Malocclusion or laterorhinia: Which one impacts aesthetic facial perception the most?

INTRODUCTION: This study aimed to evaluate the perception of facial attractiveness when nose and teeth, together or isolated, present different degrees of disharmony. The secondary objective was to compare the perception of laypersons with that of dentists. MATERIALS AND METHODS: This cross-sectional observational study included 112 individuals (58 laypersons and 54 dentists) that evaluated 6 manipulated images of the face of the same model, scoring their attractiveness using 10 cm Visual Analogue Scales (VAS), with least and most attractive at the left and right anchors, respectively. The images contained manipulations performed only on the nose (laterorhinia) and mouth (misaligned teeth), as follows: (1) standard photograph, with symmetrical nose + aligned teeth; (2) 2 mm nasal deviation + aligned teeth; (3) 4 mm nasal deviation + aligned teeth; (4) symmetrical nose + misaligned teeth; (5) 2 mm nasal deviation + misaligned teeth and (6) 4 mm nasal deviation + misaligned teeth. We used the repeated measures ANOVA test and Tukey's post-test for intra-group comparison of the images. The independent t-test was used for inter-group comparison of each image. RESULTS: In the laypersons' group, the highest grades were given to images with aligned teeth and the lowest to misaligned teeth (smallest mean difference = 2.88 cm). For this group, there was no statistically significant difference (P-values ranged from .988 to 1.000) between scores of the three images in which teeth were aligned (range of 7.70-7.78 cm). In the group of dentists, highest grades were given to images with aligned teeth and the lowest to misaligned teeth. Difference between images 3 and 4 was not statistically significant (P = .204). All other differences between any image of straight teeth and any image with misaligned teeth were significant and the smallest mean difference between the two groups of images was 1.87 (P = .039). However, in the images with aligned teeth, there was also a statistically significant difference with higher scores to the images with symmetrical nose in contrast with those with significant laterorhinia (mean difference = 1.03 cm). CONCLUSION: Teeth disharmonies had a more negative impact on the aesthetic perception of the face than did nose deviations, for both dentists and laypersons.

Long-term stability of posterior crossbite correction, treated in the mixed or permanent dentition of growing children: A systematic review and meta-analysis.

When treating posterior crossbite, the primary goal is to achieve long-term crossbite correction. The majority of studies however focus on relapse of the increase in the transverse dimension, but not relapse of the crossbite itself, which is an essential outcome. The aim of the present study was to determine long-term stability (2 years minimum post-treatment) of posterior crossbite correction, treated in mixed or early permanent dentitions of growing children. Following registration in PROSPERO (CRD42022348858), an electronic literature search including PubMed, Embase, Web of Science, the Cochrane Library, and a manual search were conducted up to January 2023, to identify longitudinal studies looking into the long-term stability of crossbite correction in growing children. Data extraction and risk of bias assessment were carried out, and subsequently, a random-effects meta-analyses models were used to calculate estimates for relapse of the crossbite and relapse at the transverse level. Twenty-two studies were included, of varying designs and quality, representing 1076 treated patients, with different expansion appliances and protocols. Meta-analysis results showed that 19.5% (95% CI: 15%; 25%) of patients present with relapse of posterior crossbite at long-term follow-up. At the transverse level, 19.3% of the total expansion (including overexpansion) relapsed (95% CI: 13%; 27%) regardless of whether there a was relapse of the crossbite itself. Data from existing studies, with a moderate level of evidence, indicate that the long-term stability of posterior crossbite correction in growing children is unfavourable in roughly 1 in 5 growing children, with crossbite relapse long-term. On average, 19% of the maxillary expansion performed (including overexpansion) relapses long-term, which may occur in cases with or without relapse of the crossbite.

Treatment stability with bonded versus vacuum-formed retainers after 12 months: A randomized clinical trial.

