantic Scholar, Science Direct and Opengrey.eu up to November 2021 and 7466 records were retrieved via the electronic search. Study selection, data extraction and subsequent risk of bias assessment (RoB) was carried out independently by two authors. In case of any discrepancy, a third author was consulted. RESULTS: After the exclusion of duplicates and the application of inclusion exclusion criteria, 19 studies (published in 25 articles) were included in the systematic review out of which 17 had a cross-sectional and two had a cohort study design. For the meta-analysis, based on the homogeneity, five cross-sectional studies measuring serum IGF-1 levels were incorporated. The meta-analysis revealed that the serum IGF-1 levels peak at the CS4 stage (401.77 ng/mL [333.50 - 470.05]) in the pooled group. However, in the subgroup analysis, it was found that the serum IGF-1 levels peak at CS3 in girls (422.82 ng/mL [377.46-468.18]) and CS4 in boys (487.04 ng/mL [391.83-582.25]). CONCLUSION: Among the various biomarkers evaluated, serum IGF-1 was the most associated with different stages of radiographic skeletal maturity indicators with its levels peaking at CS3 in girls and CS4 in boys.

Psychosocial Maternal Perception of the Outcome of Pre Surgical Infant Orthopedics in Infants Born with Cleft Lip and Palate.

BACKGROUND: The setback of having a child with cleft lip and palate deeply affects the parents psychology. The Pre Surgical Infant Orthopaedics(PSIO) is a promising procedure for improvement in facial morphology prior to primary lip repair. OBJECTIVE: The current study examines the perception of effects of PSIO procedures on the facial appearance of newborns with cleft lip/palate by their mothers and finds its correlation if any, with the change in psychosocial status of the mothers. STUDY DESIGN: The mothers of 50 infants(0-6 months) born with cleft lip/palate rated the nasal morphology, extent of cleft defect and overall facial morphology on a Likert's scale before and after PSIO procedure. This was correlated with changes in mother's depression, anxiety and stress levels by using the validated Hindi-version of Depression Anxiety and Stress scale(DASS-42) index before and after PSIO. RESULTS: The mothers reported a significant improvement in all the morphological parameters for their infants with PSIO which correlated well with significant reduction in the DASS scores from 22.54(severe) to 7.10(normal) for depression, 20.64(extremely severe) to 6.46(normal) for anxiety and 24.7(severe) to 8.4(normal) for stress. CONCLUSIONS: The changes in facial morphology by PSIO procedures are well perceived by mothers and significantly improves their depression, anxiety and stress levels.

Impact of photobiomodulation on external root resorption during orthodontic tooth movement in humans - A systematic review and meta-analysis.

Background: Photobiomodulation has been gaining traction as a plausible therapy to control orthodontically induced root resorption. Aim: The aim of the present review was to systematically appraise randomized controlled trials conducted to study the influence of photobiomodulation on external root resorption during orthodontic movement in humans. Method: ology - A systematic search was carried out employing keywords in various electronic databases namely MEDLINE (Pubmed), Cochrane Library, Google Scholar, Semantic Scholar, ScienceDirect and Opengrey.eu for studies up to March 2020. Pre-defined inclusion and exclusion criteria were used to select the studies. Data extraction was carried out and the risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analysis was conducted using random effects model for selected studies. Subgroup analysis was conducted for resorption on each axial surface of the tooth root viz. mesial, buccal, distal and palatal as well as for vertical thirds viz. cervical, middle and apical third. Summary of Findings was formulated according to GRADE Profile. Results: The search retrieved 1509 results out of which six studies were included for the systematic review. Two studies showed low overall risk of bias and the remaining four showed unclear risk of bias. The meta-analysis was conducted for three studies with an overall sample size of 120 teeth which showed a pooled mean difference of 0.08 (95% CI 0.15 - (-0.02) to 1.96, p=<0.0001) in favour of photobiomodulation group with respect to mean total resorption per tooth. I2 index revealed 88% heterogeneity. Conclusion: It is concluded that there is moderate grade of evidence to suggest beneficial effect of photobiomodulation on root resorption. Further high-quality randomized controlled trials with standardized intervention parameters are recommended. Registration: PROSPERO registration number - CRD42020167291.

