Perceived Occupational Stress and Its Psychosocial Predictors Among Indian Orthodontists.

BACKGROUND: Orthodontists, like any other medical professional, are susceptible to cumulative stressors and their undesirable consequences. The study aims to assess the self-perceived occupational stress levels and the psychological link between predictors and stress among orthodontic practitioners in India. MATERIALS AND METHODS: The participants in this cross-sectional study are active members of the Indian Orthodontic Society (IOS). The data for the survey were collected by a previously validated closed-ended occupational stress assessment (OSA) questionnaire and a job satisfaction questionnaire, which were sent through the registered e-mails. A five-point Likert scale was used to assess the severity of individual stressors, and an overall severity score was obtained by summing up the individual scores. The predictors of stress based on socio-demographic parameters were assessed using a binomial multiple logistic equation. Statistical significance was set at a p-value of <0.05. RESULTS: A total of 311 responses were received. Male orthodontists, unmarried, in the age group of 30-40 years, working in urban areas without any academic attachment were more stressed compared to the other groups in the respective categories. Tiredness/headache (39%) was reported as the most common consequence of occupational stress. The most concerning stressor was patients not wearing retainers. Orthodontists showed overall job satisfaction that is negatively correlated to overall stress (p <0.0001)(r = -0.260). CONCLUSION: A profound variation in stress levels was found among the orthodontists with their socio-demographic and professional characteristics. Despite the stress, orthodontists were highly satisfied with their careers.

Separation effect, pain perception during functional activity and gingival inflammation of elastomeric and Kansal separators-a split mouth study.

INTRODUCTION: An effective space opening for band placement with minimal pain and gingival inflammation is a prime requisite during fixed orthodontic procedures. The study aimed to compare the effectiveness of two types of separators, elastomeric and Kansal, in the amount of space opening, pain perception elicited, and gingival inflammation. METHODS: A random split-mouth study was designed with 30 subjects undergoing fixed orthodontic treatment. Two different separators (Elastomer and Kansal) were placed alternatively on the left and right sides around the mesial and distal sides of the first molars in the mandibular arch of each subject. After 3 days, the amount of separation after 3 days was assessed with a leaf gauge on both mesial and distal sides. The subjective pain perception by visual analog Scale (VAS) at different points and during different functions for each of the 3 days was evaluated. A self-filled chart was utilized to be performed by the patients. Gingival index was used to assess the inflammatory changes. RESULTS: The most significant amount of separation (0.28 mm) was found with elastomers on the mesial side and is statistically significant (p < 0.001) compared to the mesial side (0.18 mm). The Kansal separators produced equivalent separation on mesial (0.19 mm) and distal sites (0.17 mm). The highest pain score was found after 24 h with elastomeric separators (median-40) for chewing and biting and the least for sleep (median-30). There is a statistical difference of pain perception between elastomers and Kansal separators at different points for the given function (p < 0.001). Both the separators resulted in mild gingival index of score less than 1 (0.70 ± 0.65, 0.97 ± 0.720, and there was no statistically significant difference between the two types of separators. CONCLUSION: Both the separators produced adequate separation after a minimum 3 days. Kansal produces minimum discomfort and pain compared to elastomeric separators. Mild gingival inflammation was observed with both the separators.

Effects of anterior maxillary distraction compared to LeFort-1 osteotomy and total maxillary distraction osteogenesis for treating hypoplastic maxilla in patients with cleft lip and palate- A systematic review and meta-analysis.

OBJECTIVE: To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis (TMDO) to treat cleft maxillary hypoplasia. METHODS: (PROSPERO CRD42020223345) Thorough electronic search of seven databases, unpublished gray literature, and a hand search of the relevant studies reference lists was done. Studies assessing mid-facial skeletal, dentoalveolar, and soft-tissue outcomes of AMD in patients >8 years of age, hypoplastic cleft maxilla, and with either TMDO/LeFort 1/ both as control groups were included. Seven included articles were assessed for the study characteristics and qualitative synthesis. Three studies were analyzed quantitatively using the RevMan 5.4 software. The quality of studies was assessed using Cochrane ROB2 and the overall certainty of evidence using GRADE. RESULTS: AMD was performed in 241 subjects, LeFort 1 in 145 subjects, and TMDO in 42 subjects. Maxillary advancement for AMD and LeFort 1 groups showed no statistically significant difference (Mean Difference, MD -0.64°) while TMDO showed statistically significant advancement than AMD (MD -1.44°). Statistically significant upward rotation of anterior maxilla was noted with AMD (MD -6.15 degrees) than Lefort 1. Upper incisor inclination improved in both AMD and TMDO groups (MD 1.5°). Improvement in the maxilla-mandibular relationship, convexity of face, lip and nose, and marked dentoalveolar changes in overjet and upper incisor position were noted in all the three groups. Discernible airway alterations were noted in LeFort 1 and TMDOs. Total relapse was the least with AMD. CONCLUSION: Distraction osteogenesis exhibited better dento-skeletal outcomes and minor skeletal relapse than LeFort 1. TMDO is a preferred modality in treating severe maxillary hypoplasia associated with CLP than AMD. Further long-term prospective comparative studies are required, possibly involving the patient-centric merits.

