Photobiostimulatory Effect of a Single Dose of Low-Level Laser on Orthodontic Tooth Movement and Pain.

Objective: To assess the effect of low-level laser applied at 3 weeks intervals on orthodontic tooth movement (OTM) and pain using conventional brackets (CB). Materials and Methods: Twenty patients with Angle's class II div 1 (10 males and 10 females; aged 20.25 ± 3.88 years) needing bilateral extractions of maxillary first bicuspids were recruited. Conventional brackets MBT of 0.022 in slot (McLaughlin Bennett Trevisi) prescription braces (Ortho Organizers, Carlsbad, Calif) were bonded. After alignment and levelling phase, cuspid retraction began with nitinol closed coil spring on 19 × 25 stainless steel archwire, wielding 150 gram force. 7.5 J/cm2 energy was applied on 10 points (5 buccal and 5 palatal) on the canine roots on the investigational side using gallium-aluminum-arsenic diode laser (940 nm wavelength, iLase™ Biolase, Irvine, USA) in a continuous mode. Target tissues were irradiated once in three weeks for 9 weeks at a stretch (T0, T1, and T2). Patients were given a feedback form based on the numeric rating scale (NRS) to record the pain intensity for a week. Silicon impressions preceded the coil activation at each visit (T0, T1, T2, and T3), and the casts obtained were scanned with the Planmeca CAD/CAM™ (Helsinki, Finland) scanner. Results: The regimen effectively accelerated (1.55 ± 0.25 mm) tooth movement with a significant reduction in distress on the investigational side as compared to the placebo side (94 ± 0.25 mm) (p < 0.05). Conclusions: This study reveals that the thrice-weekly LLLT application can accelerate OTM and reduce the associated pain.

Biostimulatory Effects of Low-Intensity Pulsed Ultrasound on Rate of Orthodontic Tooth Movement and Associated Pain, Applied at 3-Week Intervals: A Split-Mouth Study.

Objective: Low-intensity pulsed ultrasound (LIPUS) is a noninvasive modality to stimulate bone remodeling (BR) and the healing of hard and soft tissues. This research evaluates the biostimulatory effect of LIPUS on the rate of orthodontic tooth movement (OTM) and associated pain, when applied at 3-week intervals. Methods: Twenty-two patients (11 males and 11 females; mean age 19.18 ± 2.00 years) having Angle's Class II division 1 malocclusion needing bilateral extractions of maxillary first bicuspids were recruited for this split-mouth randomized clinical trial. After the initial stage of alignment and leveling with contemporary edgewise MBT (McLaughlin-Bennett-Trevisi) prescription brackets (Ortho Organizers, Carlsbad, Calif) of 22 mil, followed by extractions of premolars bilaterally, 6 mm nickel-titanium spring was used to retract the canines separately by applying 150 g force on 0.019 × 0.025-in stainless steel working archwires. LIPUS (1.1 MHz frequency and 30 mW/cm2 intensity output) was applied for 20 minutes extraorally and reapplied after 3 weeks for 2 more successive visits over the root of maxillary canine on the experimental side whereas the other side was placebo. A numerical rating scale- (NRS-) based questionnaire was given to the patients on each visit to record their weekly pain experience. Impressions were also made at each visit before the application of LIPUS (T1, T2, and T3). Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). Mann-Whitney U test was applied for comparison of canine movement and pain intensity between both the groups. Results: No significant difference in the rate of canine movement was found among the experimental (0.90 mm ± 0.33 mm) and placebo groups (0.81 mm ± 0.32 mm). There was no difference in pain reduction between experimental and placebo groups (p > 0.05). Conclusion: Single-dose application of LIPUS at 3-week intervals is ineffective in stimulating the OTM and reducing associated treatment pain.

Awareness of obstructive sleep apnea and its effects on daily life among health professionals from Karachi, Pakistan.