OBJECTIVE: To compare the clinical effectiveness of V-bend bonded retainers (BR) versus vacuum-formed retainers (VFR) regarding their capacity to maintain treatment stability and survival rates after 12 months. MATERIALS AND METHODS: Patients finishing orthodontic treatment were randomly allocated into two groups. The BR group received maxillary and mandibular BRs in the lingual surfaces of the anterior teeth. The VFR group received VFRs right after fixed appliances removal. The patients were evaluated at four time-points: at fixed appliances removal (T0), after 3 (T1), 6 (T2) and 12 months (T3). In each time-point digital models were obtained and analysed with the OrthoAnalyzer™ software. Treatment stability based on occlusal outcomes and retainers' survival rates were evaluated. Intergroup comparisons were performed using Mann-Whitney U-tests. The Kaplan-Meier survival plot and the log-rank test were employed to assess the retainers' survival. RESULTS: Both BR and VFR groups included 25 patients. The groups were comparable regarding their baseline characteristics. Up to 6 months, both retainers were equally effective; however, after 12 months, BRs were more effective in maintaining the incisors' alignment in the maxilla and the mandible compared to the VFRs. No differences were noticed in the intercanine and intermolar widths, overjet and overbite. There were no differences regarding the retainers' survivability in both arches. CONCLUSIONS: BRs were more effective in maintaining the alignment of the incisors in the maxilla and mandible compared to VFRs after 12 months. Both retainers presented the same survival rates after the same period.

Self-reported pain during different phases of orthodontic treatment with fixed appliance: A multi-centre randomized controlled trial in adolescents with crowding.

OBJECTIVES: To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems. MATERIALS AND METHODS: Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale. RESULTS: Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively). CONCLUSIONS: Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.

Functional treatment of bilateral posterior crossbite improves mandibular kinematics during chewing.

OBJECTIVES: To evaluate the effects of treatment of bilateral posterior crossbite (BPXB) on mandibular kinematics by the percentage of reverse chewing cycles (RCCs) during soft and hard bolus chewing before and after the correction of the malocclusion with function-generating bite (FGB). MATERIALS AND METHODS: This prospective study included 71 subjects: 19 patients with occlusally symmetric BPXB (M = 9; F = 10; mean age 9.3 ± 2.2[yr.mo]), 32 patients with occlusally asymmetric BPXB (19 with more teeth in crossbite on the right side (right prevalent side), M = 7; F = 12; mean age 8.2 ± 1.6 [yr.mo] and 13 on the left side, M = 7; F = 6; mean age 9.6 ± 1.9 [yr.mo]) and 20 controls without malocclusion (M = 8; F = 12; mean age 10.2 ± 1.7 [yr.mo]). Masticatory patterns were recorded before (T0) and after (T1) the correction of the malocclusion with FGB, with the K7-I® kinesiograph using standardized soft and hard boluses. RESULTS: BPXB was corrected in all included patients. At T0, the percentage of RCCs in BPXB was significantly increased compared to controls (P < .0001); symmetric BPXB showed no difference in RCCs between the sides, whereas asymmetric BPXB showed significantly more RCCs on the side with more teeth in crossbite (prevalent side). After treatment with FGB (T1), the percentage of RCCs was significantly reduced in both symmetric BPXB patients (soft bolus, P = .003; hard bolus, P < .001) and asymmetric BPXB patients (prevalent side: soft and hard bolus, P < .00001; non-prevalent side: soft bolus, P = .01 and hard bolus, P = .0002). CONCLUSION: Functional correction of BPXB with FGB significantly improved mandibular kinematics during chewing.

Mandibular second molar extraction: A retrospective cohort study of spontaneous occlusal changes in adolescent patients.