Evaluation of Antimicrobial Properties and Shear Bond Strength of Conventional Orthodontic Adhesive Modified With Calotropis gigantea Nanoparticles: An In Vitro Study.

INTRODUCTION: Bonding of brackets with adhesives during orthodontic fixed appliance therapy is associated with white spot lesions (WSLs). An adhesive developed with an antimicrobial property is advantageous to prevent decalcification of the enamel surface. The current study assesses the antimicrobial and shear bond strength (SBS) characteristics of an experimental conventional orthodontic adhesive incorporated with different concentrations of nanoparticles (NPs) prepared from the leaves of Calotropis gigantea and compares them with non-admixed conventional adhesive. MATERIALS AND METHODS: A total of 40 premolar teeth therapeutically extracted for orthodontic purposes were randomly assigned to four equal groups of n = 10 each. In control Group I, unmodified conventional adhesive was used to bond the brackets. In the three experimental groups, Group II, Group III, and Group IV, the brackets were bonded with modified conventional adhesive admixed with the C. gigantea NPs in concentrations of 1%, 5%, and 10%, respectively. The agar well diffusion test and the disc agar diffusion (DAD) test were utilized for assessing the anti-microbial activity of the composite discs. The SBS of the groups was determined by a universal testing machine. STATISTICAL ANALYSIS: A one-way ANOVA and Tukey's honestly significant difference (HSD) post-hoc test was used to analyze the difference in shear bond strength and microbial inhibition zone diameter between the groups with a probability (p) value of equal to or less than 0.05 as statistical significance. RESULTS: The mean SBS for Group I without nanoparticles is 6.99±0.75 MPa. The SBS value decreased inversely in proportion to the concentration of NPs: Group II (1% NP) 6.29±0.67 MPa; Group III (5% NP) 4.40±0.47 MPa; and Group IV (10% NP) 1.98±0.21 MPa, which is statistically significant (p < 0.001). The incorporation of C. gigantea NPs resulted in a decrease in the actual microbial potency of the conventional adhesive. CONCLUSION: Isolated C. gigantea NPs, when used alone, proved to have antimicrobial efficacy, but orthodontic adhesives admixed with C. gigantea NPs showed no additive effect, and SBS values decreased with increased concentrations of NPs.

A Comparative Evaluation of Enamel Surface Roughness of Two Different Bonding Adhesives After Debonding With Atomic Force Microscopy.