BACKGROUND: Sleep disturbances are be poorly documented by primary care physicians. OBJECTIVE: Our objective for this survey was to assess the awareness level amongst medical and dental house officers, medical and dental practitioners, and ear, nose and throat specialists (ENTs) regarding OSA and its effects on daily life. METHODS: This was a questionnaire-based survey with yes and no and true and false type questions. In order to assess knowledge, questions related to the most common signs and symptoms of OSA were selected. Questionnaires were distributed in seven medical and dental colleges in Karachi, Pakistan under graduates and above. Stratified random sampling technique was used to assess specific professionals which made a total sample size of 614. The data of this descriptive study was compiled and analyzed using SPSS version 20. RESULTS: 84% of the participants stated their awareness about OSA. After analyzing a detailed response in the form of questionnaires, an average of only 15% showed adequate knowledge of the problem in question, the rest was unaware of the pathophysiology, signs, symptoms and management of a patient suffering from OSA. CONCLUSION: knowledge about pathophysiology of obstructive sleep apnea and its effect on daily routine work is insufficient among health professionals. It is essential to create awareness among medical and dental fraternity regarding OSA as it is often not diagnosed and treated.

Pain Perception and Rate of Canine Retraction Through Self-Ligating Brackets and Conventional Elastomeric Ligation System: A Split Mouth Study

Abstract Objective: To evaluate the rate of tooth movement and the pain perception via self-ligating (SL) and conventional elastomeric ligation brackets (CB) system. Material and Methods: This study has been conducted at the Orthodontic Department of Baqai Dental College, Baqai Medical University. The sample size of this study comprised 40 patients, falling between the age of 12-30 years without any sex discrimination. Shapiro-Wilk was used to check the distribution of data. Non-parametric Mann Whitney U test was applied to evaluate the pain associated with SL and CB brackets system. To analysis the canine retraction Wilcoxon test was applied for the comparison of CB and SL brackets system. For all statistical analyses, the p-value of <0.05 was considered significant. Results: Pain level associated with retraction via CB and SL shows significant differences. However, the rate of canine retraction via CB and SL shows no significant differences at stages T0-T1 and T1-T2. However, stage T2-T3 shows a significant difference. Conclusion: As pain during orthodontic treatment is mostly associated with the level of compression of the periodontal ligament, it may be hypothesized that lower frictional forces generate less compression of the periodontal ligament and blood vessels, and so alter the type of pain experienced.

Effects of single-dose, low-level laser therapy on pain associated with the initial stage of fixed orthodontic treatment: A randomized clinical trial.

OBJECTIVE: The aim of this study was to assess the analgesic effect of a single application of low-level laser therapy (LLLT) on spontaneous pain and pain on chewing after placement of initial archwires. METHODS: Forty-two patients (26 women, 16 men) were randomly recruited for this split-mouth randomized clinical trial. Each patient received super-elastic nickel-titanium (NiTi) initial archwires (0.012, 0.014, 0.016, and 0.018-inch [in]) in the maxilla for leveling and alignment for an interval of 4 weeks between archwires. One side of the mouth was randomly designated as experimental, while the other side served as placebo. After insertion of each archwire, the experimental side was irradiated with a diode laser for 3 seconds each on 5 points facially and palatally per tooth, from the central incisor to first molar. On the placebo side, the laser device was held the same way but without laser application. A numerical rating scale was used to assess the intensity of spontaneous and masticatory pain for the following 7 days. The Mann-Whitney U test was used to compare pain scores between sides. RESULTS: Patients in the LLLT group exhibited significantly lower mean scores for spontaneous pain after insertion of the initial two archwires (0.012-in and 0.014-in NiTi; p < 0.05), while there was no significant difference for 0.016-in and 0.018-in wires between the LLLT and placebo groups. LLLT significantly reduced chewing pain scores (p < 0.05) for all archwires. CONCLUSIONS: A single dose of LLLT considerably lessened postoperative pain accompanying the placement of super-elastic NiTi wires for initial alignment and leveling.

Effects of low-level laser irradiation on the rate of orthodontic tooth movement and associated pain with self-ligating brackets.