OBJECTIVES: Evaluate long-term spontaneous occlusal changes following L7 extraction in adolescent patients. MATERIALS AND METHODS: Study models of 144 participants (63 males, 81 females) retrospectively assessed prior to L7 extraction (9-16 years old; T1) and following L8 eruption (14-25 years old; T2). All received upper fixed appliances. A sub-group (n = 86) received no lower fixed appliances and acted as controls. Occlusal changes were compared between treatment (lower fixed appliance) and control (no lower fixed appliance) groups using PAR index. At T2, L8 occlusal outcome was assessed using ABO grading system. RESULTS: Mean follow-up period 6 (SD 2) years. At T1, lower scores observed in control group for Lower Anterior (P < .001), Midline (P = .033) and Lateral Segments (P = .040) components. At T2, lower scores continued being observed in control group for Midline (P < .001) and Lateral segment (P = .019) components. Higher decrease in Lower Anterior PAR scores observed in treatment group (<.001) with comparable scores between groups at T2 (P = .057). Similar PAR score changes between groups for Lateral Segments, Overjet and Overbite components. At T2, no significant difference observed in Total PAR score reduction between control (83%) and treatment (82%) groups. Good-to-acceptable occlusal outcome of the L8 observed in 81.55% of cases at T2 with no difference between groups. CONCLUSION: In growing patients with mild mandibular crowding, extraction of L7 followed by upper fixed appliance therapy, leads to favourable occlusal changes over a 6-year follow-up period, with or without lower fixed appliance therapy, being an alternative extraction protocol where lower fixed appliance therapy is not recommended.

Multivariate analysis of alveolar bone dehiscence and fenestration in anterior teeth after orthodontic treatment: A retrospective study.

OBJECTIVE: To compare the prevalence of fenestration and dehiscence between pre- and post-orthodontic treatment and to explore the factors related to fenestration and dehiscence in the anterior teeth after treatment. METHODS: This study included 1000 cone-beam computed tomography (CBCT) scans of 500 patients before (T1) and after (T2) orthodontic treatment. These images were imported into Dolphin 11.9 software to detect alveolar fenestration and dehiscence in the anterior teeth area. The chi-square test and Fisher's exact test were performed to compare the prevalence of alveolar bone defects between time points T1 and T2. A total of 499 patients were selected for logistic regression analysis to examine the correlation among age, sex, crowding, sagittal facial type, extraction, miniscrew use and fenestration or dehiscence post-treatment. RESULTS: Except for the maxillary lingual fenestration and labial fenestration of mandibular canines, a significant change in the prevalence of fenestration and dehiscence was noted between time points T1 and T2 (P < .025). Multinomial logistic regression showed that age, miniscrew use and extraction highly influenced the prevalence of anterior lingual dehiscence (P < .05). Dehiscence of the mandibular labial side (skeletal Class III vs. I, OR = 2.368, P = .000) and fenestration of the mandibular lingual side (skeletal Class II vs. I, OR = 2.344, P = .044) were strongly correlated with the sagittal facial type. Dehiscence of the maxillary labial side (moderate vs. mild, OR = 1.468, P = .017) was significantly associated with crowding. CONCLUSIONS: Older age, maxillary moderate crowding, skeletal Class III, extraction and miniscrew potentially significantly affect the prevalence of anterior teeth dehiscence. Adult females, skeletal Class III patients on the mandibular labial side and skeletal Class II patients on the mandibular lingual side should be monitored for anterior teeth fenestration.

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial.

OBJECTIVE: To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients. MATERIALS AND METHODS: Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05. RESULTS: Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances. G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days). CONCLUSION: Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

The Impact of the Restoration of Invisible Orthodontic Titanium Alloy Implant Without Bracket on Individuals Afflicted with Dental Malocclusion and Arch Deficiency Accompanied by Periodontitis and a Local Periodontal Inflammation.

Objective: To investigate the impact of the restoration of non-bracket invisible orthodontic titanium alloy implant on individuals with dental malocclusion and arch deficiency accompanied by periodontitis and local periodontal Inflammation. Method: A cohort of 120 patients presenting with dental malocclusion and defects compounded by periodontitis, were treated at our institution between January 2021 and January 2022; these patients were enrolled in a randomized controlled trial.. These patients were allocated into two groups. The control group (comprising 60 cases) underwent titanium alloy implant restoration, while the research group (also with 60 cases) received titanium alloy implant restoration following invisible orthodontic treatment without brackets. A one-year post-treatment follow-up was conducted, during which various parameters, including pain levels, aesthetic improvement, inflammatory response, dental function, oral hygiene, and the incidence of adverse events, were evaluated and compared before and after treatment between the two groups. Results: After six months of treatment, the visual analog scale (VAS) in the study group was lower than that in the control group (P < .05). After 6 months of treatment, the research team observed the changes in gingival crevicular interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), Interleuckin-1 (IL-1), plaque index (PLI), and soft dirt index (DI) were all lower than those in the control group (P < .05). After 6 months of treatment, the research group had higher scores for tooth functions such as chewing, swallowing, speech expression, and occlusion than the control group, as well as higher pink and white aesthetics indexes (P < .05). The difference in the incidence rate of adverse outcomes between the research and control group was not distinct (P > .05). Conclusion: In case of dental malocclusion accompanied by periodontal disease, the utilization of titanium implants for rectifying dental arch deformities without the use of orthodontic brackets, devoid of orthodontic brackets, has demonstrated notable efficacy in alleviating patients' periodontal discomfort, their oral hygiene, and dental functionality. This modality is conducive to augmenting dental aesthetics without incurring heightened rates of unfavorable consequences, thereby enhancing treatment outcomes.