Introduction The debonding procedures should restore the enamel surface to its pre-treatment state as much as possible after removing orthodontic attachments and all remaining adhesive remnants from the surface of the tooth. The orthodontic attachments are bonded commonly by a light-cured composite system. Light-cured glass ionomer cement has been developed as an alternative to the composite as a bonding agent for orthodontic brackets. There are different methods for cleaning the residual adhesive after the removal of orthodontic attachments. The study aims to evaluate and compare the enamel surface roughness of teeth between two different adhesive systems - light cure composite and glass ionomer cement adhesives - after debonding followed by the removal of resin remnants with a tungsten carbide (TC) bur. A null hypothesis is proposed that there exists no difference in the enamel surface roughness between the two adhesive systems. Materials and methods The test sample of 40 freshly extracted human premolar teeth (n = 40) for orthodontic purposes was taken up for this in vitro study based on the inclusion and exclusion criteria. The sample was randomly assigned into two equal groups, with metal brackets bonded in Group-I (n = 20) by light cure adhesive (Trans bond XT, 3M Unitek, Monrovia, CA) and Group-II (n = 20) with light glass ionomer cement (GC Fuji Ortho LC, Tokyo, Japan). All samples were stored in water at room temperature for 24 h and brackets were debonded with a debonding plier. The removal of cement adhesive remnants was performed with a TC bur with a low-speed handpiece. The three surface roughness parameters, average roughness (Ra), root mean square roughness (Rq), and maximum roughness depth (Rmax), were measured at T1 (before bonding) and at T2 (after debonding and finishing) and the values were compared. The mode of bond failure was assessed by a modified adhesive remnant index (ARI) and the time required for the clean-up of adhesive was also noted.  Statistical analysis The continuous quantitative data were statistically analyzed using SPSS Statistics v. 25.0 (IBM Corp., Armonk, NY). Student's independent t-test/independent-samples t-test is an inferential statistical test for analyzing the difference between the two groups. Paired t-test was used for comparison within the group. The ARI between the groups was analyzed by a chi-square test. The probability (p) value for statistical significance was 0.05 or less for the difference between any two groups for all the analytical tests. Results A comparison of enamel surface roughness before bonding and after debonding for both groups revealed that there was a statistically significant difference within each group. The surface roughness values of composite resin - Ra (98.75 ± 0.96), Rq (120.38 ± 1.06), Rmax (650.14 ± 1.12) - and glass ionomer cement group - Ra (98.75 ± 0.96), Rq (62.76 ± 1.32), Rmax (434.36 ± 1.60) - show that there was a statistically significant difference between the groups with p <0.01. Conclusion There was a significant increase in the surface roughness of enamel after debonding of brackets and finishing with a TC bur with both the light cure and the glass ionomer cement adhesive systems. The light cure group showed more enamel surface roughness when compared to the glass ionomer cement group. In this study, the null hypothesis was rejected as there is a significant difference between the groups tested.

Orthodontic pain control following arch wire placement; a comparison between pre-emptive tenoxicam and chewing gum: a randomized clinical trial.

Background: Pain during fixed orthodontic treatment can have a detrimental effect on patient treatment compliance. To overcome this, there is a definite need to establish the best pain-relieving methods suitable for orthodontic patients in terms of efficacy and use. The objective of this study was to compare the effect of chewing gum and pre-emptive tenoxicam on pain after initial archwire placement and to evaluate the pain perceptions of orthodontic patients in the two groups while performing various functions at specific time intervals. Methods: Forty-two patients were selected and randomly divided into two groups: group A (chewing gum) and group B (pre-emptive tenoxicam). Pain perception was documented by patients immediately; at 4 h; at bedtime on the day of archwire placement; the next morning; at 24 h; and at bedtime on the 2nd, 3rd, and 7th day after the initial archwire placement. Pain scores were noted during fitting of the posterior teeth, biting, and chewing using a visual analog scale. The data obtained were subjected to statistical analysis. Results: Group A showed a significant increase in pain until the next morning while fitting the posterior teeth, biting, and chewing [36.2, 52.0, 33.4, respectively]], followed by a gradual decrease by the 7th day. Group B showed a significant increase in pain at bedtime on biting, with a peak value of 47.5. Pain on chewing, fitting posterior teeth, peaked the morning of the next day (100.0, 45.0). The Freidman test showed a statistically significant difference with a p-value of < 0.01. Higher pain scores were observed while chewing and biting compared with that while fitting the posterior teeth in both groups. The overall comparison of pain control between the two groups was not statistically significant [P > 0.05] between the two groups. Conclusions: Chewing gum was not inferior to pre-emptive tenoxicam. Thus, chewing gum is a non-pharmacological alternative to analgesics for orthodontic pain control that eliminates the chance of adverse reactions and can be used in the absence of adult observation.

An Extensive Comparison of the Clinical Efficiency of Acidulated Phosphate Fluoride (APF) and Neutral Sodium Fluoride (NaF) Oral Rinses in the Prevention of White Spot Lesions during Fixed Orthodontic Treatment: A Randomized Controlled Trial.