Comprehensive management of Crouzon syndrome: A case report with three-year follow-up.

Crouzon syndrome is one of the most common craniosynostosis facial syndromes caused by a mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Less commonly, there is a mutation of the FGFR3 gene which results in Crouzon syndrome syndrome with acanthosis nigricans. It involves the premature fusion of sutures of the cranial vault, base, orbital and maxillary region. The clinical presentation of this congenital deformity depends on the pattern and timing of sutural fusion. The present report describes the features and management of this syndrome in an 18-year-old woman. The patient presented with a hypoplastic maxilla, deficient midface, exorbitism due to shallow orbits, severe crowding and bilateral crossbite. A multidisciplinary approach involving orthodontics and surgical intervention with distraction osteogenesis brought about marked improvement in the facial profile, occlusion and upper airway. The aesthetics and function were greatly enhanced, and the results were found to be stable at the end of three years.

Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis

ABSTRACT Introduction: The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. Objective: This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. Methods: A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. Results: The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. Conclusions: The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.

RESUMO Introdução: A protração maxilar com ancoragem esquelética intrabucal (I-SAMP) tem sido considerada um tratamento efetivo para a má oclusão esquelética de Classe III. Objetivo: O presente estudo in silico avaliou, usando análise de elementos finitos, a influência de diferentes direções da força dos elásticos Classe III com ancoragem esquelética intrabucal nas mudanças no complexo craniomaxilofacial. Métodos: Um modelo de elementos finitos tridimensional (3D) dos ossos craniomaxilofaciais, incluindo as suturas circum-maxilares, foi construído, com alta semelhança biológica. Uma montagem 3D de quatro miniplacas foi projetada e fixada na maxila e na mandíbula do modelo de elementos finitos. O modelo foi aplicado com o uso de 250g/força nas miniplacas em três angulações (10°, 20° e 30°) em relação ao plano oclusal, para medir as tensões e os deslocamentos, usando o programa ANSYS. Resultados: As suturas zigomaticotemporal, zigomaticomaxilar e esfenozigomática desempenharam um papel significativo no deslocamento para anterior e na rotação anti-horária da maxila e do zigoma, independentemente da angulação na aplicação da força. Os deslocamentos e as rotações do complexo zigomático-maxilar diminuíram gradualmente com o aumento de 10° para 30° no ângulo de aplicação da força entre as miniplacas. A mandíbula apresentou deslocamento irrelevante, com rotação no sentido horário. Conclusões: Os efeitos do tratamento com I-SAMP foram corroborados, com um vislumbre dos padrões de deslocamento e das suturas envolvidas, que não existiam nos estudos com imagens 2D e 3D realizados anteriormente. A angulação dos elásticos Classe III ancorados esqueleticamente deve ser a menor possível, visto que o deslocamento do complexo zigomático-maxilar aumenta com a redução no ângulo dos elásticos.

Biomechanical effects of Skeletally anchored Class III elastics on the maxillofacial complex: a 3D finite element analysis.

BACKGROUND: Although, the outcomes and changes in the maxillofacial complex after the application of intraoral bone anchored Class III elastics, have been reported by multiple clinical studies, there was no finite element study to assess and evaluate the stress pattern and displacement on maxillomandibular complex with bimaxillary anchorage. The present study aims to evaluate the biomechanical effects on maxillomandibular complex of Skeletally anchored Class III elastics with varying angulations using the 3D finite element analysis. METHODOLOGY: Two 3-dimensional analytical models were developed using the Mimics 8.11 (Materialise: Leuven, Belgium) and ANSYS software Version 12.1 (ANSYS Inc, Canonsburg, PA, USA) from sequential computed tomography images taken from a Skeletal Class III subject. The models were meshed into 465,091 tetrahedral elements and 101,247 nodes. Intraoral mechanics for skeletally anchored maxillary protraction (I-SAMP) were applied on two models i.e. A and B (without and with maxillary expansion respectively) between miniplates on maxilla and mandible on both right and left sides with three different angulations of forces-10°, 20° and 30°). RESULTS: Although the craniomaxillary complex in both the models (A and B) displaced forward while demonstrating rotations in opposite directions, the displacements and rotations decreased gradually with the increase of the angle of load application from 10° to 30°. The mandible rotated clockwise in both the simulations, but the displacement of mandibular surface landmarks was higher in Simulation A. However, the antero-inferior displacement of the glenoid fossa was higher in Simulation B than in A. CONCLUSION: Significant displacement of maxillofacial sutures and structures was witnessed with I-SAMP with maxillary expansion and Class III elastics for correction of Skeletal Class III with maxillary retrognathism. Thus, I-SAMP with maxillary expansion is a desired protocol for treatment of maxillary retrognathism. However, the prescribed angulation of the Class III elastics should be as low as possible to maximise the desired effects.