Need for orthodontic treatment and oral health-related quality of life in children and adolescents - A systematic review.

OBJECTIVES: To determine the relationship between the need for orthodontic treatment and OHRQoL in children and adolescents, and to identify potential modifying factors of this relationship. METHODS: Systematic review, starting with searches of PubMed, Scopus, and EBSCO Discovery Service. Observational studies which examined the relationship between the need for orthodontic treatment and OHRQoL, in children and adolescents, were considered eligible. RESULTS: Eighteen studies were included, of which, one was a prospective cohort study and 17 were cross-sectional. Twelve of 18 studies reported a relationship between the need for orthodontic treatment and OHRQoL, while the remainder failed to demonstrate a clear relationship. Gender and self-esteem were found to modify this relationship. CONCLUSIONS: Need for orthodontic treatment is associated with OHRQoL in children and adolescents. Gender and self-esteem are potential effect modifiers of this relationship.

Evaluation of the impact of orthodontists' smile with malocclusions on social media and professional credibility.

OBJECTIVES: This study assessed laypeople's perceptions of orthodontist credibility based on malocclusions and whether these views affect their choice to seek treatment. Eye-tracking technology and questionnaires were utilized. MATERIALS AND METHODS: Ninety-five lay raters, through eye tracking and a questionnaire, assessed 12 images of orthodontists with malocclusions. Malocclusions were categorized by the Index Of Treatment Need (IOTN) as grade 1 (near ideal), 3 (anterior crowding), and 5 (with diastemas). Fixation points were recorded, and credibility was gauged via questionnaires. A Mentimeter word cloud was generated. RESULTS: IOTN 1 orthodontists were viewed as more credible than IOTN 3 (p < 0.001) and 5 (p < 0.001). Raters were more willing to receive treatment from IOTN 1 orthodontists. The focus for IOTN 1 was between eyes and mouth, while IOTN 3 and 5 were on the mouth. "Crooked teeth" and "spacing" were predominant in word clouds for IOTN 3 and 5. CONCLUSION: Orthodontists with an IOTN grade 1 rating were perceived as more competent, reliable, and professional, thus making it more likely for laypeople to choose them as their preferred providers. CLINICAL RELEVANCE: The smiles of professionals play a significant role in laypeople's decision to choose them as their orthodontist, and strategic utilization of social media can effectively deliver health information to a larger audience in a faster and more direct manner.

Orthodontic findings in adults with Trisomy 21.

OBJECTIVES: Objective of this study was to describe orthodontic findings in adults with Down's syndrome, a matter insufficiently regarded in literature. MATERIALS AND METHODS: A group of 104 adults (33.8 ± 15 years) with trisomy 21 had an orthodontic check-up in their accustomed environment. Anamnestic and dental findings completed the examination and descriptive analysis was performed using SPSS23. Relative frequencies with 95% confidence intervals were compared to the average population (SHIP-study, 2003; DMS IV, 2006). RESULTS: Among the participants 46.2% (36.3-56.2%) (SHIP 36.7%) had already undergone orthodontic treatment. In 87.5% (79.6-93%) of the patients, less than 25.6 properly functioning permanent teeth (DMS IV's mean) were found. Gingival bleeding and recessions, as well as periodontal disease, were increasingly found in older affected persons. Patients with Down's syndrome showed less crowding, e.g., maxillary incisors 28% (19.3-39%) versus 41.9% (SHIP). Frontal open bite (35.2% (25.3-46.1%) versus 3.6% (SHIP)) and frontal crossbite (40.9% (30.5-51.9%) versus 4.2% (SHIP)) were more often observed. No considerable differences in frequencies of orthodontic findings were detected in the comparison of the subgroups "18-28 years" versus ">28 years", "with" versus "without orthodontic treatment", "male" versus "female", "with" versus "without periodontal problems", or "with" versus "without orofacial disturbances". CONCLUSIONS: Within the bounds of this study, we gathered orthodontic findings in adults with trisomy 21 for the first time. In comparison to the average population, the subject group showed a greater number of complex orthodontic findings. CLINICAL RELEVANCE: These persisting dental and orofacial problems must be considered when treating patients with Down's syndrome.