Background: The purpose of this randomized trial is to compare the efficacy of weekly once regime of neutral sodium fluoride (NaF) oral rinse with that of acidulated phosphate (APF) formulated daily mouth rinse in the reduction of white spot lesions (WSLs) associated with fixed orthodontic appliance treatment. Methods: The participants (n = 90) of this single-center, two-arm parallel study without a control group were randomly assigned with 1 : 1 distribution to each of the two groups after the bonding of brackets. Group A/test group 1 (n = 45) was given weekly rinse of neutral sodium fluoride (Colgate® PreviDent® Dental Rinse-0.2% NaF), and for group B/test group 2 (n = 45), an APF formulated daily oral rinse (Colgate® Ortho Defense@ PhosFlur® Rinse-0.044% w/v of NaF) was given for six months. The outcome was assessed by the International Caries Detection and Assessment System (ICDAS) index for scoring the demineralization, and for scoring gingivitis, Loe and Silness gingival index (GI) was utilized. Four different time points "T0"immediately before bonding procedures, "T1" after 4weeks, "T2" after 12 weeks, and "T3" after 24 weeks were taken to assess the ICDAS and GI scores. Results: The mean ICDAS scores for group A (NaF) were 0.025, 0.051, 0.093, and 0.113 and for group B (APF) were 0.014, 0.022, 0.038, and 0.015 at different points of time. The GI scores for group A were 0.008, 0.22, 0.33, and 0.38 and for group B were 0.003, 0.136, 0.181, and 0.097 at different time points. There was a statistically significant difference (p < 0.05) for both groups in terms of reducing WSL and GI. Conclusion: APF formulated daily oral rinse-0.044% w/v of NaF-is more effective than the weekly once regimen of 0.2% NaF oral rinse to prevent white spot lesions.

Sagittal Positional Changes of the Mandible Following Alignment and Levelling of Class II Division 2 Cases: An Observational Study in Decelerating Stages of Adolescent Growth Spurt.

Introduction The objective of this observational study is to compare the dental and skeletal changes that occur following the release of incisor locking in class II division 2 patients in the decelerating phase of the adolescent growth spurt. Materials and methods Lateral cephalograms of 17 subjects with skeletal class II and division 2 malocclusion, taken at the pre-treatment (T1) and post-leveling and alignment (T2) phases, were analyzed. All these patients were treated with non-extraction methods in the initial stage. A total of 25 skeletal and dental parameters, which included linear and angular measurements, were evaluated. Statistical analysis A paired t-test was used to compare the difference in the dimensional values between (T1) and (T2) points of the time period. The results were considered statistically significant at Bonferroni adjusted p<0.002. Results A statistically significant positional change was noted in the condylar position both in the vertical and sagittal directions, resulting in sagittal changes of the mandible in the forward direction. The deep bite was relieved by vertical changes in the dental structures in both the posterior and anterior segments. Growth changes in the vertical direction were also noted but not conclusive. Conclusions There was a definite horizontal shift of the mandible, improving maxillo-mandibular relations following the unlocking of the bite in class II division 2 patients. This shift is mostly attributed to the condylar repositioning in the forward and downward directions.

Three-Dimensional Evaluation of the Tongue Volume in Different Dentoskeletal Patterns - A Cone Beam Computed Tomographic Study.

AIM: The aim of this study is to evaluate tongue volume using cone-beam computed tomographic (CBCT) and its correlation to different growth patterns in patients. MATERIALS AND METHODS: Sixty preorthodontic records of CBCT scans of subjects ranging from 14 to 25 age group from retrospective data of department were selected for the study. Patients were classified into three groups based on angle FMA; Group I (n = 20) with average growth pattern (FMA 22°-28°); Group II (n = 20) vertical growth pattern (FMA >28°); Group III (n = 25) horizontal growth pattern (FMA <20°). Tongue volume evaluation was done using Myrian® Software. Dentoskeletal features and parameters related to archform such as palatal vault depth, interpremolar, and intermolar distance were evaluated in all the subjects. ANOVA test was used for intergroup comparison of tongue volume and dentoskeletal parameters in all three groups. Correlation of the tongue volume to dentoskeletal parameters was done using Pearson's correlation test. RESULTS: Mean tongue volume in Group I was 66.10 cm3, Group II, 66.04 cm3 and Group III was 66.72 cm3. There was a statistically significant correlation (P < 0.5) of tongue volume with palatal vault width, maxillary length, and mandibular interpremolar and intermolar distance among dentoskeletal parameters. CONCLUSION: Tongue volume was found equal in all groups despite the variation in growth patterns. Skeletal differences leading to different growth patterns were found to be related to mandibular morphology. The results indicate the indirect role of the tongue in causing malocclusion in orthodontic patients.