Clinico-Histological Evaluation of Dentino-Pulpal Complex of Direct Pulp Capping Agents: A Clinical Study.

INTRODUCTION: Direct pulp capping treatment (DPC) maintains pulp vitality by promoting healing or repair in dentistry, which can be attributed to the advent of bioceramic materials. AIM: This examination looked to evaluate the clinical and histological effectuality of Biodentine with Dycal for DPC. MATERIALS AND METHODOLOGY: In this study, 30 intact human orthodontic teeth undergoing therapeutic extraction were chosen to perform DPC. They were arbitrarily divided into two groups (n = 15) and DPC with Biodentine and Dycal was performed. Composite resin was used as permanent restoration. After a period of 1 and 6 weeks, clinical as well as electric pulp tests were carried out. Asymptomatic patients were re-called after 6 weeks; follow-up radiograph was taken. Electric pulp testing and thermal testing was done to check the pulpal status of the teeth. This was followed by atraumatic extraction, and the teeth were sent for histological examination. SPSS Version 21.0. Armonk, NY: IBM Corp.was used for data analysis. RESULTS: There was no pain and sensitivity in using Biodentine. Whereas, sensitivity and pain was noted when Dycal was used. The dentinal bridge was better with Biodentine when compared with Dycal. CONCLUSION: In accordance with the obtained results, it was concluded that on clinical and histological evaluation, Biodentine performed better as DPC agent. Subsequently, Biodentine is more dependable for the long-haul protection of dental pulp than Dycal.

Closure of large alveolar defect by maxillary alveolar distraction using a vector-controlled distractor appliance in cleft patients: A pilot study.

OBJECTIVE: To assess the treatment outcome of custom made maxillary transport distractor appliance for closure of large alveolar clefts. METHOD: A pilot study was conducted on 12 large alveolar cleft defects present in 11 non-syndromic cleft lip and palate patients (1 bilateral and 10 unilateral) in the age group of 16-25 years. All the subjects underwent pre-surgical orthodontics followed by alveolar distraction using custom-made distractor appliance. Study models, lateral cephalogram, panoramic radiograph and cone beam computed tomograms were obtained pre-surgically (T0) and after distractor removal (T1). The reduction in the width and volume of the alveolar cleft defect and change in the mesiodistal axial inclination of the teeth in transport segment following distraction were recorded. P value â€‹< â€‹0.05 was considered statistically significant. RESULTS: Significant reduction in cleft width (9.18 â€‹mm), volume (89.82 â€‹mm3) and the change in the mesiodistal axial inclination of the teeth in the transport segment (3.05°) (P â€‹< â€‹0.05) were observed. SNA (1.75°), ANB (1.58°), maxillary length (1.58 â€‹mm), upper incisor inclination (3°) and distal movement of anchorage teeth (0.95 â€‹mm) also showed significant change (P â€‹< â€‹0.05). CONCLUSION: The custom-made tooth borne distraction appliance successfully closed the large alveolar cleft defect with minimal or no inadvertent effects on the oral tissues.

Effect of photobiomodulation on external root resorption during orthodontic tooth movement - a randomized controlled trial.