Influence of malocclusion on OHRQoL in adolescents in initial orthodontic treatment phase.

OBJECTIVES: Besides correcting malocclusions, another main objective of orthodontic treatment is to improve patients' oral health-related quality of life (OHRQoL). This study aimed to assess changes in OHRQoL of children within the first six months of orthodontic therapy with fixed orthodontic appliances. METHODS: 85 patients aged 11 to 14 years requiring fixed orthodontic appliance therapy were included. The children completed the German version of the Child Perceptions Questionnaire (CPQ-G-11-14) before (T0), 1 month (T1) and 6 months (T2) after the start of orthodontic treatment. The type of malocclusion was categorized according to the Index of Orthodontic Treatment Need (IOTN). RESULTS: The initial type of malocclusion affected the children's OHRQoL, whereas gender and age did not. The IOTN dental health component (DHC) had a significant impact on the CPQ score (median CPQ of 15.00 for the group DHC 4 vs. 22.50 for DHC 5, p = 0.032). The onset of orthodontic treatment initially affected the CPQ domains "Oral symptoms" and "Functional limitations, with a change versus baseline of 2.00 (p = 0.001), but improved again after 6 months. Regression analysis demonstrated that children with an IOTN DHC 5 malocclusion experienced a greater impact on their ORHQoL, as indicated by a CPQ score 7.35 points higher than that of children with an IOTN DHC 4 malocclusion (p = 0.015). CONCLUSIONS: At the beginning of orthodontic treatment, the OHRQoL slightly worsens, probably due to the discomfort and appearance of the appliances. However, 6 months after the start of orthodontic treatment, OHRQoL improved again in patients with severe malocclusion (IOTN 4 and 5), and approached baseline values. CLINICAL RELEVANCE: The results help the clinician to better understand specific aspects of oral health that may be affected by different malocclusions, thereby improving the child's satisfaction and overall quality of life.

Comparison of transverse dimensional and incisor changes between wide and narrow orthodontic archwires: a randomized controlled trial.

OBJECTIVES: To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. MATERIALS AND METHODS: Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. RESULTS: Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group (P = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width (P = 0.042), and mandibular inter-first premolar (P = 0.043), inter-second premolar (P = 0.008) and inter-molar widths (P = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination (P = 0.004) and horizontal advancement (P = 0.038) in the Damon group. CONCLUSIONS: Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. CLINICAL RELEVANCE: Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.

Correlation of salivary cytokine IL-17A and 1,25 dihydroxycholecalciferol in patients undergoing orthodontic treatment.