A Survey of Retention Practices and Protocols Followed Among Orthodontists in India.

BACKGROUND: There are different types of retention protocols and retainers prescribed by the orthodontists across the globe. AIM: The study was conducted with the aim of evaluating the retention practices followed by the orthodontists in India. MATERIALS AND METHODS: A questionnaire link with a set of 29 questions was generated using the Google Forms App. The questions related to the basic demographic details followed by retention procedures in maxilla and mandible as related to the type of retainer, duration of wear, retention check-ups, and adjunctive procedures being followed. The Google forms were mailed to 1147 registered life members of the Indian Orthodontic Society. RESULTS: The overall response rate was 20.1%. On receiving of the completed questionnaires, the data were statistically analyzed. Dual mode of retention, fixed retainers with removable thermoplastic resin (TR)/vacuum formed retainers (VFR) (24%) were the common type of retention in maxilla whereas the fixed bonded retainer (44.5%) was more commonly used in mandible. Full time wear of maxillary retainer was recommended by 85.2% of the respondents. The recommended duration of the fixed retainer is for 2-5 years (41.9%). CONCLUSION: A trend towards more dual retention instead of solitary removable or solitary fixed retention, more VFR instead of Hawley-type retainers has been demonstrated in the survey.

Impact of self-esteem on the relationship between orthodontic treatment and the oral health-related quality of life in patients after orthodontic treatment - a systematic review.

OBJECTIVE: The treatment protocol in the modern health care paradigm has shifted considerably towards enhancing the quality of life in the last decade. This is particularly important in cosmetic and elective treatments, and hence the interest in oral health-related quality of life (OHRQoL) also has increased. OHRQoL always been measured by endogenous, functional, social, or psychological determinants. Self-esteem (SE) is one of the internal factors that affect the perception of malocclusion and hence OHRQoL before and after treatment. The purpose of this review is to assess whether there exists any correlation between the Oral Health-Related Quality of Life, Self-esteem (SE) in patients following orthodontic treatment. METHODS: A literature search was confined to the English language using Medical Subject Heading terms (MeSH) in PubMed, Cochrane Library, and Ovid® covering the period from January 1, 1951 to May 15, 2020. Search in Google Scholar, grey literature, and hand search on cross-references was performed to find additional data. The studies found to be suitable were selected based on the predefined inclusion and exclusion criteria. The quality of assessment and risk of bias for the included studies were evaluated independently by two invigilators utilizing "The Cochrane Collaboration's tool for assessing the risk of bias" and "Modified version of the Newcastle Ottawa scale" for Randomized Controlled Trials (RCTs) and non-randomized trials respectively. RESULTS: A total of 7688 studies were retrieved from all the sources. After screening all the titles and excluding the duplicates, 28 studies were finally included for text review, and all of them were fit for quality appraisal. The design of the final studies included comprised of 3 RCTs, 14 cohort studies, 9 cross-sectional studies, and 2 case-control studies. CONCLUSION: There is moderate evidence to show that fixed orthodontic treatment improves OHRQoL and SE in children. OHRQoL also increased in adolescents and adults. However, there is a weak correlation between SE and OHRQoL. More evidence-based studies are needed to analyze the relationship.

Comparative evaluation of the efficacy of the desensitizing and remineralizing agent in the reduction of dentin hypersensitivity after orthodontic debonding - a randomized clinical trial.

INTRODUCTION: Enamel loss is a common problem during various orthodontic procedures. The study aims to compare the efficacy of a desensitizer and remineralizer in the reduction of the dentin hypersensitivity (DH) associated with enamel microcracks after orthodontic debonding. METHODS: A unicentric two arm parallel study with 30 subjects randomly assigned to each groups following debonding. Group-1 subjects were treated with Gluma® desensitizer (5% glutaraldehyde and 35% hydroxyethyl methacrylate (HEMA)) and the Group-2 intervention included a remineralizing agent GC Tooth Mousse Plus® (casein phospho peptide and amorphous calcium Fluro phosphate (CPP:ACFP)). The Visual Analogue Scale (VAS) was utilized to evaluate DH as subjective perception of pain following the Air blast test and Cold test. The VAS scale was indexed from 0-10 markings based on the intensity of perception. Five different time points T0 and T1 - immediately after debonding and intervention on day 1, T2 - 48 hours, and T3 after 72 hours were taken for the assessment of VAS scores. RESULTS: The VAS scores for the airblast test for group 1 were (2.73, 0, 0.06, 0.03) and group 2 (2.46, 0, 0.16, 0.13) at different periods. The sensitivity scores for the cold blast test for group 1 were (2.73, 0, 0.13, 0.03) and for group 2 (2.46, 0, 0.16, 0.13). There was 98 percent reduction in DH between T0 and T3 and was statistically significant (p<0.05) for both the groups. CONCLUSION: Gluma® desensitizer and GC Tooth Mousse Plus® are equally effective in the reduction of DH in the orthodontic patient following debonding.