INTRODUCTION: The aim of this study was to evaluate the effect of low-level laser irradiation applied at 3-week intervals on orthodontic tooth movement and pain associated with orthodontic tooth movement using self-ligating brackets. METHODS: Twenty-two patients (11 male, 11 female; mean age, 19.8 ± 3.1 years) with Angle Class II Division 1 malocclusion were recruited for this split-mouth clinical trial; they required extraction of maxillary first premolars bilaterally. After leveling and alignment with self-ligating brackets (SmartClip SL3; 3M Unitek, St Paul, Minn), a 150-g force was applied to retract the canines bilaterally using 6-mm nickel-titanium closed-coil springs on 0.019 x 0.025-in stainless steel archwires. A gallium-aluminum-arsenic diode laser (iLas; Biolase, Irvine, Calif) with a wavelength of 940 nm in a continuous mode (energy density, 7.5 J/cm2/point; diameter of optical fiber tip, 0.04 cm2) was applied at 5 points buccally and palatally around the canine roots on the experimental side; the other side was designated as the placebo. Laser irradiation was applied at baseline and then repeated after 3 weeks for 2 more consecutive follow-up visits. Questionnaires based on the numeric rating scale were given to the patients to record their pain intensity for 1 week. Impressions were made at each visit before the application of irradiation at baseline and the 3 visits. Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). RESULTS: Canine retraction was significantly greater (1.60 ± 0.38 mm) on the experimental side compared with the placebo side (0.79 ± 0.35 mm) (P <0.05). Pain was significantly less on the experimental side only on the first day after application of LLLI and at the second visit (1.4 ± 0.82 and 1.4 ± 0.64) compared with the placebo sides (2.2 ± 0.41 and 2.4 ± 1.53). CONCLUSIONS: Low-level laser irradiation applied at 3-week intervals can accelerate orthodontic tooth movement and reduce the pain associated with it.

Assessment of Gender Dimorphism on Sagittal Cephalometry in Pakistani Population.

OBJECTIVE: To determine and compare the cephalometric values among Pakistani males and females using commonly used sagittal skeletal measurements (ANB, Wits appraisal, Beta-angle) and newly developed cephalometric analyses (Yen-angle and W-angle). STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Orthodontic Department of Baqai Medical University, Karachi, Pakistan, from August to October 2013. METHODOLOGY: Atotal of 209 pre-treatment lateral cephalometric radiographs of orthodontic patients were selected from departmental records, comprised of 92 males and 117 females. Radiographs were traced for measurements of ANB, Wits appraisal, Beta-angle, W-angle and Yen-angle. Patients were categorized into skeletal classes I, II, and III on the basis of performed measurements, incisor classification, and profile recorded from their records. Descriptive analysis was used to obtain median interquartile range in both the genders and Mann-Whitney U-test was used to observe gender dimorphism. RESULTS: Skeletal class II was the most prevalent type of malocclusion. There were no difference in the obtained measurements between males and females except the Wits appraisal and Beta-angle in class II patients, which showed significant difference in values (p < 0.05). CONCLUSION: Pakistani population has no significant different difference in the craniofacial morphology of males and females, with the exception of Wits-appraisal and Beta-angle in class II cases.

Effect of a single dose of low-level laser therapy on spontaneous and chewing pain caused by elastomeric separators.

INTRODUCTION: The aim of this study was to see the effect of a single dose of low-level laser therapy on spontaneous and chewing pain after the placement of elastomeric separators. METHODS: Eighty-eight patients were randomly selected for this single-blind study. Elastomeric separators were placed mesial and distal to the permanent first molars in all quadrants. Both arches were divided into experimental and control sides. The experimental sides were treated with low-level laser therapy on 3 points on the buccal mucosa for 20 seconds each, with a 940-nm gallium-aluminum-arsenic diode laser on continuous mode and power set at 200 mW. The other side received placebo laser therapy without turning on the laser. A numeric rating scale was used to assess the intensity of spontaneous and chewing pain for the next 7 days. The independent sample t test and repeated-measures analysis of variance with the post hoc Tukey test was used to analyze the results. RESULTS: Significant differences were found in spontaneous and chewing pain among both groups (P <0.05). CONCLUSIONS: A single dose of low-level laser therapy can be an efficient modality to reduce the postoperative pain associated with the placement of elastomeric separators.

Minimally Invasive Techniques to Accelerate the Orthodontic Tooth Movement: A Systematic Review of Animal Studies.

OBJECTIVE: To evaluate various noninvasive and minimally invasive procedures for the enhancement of orthodontic tooth movement in animals. MATERIALS AND METHODS: Literature was searched using NCBI (PubMed, PubMed Central, and PubMed Health), MedPilot (Medline, Catalogue ZB MED, Catalogue Medicine Health, and Excerpta Medica Database (EMBASE)), and Google Scholar from January 2009 till 31 December 2014. We included original articles related to noninvasive and minimally invasive procedures to enhance orthodontic tooth movement in animals. Extraction of data and quality assessments were carried out by two observers independently. RESULTS: The total number of hits was 9195 out of which just 11 fulfilled the inclusion criteria. Nine articles were good and 5 articles were moderate in quality. Low level laser therapy (LLLT) was among the most common noninvasive techniques whereas flapless corticision using various instruments was among the commonest minimally invasive procedures to enhance velocity of tooth movement. CONCLUSIONS: LLLT, low intensity pulsed ultrasound (LIPUS), mechanical vibration, and flapless corticision are emerging noninvasive and minimally invasive techniques which need further researches to establish protocols to use them clinically with conviction.