OBJECTIVE: The objective of the study was to compare external root resorption during orthodontic tooth movement between patients who were subjected to photobiomodulation and those who were not. MATERIALS AND METHODS: The study was designed as a split-mouth, single-blind randomized controlled trial conducted on twenty-two orthodontic patients requiring extraction of maxillary first premolars (age group 13-30years). A buccal force was applied to all the premolars using a 0.019″×0.025″ beta-titanium cantilever spring for 28days. The test group premolars were irradiated by indium-gallium-arsenide (InGaAs) diode laser (980nm, 100mW) 0, 3, 7, 11, 15 and 28days after force application. Each premolar was irradiated at ten locations on the buccal and palatal gingiva resulting in a total energy of 10J delivered per tooth. After 28days, the root surface of all the premolars were studied for the number and volume of resorption craters using three-dimensional optical profilometry by a blinded assessor. One-sample Kolmogorov-Smirnov test was used to ascertain normality and Mann-Whitney U test was applied for data analysis. RESULTS: All twenty-two patients enrolled completed the study. The root surface analysis showed formation of 32.78% less number of resorption craters (P<0.05) and 39.49% less volume of resorption craters (P<0.05) in the test group premolars relative to the control group premolars. CONCLUSIONS: The results of the present study, therefore, suggest that photobiomodulation reduces external root resorption during orthodontic tooth movement. TRIAL REGISTRATION/REGISTRATION NUMBER: CTRI/2018/04/013520.

Effect of fixed mechanotherapy on psychosocial impact of malocclusion using PIDAQ in the Indian population - A follow up study.

BACKGROUND: The presence of malocclusion in an individual not only distresses the oral form and function but also has a significant impact on the psychological and social well-being of an individual. Adoption of a patient centered approach during the correction of malocclusion serves to benefit both the individual and the orthodontic fraternity, as it aims to improve the function, aesthetics and subsequently, the overall quality of life. MATERIALS AND METHODS: In this study, the psychosocial impact of malocclusion was evaluated on 93 patients using the IOTN (Index of Orthodontic Treatment Needs) and the PIDAQ (Psychosocial impact of dental aesthetics questionnaire) indices. The questionnaires were paired accordingly and statistically analysed. Association of the age and gender with the psychosocial impact of malocclusion was also assessed. RESULTS: Mean total and the individual component scores of the PIDAQ were assessed pre and post treatment and a significant reduction in the scores was observed. The IOTN-AC (IOTN - Aesthetic Component) scores also improved drastically with treatment. However, no statistically significant association of age, education level or socioeconomic class with the psychosocial impact of malocclusion was observed. CONCLUSION: The significant improvement in the mean PIDAQ and IOTN-AC scores obtained after completion of fixed orthodontic treatment, indicate the high initial psychosocial impact of malocclusion which significantly reduced with treatment, accenting the role of orthodontics in improving the overall psychological and social well-being of an individual.

External apical root resorption in orthodontic patients: molecular and genetic basis.

External apical root resorption is one of the most deleterious complications after orthodontic treatment. Studies to explain the causal relationship between orthodontic tooth movement and external apical root resorption have been inconclusive till date. Individual variations in external apical root resorption sometimes overshadow the treatment related factors which indicate genetic predisposition and/or multifactorial etiology. Mechanism of root resorption is not completely understood. Inflammatory root resorption induced by orthodontic treatment is a part of process of elimination of hyaline zone. An imbalance between bone resorption and deposition may contribute to root resorption by the cementoclasts/osteoclasts. This narrative review article explains the molecular pathway involved in external apical root resorption and also role of various genes involved at different level. It also reviews the literature published during the past 20 years concerning the association studies linking EARR to genetic polymorphisms. This literature review provides an insight into genetic predisposition of external apical root resorption that can be used in orthodontic practice to enable 'high-risk' subjects to be identified on the basis of their genetic information before orthodontic treatment is initiated.

A review of genetics of nasal development and morphological variation.