Dental Diseases and Factors Defining Utilization of Dental Care Services among Rural Children Aged 12 Years in Nellore District, Andhra Pradesh: A Community-Based Study.

BACKGROUND: Rural children are predisposed to variety of dental problems, which may influence their overall health and well-being. Despite relentless efforts and achievements in oral health promotion by authorities, its impact seems limited in rural areas of developing countries. AIM: To generate data on the prevalence of dental caries and gingivitis, among 12-year-old rural children of Nellore district, Andhra Pradesh and factors facilitating or impeding uptake of dental care services. METHODS: A cross-sectional, house-to-house survey was conducted in Kavali revenue division of Nellore district by random selection. A cluster sampling methodology was followed, and a total of 169 adolescents were involved in the study. Dental caries detection was performed according to the World Health Organization dentition status criteria and gingivitis according to modified Community Periodontal Index as gingivitis present or absent. Descriptive statistics were calculated. RESULTS: Overall prevalence of dental caries and gingivitis was 39% and 35%, respectively, with <15% utilization of oral health care services. The main hurdle for this notably low utilization of oral health care services was that dental issues were not fatal or life-threatening. CONCLUSION: The prevalence of dental caries and gingivitis was high and poor utilization of oral health services was an importunate finding in this study. Understanding the trends of common oral diseases and hurdles in uptake of oral health care services could provide a basis for further research and improvement in accessibility to oral health care services in rural areas of developing nations.

Data Set For Computation Of Maxillary Arch Perimeter With Ramanujan's Equation For Ellipse In Different Skeletal Malocclusions.

Every practicing orthodontist today is aware of the importance of considering arch form in the attainment of a functional orthodontic correction [1]. Arch perimeter or circumference prediction is an essential component when Tooth Size Arch Length Discrepancy (TSALD) is estimated. Arch perimeter is the distance from mesial contact of the permanent molar on one side to the mesial contact of the permanent molar on the other side, with the line connecting the buccal/incisor tip points in the intervening teeth. This is most evident when seeking to resolve dental crowding or arch-length discrepancy (ALD) [2]. The shape of the arch form of maxillary and mandible resembles that of the various geometric forms such as including ellipse, parabola, hyperbola, and catenary curve [3], [4], [5], [6]. Ellipse is the best form that fits the shape of the Maxillary arch [1,2]. The mathematical equation formulated by Srinivasan Ramanujan in 1914 for widely considered to be the most accurate for calculation of the circumference of an ellipse is [7]. The computation of the circumference of the ellipse by this equation requires two values- 'a' and 'b,' the semi-major and semi-minor axis [half of the major axis and minor axis of the ellipse] respectively [8]. The perimeter (P) of an ellipse is given by the formulae; = π(a+b){1+(3h/(10-√(4-3h))}; where h=(a-b)2/(a+b)2 and calculated Maxillary arch perimeter (CP) =1/2 P. This necessitates a complex series of steps, and to overcome this, a statistical formula is developed by algorithm steps for mathematical equation where perimeter can be directly obtained by just two inputs 'a' and 'b' in excel sheet. We correlated this calculated arch perimeter (CP) with directly measured perimeter (MP) and marginal difference estimated in three different classes of malocclusion.

Evaluation of Sagittal Changes in Class II Div 2 Patients with Decelerating Phase of Growth by PowerScope Appliance: A Retrospective Cephalometric Investigation.