The management of malocclusion has developed greatly in terms of treatment simulation and biomechanics, but treatment duration has been a great concern to the clinician as well as the patient. 1-25dihydroxycholecalciferol (biologically active form of Vitamin D) stimulates both osteoclasts and osteoblasts and was found to be the most significant in Orthodontic Tooth Movement acceleration. Inflammatory cytokines like IL-17A also play an important role in osteoclastogenesis and can enhance the rate of Orthodontic Tooth Movement.To perform a simultaneous evaluation of pro-inflammatory salivary cytokine IL-17A and salivary 1-25dihydroxycholecalciferol and to correlate their role on orthodontic tooth movement.A prospective cohort study was conducted among n = 97 patients. Saliva samples were collected from the patients at three phases of the orthodontic treatment, centrifuged and stored at 4℃ for evaluation of salivary 1-25dihydroxycholecalciferol levels and Pro-inflammatory cytokine IL-17A using ELISA.The mean salivary 1-25dihydoxycholecalciferol levels were 41.250 ng/ml, 33.246 ng/ml and 35.043 ng/ml during the initial phase, lag phase and post lag phase of orthodontic treatment. The mean pro-inflammatory cytokine IL-17 A levels were 107.79 pg/ml, 102.98 pg/ml and 66.156 pg/ml during the initial phase, lag phase and post lag phase of orthodontic treatment. There was a correlation between the salivary 1-25dihydroxycholecalciferol level and salivary cytokine IL-17A levels during the various phases of orthodontic treatment using Spearman's correlation rho test and linear regression analysis. There was no significant difference (p > 0.05) between 1-25dihydroxycholecalciferol levels and gender during the various phases (initial phase, lag phase and post lag phase) of Orthodontic treatment.There was a negative correlation between salivary 1-25dihydroxycholecalciferol level and salivary cytokine IL-17A levels during the various phases of orthodontic treatment. The level of 1-25dihydroxycholecalciferol and salivary cytokine IL-17A have been quantified during the various phases of Orthodontic treatment and this can be used clinically for the supplementation of Vitamin D in patients with low vitamin D levels and can enhance the treatment duration for the patient with less damaging effects to the surrounding tissues.

Precautions and possibilities in orthodontic treatment of periodontally compromised patients: Current recommendations.

OBJECTIVE: Orthodontic treatment plays a crucial role in achieving optimal dental esthetics and functional occlusion. However, when periodontally compromised patients are involved, additional precautions and considerations are critical. This article aims to provide up-to-date recommendations for the orthodontic treatment of periodontally compromised patients. CLINICAL CONSIDERATIONS: Comprehensive diagnosis of the patient's periodontal status, inherent malocclusion, and secondary malocclusion resulting from periodontal disease are essential for achieving optimal esthetics and functional occlusion. This can be facilitated through the use of a simplified checklist. Prior to orthodontic treatment, pre-existing periodontal diseases should be managed. Light and controlled forces should be used to minimize the risk of adverse effects on the periodontium, and any potential traumatic occlusion during tooth movement should be minimized. Furthermore, careful anchorage management is required, and proper application of temporary anchorage devices can significantly expand the scope of orthodontic treatment. Finally, treatment results are maintained by ongoing supportive periodontal therapy even during the retention period. CONCLUSIONS: This article presents clinical cases demonstrating the importance of accurate diagnosis in orthodontics and periodontics and the positive impact of orthodontic treatment on patients with pre-existing periodontal diseases. CLINICAL SIGNIFICANCE: An up-to-date orthodontic treatment protocol for periodontally compromised patients is presented.

Effects of nasoalveolar molding on maxillary arch dimensions and malocclusion characteristics in primary dentition patients with cleft lip and palate.

BACKGROUND: Nasoalveolar molding (NAM) is a presurgical orthopedic technique used in the management of cleft lip and palate deformities. Despite the widespread use of NAM therapy, there is a need for further investigation to assess its specific effects on arch dimensions and malocclusion characteristics. AIM: To evaluate the effects of NAM therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). DESIGN: Patients in primary dentition were referred to the Institutional Department of Orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7 ± 0.7 years) and 12 patients with BCLP (mean age 4.8 ± 0.7 years). Sixteen patients with UCLP (mean age 4.9 ± 0.9 years) and five patients with BCLP (mean age 5.4 ± 1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. RESULTS: Intercanine and intermolar widths showed statistically significant differences according to the cleft type (p < .01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (p > .05). The prevalence of anterior crossbite was 12.1% in the NAM group and 23.8% in the non-NAM group. CONCLUSION: NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.

Association between crowding estimation and extraction recommendations in orthodontics.

