Sequelae of Unreplaced Tooth Loss in Orthodontic Patients: A Cross-Sectional Study in Najran, Kingdom of Saudi Arabia.

Background: The early tooth loss has an adverse effect on the overall well-being of an individual. The aim of the current study was to highlight the orthodontic complications of long-term tooth loss in the city of Najran. Materials and Methods: This was a cohort study of patients presenting for orthodontic rehabilitation. A total of 326 patients that presented for orthodontic rehabilitation were examined clinically and data such as age, gender, number of missing teeth, missing teeth, duration of missing teeth, tipping, and overerupted and rotated teeth were recorded. Patients that can be treated with orthodontic space closure were excluded from the study. Patients' data were analyzed using IBM SPSS Statistics and results were presented as simple frequencies and descriptive statistics. Results: Out of 326 patients that presented for orthodontic rehabilitation, 259 patients had missing teeth with its sequelae that will demand prosthodontic rehabilitation with a prevalence rate of 79.4%. There are 97 (37.5%) males and 162 (62.5%) females with M:F ratio of 1:1.7. The age ranged from 15 to 52 years with mean ± standard deviation (28.5 ± 8.5). The age group 21-30 years constitutes the group with the highest number of missing teeth. A total number of 595 (60.2%) teeth were missing, 173 (17.5%) teeth were tipped, and 124 (12.5%) teeth were overerupted, whereas only 97 (9.8%) teeth were rotated (n = 989). Fixed orthodontic appliances (FOAs) were used for all cases with rotation and FOAs + Mini Screws were used for all cases with tipping, overeruption, and/or combinations. The dental loss was managed by prosthesis depending on patients' choice and financial capability ranging from removable/fixed prosthesis and dental implants. Conclusion: Orthodontic consequences of early tooth loss include tipping and rotation of adjacent teeth and overeruption of opposing teeth. Early acknowledgment of tooth replacement after tooth loss is essential in preventing long-term orthodontic adverse effects.

Comparing Circumferential Supracrestal Fiberotomy with Surgical Scalpel Versus Photobiomodulation in Orthodontic Relapse Reduction: A Clinical Trial.

Objective: This investigation aimed to compare the efficacy of circumferential supracrestal fiberotomy (CSF) with surgical scalpel, laser CSF, and photobiomodulation for reduction of relapse after orthodontic tooth rotation. Background: Relapse is the tendency of teeth to move back to their preoperative position after removal of orthodontic appliances. Materials and methods: This randomized controlled clinical trial was conducted on 90 rotated teeth at the final stages of fixed orthodontic treatment. The teeth were randomly divided into six groups (n = 15) of (1) control (no intervention), (2) photobiomodulation alone (wavelength of 940 nm, 0.2 W, and 4 J/cm2), (3) conventional CSF, (4) laser CSF (wavelength of 940 nm, 1.5 W, and 4 J/cm2, and power density of 160 mW/cm2), (5) conventional CSF plus photobiomodulation, and (6) laser CSF plus photobiomodulation. Measurements were made on clinical photographs and dental casts using the AutoCAD software. Level of pain of patients was measured within the first 24 h after fiberotomy using a visual analog scale. Data were analyzed by ANOVA and Kruskal-Wallis test (α = 0.05). Results: The magnitude (p = 0.014) and percentage (p = 0.035) of relapse were significantly different among the six groups, and they were the highest in the control group followed by photobiomodulation alone, laser CSF, conventional CSF, conventional CSF plus photobiomodulation, and finally, laser CSF plus photobiomodulation. Moreover, photobiomodulation plus laser CSF and photobiomodulation plus conventional CSF had significantly different results from the other groups. The six groups had no significant difference in sulcus depth changes, gingival recession (difference in primary and secondary crown height), or pain score (p > 0.05). Conclusions: This study suggests that utilizing photobiomodulation combined with laser CSF or conventional CSF can be effective in reducing relapse. However, further clinical trials are required to support this idea. Iranian Registry of Clinical Trials (IRCT20210621051653N1).

Effects of a ceramic active self-ligating bracket on retraction/tipping/ rotation of canine, premolar mesialization, and transverse arch dimensions: A preliminary single-blind split-mouth randomized clinical trial.

BACKGROUND: There is no clinical study on ceramic self-ligating brackets (SLBs). Therefore, this preliminary study was conducted for the first time to address its effects. MATERIALS AND METHODS: This split-mouth randomized trial was performed on 32 quadrants in 16 orthodontic patients needing extraction of maxillary premolars and distalization of canines. In each blinded patient, right/left sides were randomized into control (ceramic bracket) and experimental (ceramic SLB) groups. Dental stone models were taken before canine retraction and 3 months into retraction. Models were digitized as three-dimensional models. Changes were measured on superimposed models. Groups were compared using Wilcoxon signed-rank test (α = 0.05, ß = 0.1). RESULTS: Both bracket types caused significant changes after 3 months in terms of all assessed clinical outcomes (P ≤ 0.002). Compared to conventional ceramic brackets (control), ceramic SLBs reduced retraction rate (P = 0.001), canine rotation (P = 0.001), canine tipping (P = 0.002), and arch expansion at the canine site (P = 0.003). However, the extents of anchorage loss (P = 0.796) and arch constriction in the premolar area (P = 0.605) were not statistically different between the bracket types. CONCLUSION: Compared to conventional metal-lined ceramic brackets, active ceramic SLB can increase the duration of canine distalization, while reducing canine rotation and tipping (inducing more bodily movements). The loss of anchorage with ceramic SLB was similar to that of conventional ceramic bracket after 3 months of treatment (considering the lower rate of SLB canine retraction during that time). Both brackets similarly constricted the arch at the premolar site. In the canine area, they expanded the arch, with the SLB causing smaller extents of expansion.