BACKGROUND: Restricted mandibular growth is observed in Class II Div 2 malocclusions. The fixed functional appliances are used to effect the skeletal changes in patients with end stages of skeletal maturity. AIM: This cephalometric study aimed to distinguish the skeletal and dental corrections done in the mandible on skeletal Class II Div 2 subjects when treated with PowerScope appliance (American Orthodontics, Sheboygan, WI). MATERIALS AND METHODS: This is a cephalometric study based on the retrospective data. The patients selected for this study were with Class II Div 2 malocclusion and assessed to be in decelerating phase of skeletal growth. A total of 12 patients were selected after applying inclusion and exclusion criteria. A PowerScope was placed after incisor correction and followed up till Class I molar relation was achieved. The initial values (T1) at the time of placement of the appliance and the final values at the end of the molar correction (T2) were noted. The cephalometric parameters at T1 and T2 were assessed using sagittal occlusal (SO) analysis by Pancherz. The paired Student's t-test was used to analyze pre- and posttreatment changes. RESULTS: There was sufficient lengthening of the mandible (4.38 mm). Both the dental and skeletal alterations were observed in the mandible. These changes were marked compared to the maxilla. The pre- and posttreatment changes were statistically significant for the mandibular skeletal changes (P < 0.001) as well as mandibular incisor proclination (P < 0.001). CONCLUSION: The PowerScope can be used as a propeller for sagittal mandibular correction in Class II Div 2 patients.

A case of cleft lip and palate with severe maxillary retrognathism treated by distraction osteogenesis and custom made intraoral rapid maxillary expansion appliance: A 2-year follow-up of retention.

Herewith, a case is reported of an adolescent female patient with maxillary retrognathism due to restricted growth arising out of the previous cheiloplasty and palatoplasty surgeries treated for cleft lip and palate. She also presented an oroantral fistula in the scarred tissues of the palatal region. There was anterior crossbite and distorted occlusion in the anterior segment with crowding and open bite. There is maxillomandibular discrepancy of 6 degrees°. The distraction osteogenesis was performed so as treat the maxillary hypoplasia. This allows undermanding adaptation of the soft-tissue structures to the modification in the skeletal structures as a result of surgical procedures and ensures long-term stability. A custom made intraoral rapid maxillary expansion device was prepared utilizing the hyrax screw for the distraction of the bony segments. At the end of the treatment and a retention period of 24 months, the patient exhibited improved facial profile and hence esthetics.

Comparison of the effect of labiolingual inclination and anteroposterior position of maxillary incisors on esthetic profile in three different facial patterns.

OBJECTIVE: To test the null hypothesis that there is no effect of esthetic perception of smiling profile in three different facial types by a change in the maxillary incisor inclination and position. MATERIALS AND METHODS: A smiling profile photograph with Class I skeletal and dental pattern, normal profile were taken in each of the three facial types dolichofacial, mesofacial, and brachyfacial. Based on the original digital image, 15 smiling profiles in each of the facial types were created using the FACAD software by altering the labiolingual inclination and anteroposterior position of the maxillary incisors. These photographs were rated on a visual analog scale by three panels of examiners consisting of orthodontists, dentists, and nonprofessionals with twenty members in each group. The responses were assessed by analysis of variance (ANOVA) test followed by post hoc Scheffe. RESULTS: Significant differences (P < 0.001) were detected when ratings of each photograph in each of the individual facial type was compared. In dolichofacial and mesofacial pattern, the position of the maxillary incisor must be limited to 2 mm from the goal anterior limit line. In brachyfacial pattern, any movement of facial axis point of maxillary incisors away from GALL is worsens the facial esthetics. The result of the ANOVA showed differences among the three groups for certain facial profiles. CONCLUSION: The hypothesis was rejected. The esthetic perception of labiolingual inclination and anteroposterior of maxillary incisors differ in different facial types, and this may effect in formulating treatment plans for different facial types.

Comparison of Anchorage Pattern under Two Types of Orthodontic Mini- Implant Loading During Retraction in Type A Anchorage Cases.