Camouflage of Severe Skeletal Class II Gummy Smile Patient Treated Nonsurgically with Mini Implants.

Skeletal class II has always been a challenge in orthodontics and often needs assistance of surgical orthodontics in nongrowing patients when it presents with severe discrepancy. Difficulty increases more when vertical dysplasia is also associated with sagittal discrepancy. The advent of mini implants in orthodontics has broadened the spectrum of camouflage treatment. This case report presents a 16-year-old nongrowing girl with severe class II because of retrognathic mandible, and anterior dentoalveolar protrusion sagittally and vertically resulted in severe overjet of 13 mm and excessive display of incisors and gums. Both maxillary central incisors were trimmed by general practitioner few years back to reduce visibility. Treatment involved use of micro implant for retraction and intrusion of anterior maxillary dentoalveolar segment while lower incisors were proclined to obtain normal overjet, and overbite and pleasing soft tissue profile. Smile esthetics was further improved with composite restoration of incisal edges of both central incisors.

Differences in various measurements on panoramic radiograph among erupted and impacted lower third molar groups.

OBJECTIVE: To determine the differences in various linear and angular measurements between erupted and impacted lower third molar group on conventional panoramic radiographs. METHODS: The quasi-experimental study based on non-probability convenience sampling and done at the National Institute of Oral Diseases, Karachi, comprised 140 patients having full dentition with bilaterally present mandibular third molars varying between ages of 18-30 years. After clinical examination, 280 lower third molars were divided into two groups; Group A had erupted, while Group B comprised impacted mandibular third molars. All radiographs were traced and measured for five variables to compare the two groups. For statistical purpose, SPSS version 10, and t test were used. RESULTS: Retromolar space measured from Xi (centre of ramus) was 31.60 +/- 3.33 mm in Group A and 27.02 +/- 4.17mm in Group B. Retromolar space measured from anterior edge of ramus (AER) was 16.30 +/- 2.51 mm in Group A and 11.21 +/- 3.69 in Group B. Mesiodistal width was 13.39 +/- 1.44mm in Group A and 13.80 +/- 1.58 in Group B. Retromolar space/width ratio was 1.22 +/- 0.20 for Group A and 0.82 +/- 0.34 for Group B. Mean angulations in Group A was 5.98 +/- 5.9 degrees whereas 34.56 +/- 27.89 degrees in Group B. CONCLUSION: The probability of eruption of the lower third molar increases if retromolar space measured from anterior edge of ramus (AER-7) and centre of rumus point (Xi-7) is 13mm and 25mm respectively, provided the space/width ratio is greater than 1 and angulation is also vertical. Mesiodistal width of the tooth has no significant role in impactions.

Relation between centric slide and Angle's classification.

OBJECTIVE: To compare the difference in sagittal cephalometric analysis in centric occlusion (CO) and in centric relation (CR), among Angle's classes i.e. class I, class II, and class III. DESIGN: Comparative, cross-sectional study. PLACE AND DURATION OF STUDY: Orthodontic Outpatient Department, Karachi Medical and Dental College, Karachi, from July 2003 to December 2004. PATIENTS AND METHODS: Eighty pre-treatment orthodontic patients were divided into 3 groups according to Angle's classification. The first lateral cephalogram was taken in CO. Then leaf gauges were placed in between incisors for deprogramming. The second cephalogram was taken with leaf gauges in place to obtain centric relation. Both the radiographs were traced. Angle ANB was measured for sagittal analysis. ANB angle compares the position of mandible with the maxilla relating it with the cranial base. Angles from both cephalograms were compared with each other. RESULTS: Significant difference (p<0.0001) was found in values of ANB in CO (2.93 degrees -/+3.7) and CR (4.88 degrees -/+3.4) cephalograms. Significant CO-CR discrepancy was found (p<0.05) in Angle's class III patients (3.05 degrees -/+0.55) in comparison to Angle's class I (1.96 degrees -/+0.94) and class II (1.65 degrees -/+0.65). CONCLUSION: CO-CR discrepancy can occur regardless of Angle's classification. Special emphasis should be given to Angle's class III patients for the centric slide.