The nose is central in the determination of facial esthetics. The variations in its structural characteristics greatly influence the ultimate dentoskeletal positioning at the end of an orthodontic therapy. A careful insight into its developmental etiology will greatly aid the health care professional in identifying patient's real concern about the facial appearance. This in turn will aid in the fabrication of a better treatment plan regarding the end placement goals for the teeth and jaws in all the three dimensions of space. However, this important structure is often missed as a part of the diagnostic and treatment planning regime owing to the lack of meticulous understanding of its developmental etiology by the orthodontists. The development of the nose in the embryo occurs in pre skeletal and skeletal phases by a well-coordinated and regulated interaction of multiple signaling cascades with the crucial importance of each factor in the entire mechanism. The five key factors, which control frontonasal development are sonic hedgehog (SHH), fibroblast growth factors (FGF), transforming growth factor ß (TGFß), wingless (WNT) proteins, and bone morphogenetic protein (BMP). The recent evidence suggests the association of various nasal dimensions and their related syndromes with multiple genes. The revelation of nasal genetic makeup in totality will aid in ascertaining the direction of growth, which will govern our orthodontic treatment results and will also act as a harbinger for potential genetic editing and tissue engineering. This article describes at length the morphological and genetic aspect of nasal growth and development in light of the gender and racial variability along with the emphasis on the importance of knowing these nasal features with regard to diagnosis and treatment planning in orthodontics.

Different approaches for management of Class III siblings: A long-term follow-up of two case reports.

Class III malocclusion can be varied in presentation and progression. This report describes the presentation, course of treatment and long-term follow-up of two siblings with Class III malocclusion. Two cases discussed in this report were different in their presentation. Sibling 1, a 19-year-old male patient had developed skeletal Class III malocclusion with severe maxillomandibular discrepancy, showing both components of maxillary hypoplasia and mandibular prognathism & asymmetry with average growth pattern. Sibling 2, a 13-year-old male patient had developed a Class III malocclusion with maxillary retrognathism with vertical growth pattern. An insight into the similarities and dissimilarities in the presentation, course of treatment and long-term follow-up of the two cases is provided. The two cases were successfully managed with entirely different treatment approaches. Sibling 1 underwent maxillary advancement with Le Fort I surgery and mandibular set back and rotation with bilateral sagittal split osteotomy which was preceded by pre-surgical orthodontic treatment with extraction of upper first premolars for orthodontic decompensation. Sibling 2 was treated with skeletally anchored facemask therapy followed by fixed mechanotherapy. Acceptable clinical outcome with long-term stability of the treatment results was observed in the two siblings. Orthognathic surgery may be completely avoided later if early orthopaedic treatment to advance the maxilla is initiated at an appropriate age.

Comparison of Dentoskeletal Changes, Esthetic, and Functional Efficacy of Conventional and Novel Esthetic Twin Block Appliances among Class II Growing Patients: A Pilot Study.

OBJECTIVE: A twin block appliance used for correction of skeletal Class II malocclusion suffers from undesirable dental effects and bulkiness. To overcome these limitations and the need for more esthetic appearance of this appliance, an esthetic twin block was designed and used in patients. This study aimed to compare dentoskeletal changes and esthetic and functional efficacy in patients treated with conventional and newly designed esthetic twin block (CTB and ETB) appliances using cephalometric measurements and a questionnaire. METHODS: A pilot study with a 2-arm parallel-randomized double-blind clinical trial was conducted on 24 patients (20 males, 4 females) in the age group of 11-13 years. Subjects were treated with CTB (group 1 [G1]: n=12; mean age=11.67±0.49 years) and ETB (group 2 [G2]: n=12; mean age=11.75±0.62 years) appliances. A modified Pancherz analysis was performed to evaluate skeletal and dental changes. The esthetic and functional efficacy was evaluated by a questionnaire using Likert scale. Wilcoxon and Mann-Whitney U tests were employed for intra and intergroup comparisons respectively (p<0.05). RESULTS: In G1, a significant increase in lower incisor inclination was observed (p<0.05) whereas it was insignificant in G2. The changes were predominantly skeletal in G2 whereas they were both skeletal and dental in G1. ETB was found to be esthetically and functionally acceptable in all the patients while CTB patients were esthetically conscious, lacked confidence and had discomfort and difficulty in eating, chewing and speaking. CONCLUSION: ETB had greater skeletal effects with a reduced tendency of lower incisor proclination, was esthetically acceptable, and functionally more comfortable than the CTB.