Rotational relapse of anterior teeth following orthodontic treatment and circumferential supracrestal fiberotomy.

BACKGROUND/PURPOSE: Several factors cause relapse of orthodontically de-rotated teeth after appliance removal. Circumferential supracrestal fiberotomy (CSF) may release the tension on the supra-alveolar fibers following tooth de-rotation, thereby reducing the relapse risk. However, careful identification of the amount and location of relapse enables proper clinical evaluation. We aimed to determine the amount of orthodontic relapse following CSF for de-rotated anterior teeth. MATERIALS AND METHODS: Eleven patients with 90 orthodontically de-rotated anterior teeth were enrolled. CSF was performed after orthodontic treatment, during fixed retainer placement. Rotational correction and relapse were measured on three casts (preorthodontic treatment, cast 1; postorthodontic treatment + CSF, cast 2; and 12-month follow-up, cast 3). The Wilcoxon test was used to assess significant differences in the tooth rotation angles between casts 1 and 2 and casts 2 and 3. The relationship between the magnitude of relapse and pretreatment severity of rotation was assessed by the point biserial correlation test. The Mann-Whitney U test helped in identifying significant differences in the amount of relapse between maxillary and mandibular teeth. RESULTS: The mean amount of rotational correction was 14.05°, while the mean amount and percentage of relapse were 1.1° and 10.8%, respectively [0.81° (8%) and 1.44° (14%) for maxillary and mandibular teeth, respectively]. The relapse amount was proportional to the pretreatment rotation severity, and it was larger for the mandibular canines. There was no significant difference in the amount of relapse between the maxillary and mandibular teeth (P = 0.07). CONCLUSION: Post-treatment rotational relapse of anterior teeth subjected to CSF was minimal and statistically insignificant after 1 year of follow-up. This validates the promising results of CSF when combined with appropriate mechanical retention for an adequate period.

Intentional replantation with 180° rotation of a complicated crown-root fracture: A Case Report.

Complicated crown root fractures are mostly difficult to treat and have a poor prognosis. To restore the biological space, intentional replantation may be chosen when other immediate treatment options are not viable. Intentional replantation with tooth rotation consists of extraction, 180° rotation and replantation, thereby maintaining the biological width. This article presents management of a maxillary central incisor with complicated crown root fracture with open apex. The tooth was rotated and splinted for one week. The apex was closed with mineral trioxide aggregate (MTA) followed by obturation and post placement. The incompletely obturated adjacent tooth was non-surgically managed by retreatment. Finally, glass fibre post followed by crown with indirect composite built up was made. Patient was followed up every three months for the next two years without any complications.

Comparison of transverse dental changes induced by the palatally applied Frog appliance and buccally applied Karad's integrated distalizing system.

OBJECTIVE: To compare the transverse dental changes induced by the palatally applied Frog appliance and buccally applied Karad's integrated distalizing system (KIDS). METHODS: We evaluated the pre- and post distalization orthodontic models of 39 patients, including 19 treated using the Frog appliance, which is palatally positioned (Frog group), and 20 treated using KIDS, which is buccally positioned (KIDS group). Changes in intermolar and interpremolar distances and the amount of maxillary premolar and molar rotation were evaluated on model photocopies. Wilcoxon and Mann-Whitney U tests were used for statistical evaluations. A p-value of < 0.05 was considered statistically significant. RESULTS: Significant distopalatal rotation of premolars and distobuccal rotation of molars were observed in Frog group (p < 0.05), while significant distopalatal rotation of molars (p < 0.05), with no significant changes in premolars, was observed in KIDS group. The amount of second premolar and first molar rotation was significantly different between the two groups (p < 0.05 and p < 0.001, respectively). Furthermore, expansion in the region of the first molars and second premolars was significantly greater in KIDS group than in Frog group (p < 0.001 for both). CONCLUSIONS: Our results suggest that the type and amount of first molar rotation and expansion vary with the design of the distalization appliance used.

Surgical management with intentional replantation on a tooth with palato-radicular groove.

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

Treatment of severe rotations of maxillary central incisors with whip appliance: Report of three cases.

The routine treatment for rotated maxillary incisor is a fixed appliance, but in some instance the use of this method is impossible. In addition, in only limited cases of rotation, removable appliance is applicable. In this study, the use of a semi-removable appliance is presented, which has some benefits over the other methods. In this study, the corrections of about 70-90° rotation of the maxillary central incisors in different phases of mixed dentition were performed in three patients using whip appliance. This method was performed using a simple removable appliance such as Hawley appliance and whip spring that forced the couple to derotate the tooth. In all cases, treatment was successfully completed in relative short duration. Whip appliance can be recommended as an effective method to correct rotation of maxillary incisor in mixed dentition with several advantages like rapid correction.