INTRODUCTION: Little is known about how precisely orthodontists in the United States (US) assess crowding or at what range of crowding they recommend extraction. This study aimed to assess the relationship between estimated crowding in patients with a Class I relationship and extraction recommendation by orthodontists in the US. The secondary aims were to evaluate the accuracy and precision of clinician estimations and determine if clinician background traits play a role in extraction decision-making. METHODS: An electronic survey was prepared using 4 patients with a Class I relationship with anterior crowding selected from a University Orthodontics Clinic and was sent to approximately 10,400 subjects through Facebook and the American Association of Orthodontists Partners in Research program. RESULTS: From the 297 responses received, most clinicians recommended extraction once crowding reached 9-10 mm in either the maxilla or the mandible. The data from 2 patients suggest this decision was more strongly correlated with mandibular crowding. Clinician estimations varied widely but, on average, were precise within approximately 2 mm of objective measurements. There was a tendency to overestimate crowding, especially by Northeastern practitioners. Clinicians who reported routinely measuring crowding or who reported that they recommended extractions to >10% of their patients were 1.2-2.0 and 1.4-1.6 times more likely, respectively, to recommend extraction in the patients. CONCLUSIONS: Crowding estimation was highly subjective and varied widely among clinicians. Most clinicians recommended extraction once maxillary or mandibular crowding approximated 9-10 mm. Some clinician demographics were correlated with the precision and accuracy of estimations and the likelihood of extraction in the patients.

Three-dimensional evaluation of dentopalatal changes after rapid maxillary expansion in growing children.

INTRODUCTION: In growing children with transverse malocclusion problems, various types of rapid maxillary expanders (RMEs) have been effectively used in skeletal and dental expansions. We evaluated 3-dimensional dentopalatal changes in growing children who underwent maxillary expansion using RMEs and bonded RMEs. METHODS: We investigated dentopalatal changes in 20 patients treated with bonded RMEs, 19 with RMEs, and 38 control patients. Dental plaster models before and after expansion were scanned 3-dimensionally and superimposed to evaluate transverse expansion, expansion ratio, angular expansion, and palatal expansion height ratio. RESULTS: Using bonded RMEs, similar anterior and posterior dental expansions were achieved with an efficiency of 69%-76% (expansion ratio), and palatal soft-tissue expansion occurred more apically in the posterior area (palatal expansion height ratio, 1.00) than in the anterior area (palatal expansion height ratio, 0.64). Using RMEs, a larger posterior dental expansion was achieved, with an efficiency of 106%-117% (expansion ratio), than anterior dental expansion (55%-60%), and palatal soft-tissue expansion occurred more apically in the posterior area (palatal expansion height ratio, 0.99) than anterior area (palatal expansion height ratio, 0.23). CONCLUSIONS: Dental expansions in the anterior and posterior areas were similar using bonded RMEs, whereas the posterior dental expansions were larger than those of the anterior area using RMEs. The entire palatal soft-tissue slope expanded in the posterior area, whereas the occlusal part expanded in the anterior area using RMEs and bonded RMEs.

The orthodontic extraction of second premolars: The influence on airway volume.

INTRODUCTION: The extraction of second premolars and associated changes in the volume of the airway have not been previously explored. This retrospective study aimed to compare the volumetric changes of the airway preorthodontic and postorthodontic treatment in relevant extraction and control samples and to identify variables that may influence the outcome. METHODS: Cone-beam computed radiography scans of 54 patients with second premolar extraction and 59 nonextraction patients treated in a private orthodontic practice were matched for crowding. The average age for both samples was 15 years. The images were individually landmarked and measured by applying volumetric, linear, and angular parameters. The results were analyzed using repeated measures, such as variance analysis, correlation testing, and regression statistical analyses. RESULTS: There was a statistically significant increase in the airway volume for both groups (P <0.05). The difference in increase between the groups was not statistically significant. Seven variables demonstrated a collectively significant effect on changes to airway volume (F[7,112] = 38.48; P <0.001; r2 = 0.701), with 70% of the variation predicted by the variables. Multiple regression analyses indicated that changes to the area of minimum constriction (B = 32.45; t = 11.95; P <0.001) and changes to airway length (B = 94.75; t = 7.79; P <0.001) had a statistically significant effect on airway volume. CONCLUSIONS: The volume of the airway increased in both the extraction and nonextraction samples. The biggest contributors to the increase were an increase in airway length and an increase in the area of minimum constriction, which likely occurred as a result of natural growth.