INTRODUCTION: The orthodontic mini-screws are the mainstay of direct skeletal anchorage which requires minimal compliance and provides maximal anchorage control. However, the timing of initiation of orthodontic loading of these mini-screws is not clearly established in the available studies. AIM: The purpose of this study was to determine the reciprocal effects on mini-screw implant with immediate loading in comparison to that of delayed loading during retraction. MATERIALS AND METHODS: The prospective clinical study included a sample of 25 orthodontic patients in the age range of 18-25 years. All the cases were of bi-maxillary proclination with Type-A anchorage demands. All the first premolars were indicated for extraction. A split mouth technique for each patient was utilized by loading mini-implant immediately after its placement on one side and the opposite side implant was loaded after a time lag of two weeks post-insertion. Retraction force of 150g was applied for three months on each side. The displacement of the head and tail of the implant, molar anterior tooth retraction was measured on Orthopantomograph (OPG) taken at T1 (initial) and T2 (after three months). A grid method with each 1mm magnified to 500 pixels was superimposed on OPG and the relative displacements were evaluated. Student's unpaired 't' test was used for comparison between left and right side and paired 't' test for the parameters on the same side. The p-value equal to or less than 0.05 was taken as statistically significant. RESULTS: The mean displacement of head of the implant on the immediate loading is 0.57mm where as the tail exhibited 0.75 mm. The head and tail of the implant on the delayed loading displaced by 0.35mm and 0.38mm respectively, on an average when data was analysed. Significant difference between the two types of loading was noted. CONCLUSION: Delayed loading is beneficial as compared to immediate loading during extraction space closure.

Evaluation of Mechanical and Physical Properties of Clinically Used and Recycled Superelastic NiTi Wires.

INTRODUCTION: The initial leveling and aligning phase has been simplified with the introduction of superelastic nickel-titanium archwires. The relatively high cost of these wires has prompted some of the clinicians to reuse them after sterilization. The quantitative changes in the surface properties of superelastic 'NiTi' wires after clinical application and recycling by autoclave method have not been established in earlier studies. AIM: To quantify the changes in mechanical and physical properties of four different commercially available superelastic nitinol (NiTi) archwires after clinical usage and recycling. MATERIALS AND METHODS: The superelastic 'NiTi archwires obtained from four different manufacturers: Group I-GAC (McMinnville, USA); Group II- 3M Company (California, USA); Group III- G&H Company(Franklin, USA) and Group IV- American Orthodontics (AO) (Sheboygan, USA) were selected for the study. Each of the four groups comprised of 20 samples of wire with 10 of them selected randomly as control and remaining 10 as test specimen in each group. The experimental archwires were placed on selected patients for a period of three months followed by Standard Autoclave sterilization at 121°C and 15 to 20 psi pressure for 20 minutes and were retrieved. The tensile strength was evaluated by Instron-Universal Testing Machine. The quantification of changes in surface roughness was investigated by grid method using Scanning Electron Microscope (SEM). The Control Wires (C) were evaluated at initial time "T1" where as the Experimental sample of wires (T) were subjected to testing at an initial time 'T1' and after clinical usage and sterilization at 'T2'. STATISTICAL ANALYSIS: Paired t-test was used for intra-group comparison and one way ANOVA and Post Hoc Tukey tests were used for inter-group comparison. RESULTS: There was significant decrease in tensile strength (p = 0.0015 to 0.001) and surface roughness (p< 0.001) between control and experimental arch wires within each group when properties at T1 and T2 were compared. CONCLUSION: The study suggests discouraging the use of clinically used and sterilized superelastic NiTi archwires.

Evaluation of body weight, body mass index, and body fat percentage changes in early stages of fixed orthodontic therapy.

AIM: The aim of this study was to evaluate and compare the changes in body weight, body mass index (BMI), and body fat percentage (BFP) during the initial stages of fixed orthodontic treatment. MATERIALS AND METHODS: The sample for this observational prospective study included 68 individuals with fixed orthodontic appliance in the age group of 18-25 years of both the sexes (25 males and 43 females). The control group consisted of 60 individuals (24 males and 36 females). The weight, BMI, and BFP were measured using a Body Composition Monitor at three points of time "T1" initial; "T2" after 1 month; and "T2" after 3 months. The results were tabulated and analyzed with the Statistical Package for the Social Sciences software. The mean changes between different parameters in both the study and control groups and between males and females in the study group was compared by using two-tailed unpaired student's t-test. The statistical significance is set atP ≤ 0.05. RESULTS: There was an overall decrease in the body weight, BMI, and BFP after 1 month in the study cohort, which was statistically significant compared to the control group (P < 0.0001). This was followed by an increase in the parameters after the end of the 3(rd) month. Comparison of the parameters between the study and control group at the start of the treatment and at the end of the 3(rd) month had no statistical significance. There was a marked variation in the changes of these parameters between males and females of the study group, which is statistically significant (<0.0001). CONCLUSION: There is a definite reduction in the weight, BMP, and BMI at the end of the first month followed by a gain of weight, but not at the initial point by the end of the 3(rd) month.