Comparison of Electric Toothbrush, Persica and Chlorhexidine Mouthwashes on Reduction of Gingival Enlargement in Orthodontic Patients: A Randomised Clinical Trial.

PURPOSE: To compare the efficacy of chlorhexidine, Persica mouthwash and electric toothbrushes in improving gingival enlargement in patients with fixed orthodontic appliances. MATERIALS AND METHODS: Seventy-two orthodontic patients with at least two sites of gingival enlargement were randomly allocated into four equal groups: 1) manual toothbrush; 2) electric toothbrush; 3) manual toothbrush+Persica mouthwash; 4) manual toothbrush+chlorhexidine mouthwash. All participants were instructed to brush their teeth at least twice a day. The subjects in groups 3 and 4 were instructed to use Persica or chlorhexidine according to the respective manufacturer's instructions. Bleeding on probing (BOP) index, gingival index (GI), O'Leary's plaque index (PI) and constructed hyperplastic index (HI) of all the subjects were measured in a blind manner at the start of the study and 2 weeks later. Changes of indices in the entire oral cavity and individual affected teeth were analysed with SPSS 16 using chi-square, ANOVA, ANCOVA, LSD and the paired t-test. RESULTS: In the entire oral cavity, there was a statistically significant improvement in indices in all the groups except for HI, which significantly improved only in group 4 (p=0.001). Data of individual teeth with hyperplastic gingiva showed significant reduction of all the variables except for HI in group 1 (p=0.08). No significant differences were found between groups 1 and 2 or between groups 3 and 4. CONCLUSION: The efficacy of Persica was similar to that of chlorhexidine in improving gingival conditions. None of the treatment modalities could reduce gingival enlargement to the clinically acceptable level of health.

Efficacy of Er,Cr Laser incision Corticotomy in Rapid Maxillary Canine Retraction: A Split-Mouth Randomized Clinical Trial.

Introduction: This study sought to evaluate the efficacy of lasercision corticotomy for the acceleration of canine movement. Our secondary objectives were assessing the canine rotation, the rate of anchorage control, the level of pain, and the gingival index (GI). Methods: Twelve orthodontic patients (9 females and 3 males) referring to the School of Dentistry and one dental clinic from May 2019 to September 2019 participated in this split-mouth randomized clinical trial. The allocation of the test and control sides was performed by flipping a coin. The mean age of patients was 18.91±3.87 years (range 15-30 years). The treatment plan included maxillary first premolar extraction. Following the initial leveling and alignment phase, an initial impression was made. Corticotomy was carried out with the erbium, chromium-doped yttrium scandium gallium garnet (Er, Cr: YSGG) laser (3.5 W, 30 Hz, 40% air, 80% water) in one maxillary quadrant (the laser side). Canine retraction was immediately initiated following surgery using nickel-titanium closed-coil springs with 150 g force. The impression was repeated 1 month after the onset of retraction. The casts were scanned, and the distance between the canine cusp tip and the rugae line was measured to quantify the amount of anteroposterior canine movement. The molar anchorage control was also evaluated by measuring the distance between the mesial contact of the permanent first molar and the rugae line. Gingival health was evaluated using the GI. The modified McGill pain questionnaire was used to assess the level of patients' pain. Results: Lasercision corticotomy accelerated canine retraction with no adverse effect on gingival health. Anchorage loss in the posterior teeth and pain scores were not significantly different between the control and laser sides. Conclusion: Laser corticotomy can effectively accelerate canine retraction with no complications or discomfort for the patients.

Effect of CO2 Laser on the Prevention of White Spot Lesions During Fixed Orthodontic Treatment: A Randomized Clinical Trial.

OBJECTIVE: This study aimed to assess the effect of carbon dioxide (CO2) laser on prevention of white spot lesions (WSLs) associated with fixed orthodontic treatment. METHODS: In this parallel controlled trial, 554 maxillary anterior teeth in 95 patients with age range of 12-30 years were included. The samples were randomly divided in two groups: 1) CO2 laser (n=278) and 2) control (n=276) groups. Following bracket attachment, the teeth in the laser group were exposed to CO2 laser (0.4 mw, 10.6 µm, 5 Hz) for 20 s, and the control group received placebo light. Incidence, severity, and extent of the lesions were assessed in four surface regions (gingival, incisal, mesial, and distal) at baseline and 6 months post-irradiation. The inter-group comparison was performed by the Mann-Whitney U test and McNemar analysis. RESULTS: A significant difference regarding WSLs incidence in all teeth was observed between the two study groups (p<0.001). The two study groups illustrated a significant difference in lesion extent and incidence in incisal, mesial, and distal regions (p<0.05). The WSLs were significantly different in terms of severity in the incisal and mesial sites (p<0.05). CONCLUSION: The CO2 laser irradiation seemed to effectively prevent incidence of WSLs. In addition, its effectiveness varied depending on the surface region.

Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review.

PURPOSE: The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. METHODS: All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. RESULTS: The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. CONCLUSION: Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.

Clinical comparison of two initial arch wires (A-NiTi and Heat Activated NiTi) for amount of tooth alignment and perception of pain: A randomized clinical trial.

OBJECTIVES: The aim of this study was to compare two initial arch wires, 0.014″ A-NiTi and 0.016″ Heat Activated NiTi (HANT), for amount of tooth alignment and perception of pain. MATERIALS AND METHODS: In total, 59 orthodontic patients (21 males and 38 females) from three orthodontic clinics participated in this 2-arm, parallel-group clinical trial and were randomized to 0.014″ A-NiTi (n=30) or 0.016″ HANT groups (n=29). Patient recruitment commenced in April 2016 and ended in December 2016. Age of the patients was between 12 to 25 years with an average of 17.92±3.74 years. Eligibility criteria included permanent dentition, non-extraction treatment plan in lower arch, Irregularity Index>2 in lower arch, no systemic disease influencing pain, no chronic Non Steroid Anti Inflammatory Drug (NSAID) therapy, and no history of dental pain, mucosal ulcers or temporomandibular disorders (TMD). Blinding was applicable to the patients and outcome assessment. The primary outcome was to compare the reduction of the Irregularity Index mean from bonding sessions to 4 weeks later in these groups and the secondary outcome was evaluation of the pain according to the modified McGill Pain Questionnaire (MPQ) with Visual Analogue Scale questionnaire (VAS). RESULTS: The mean differences of irregularity indices between the two groups are not statistically significant (95% CI: 0.39-1.03; P=0.36) and according to the questionnaire, there was no significant difference between the two groups in trigger, site, description, duration, beginning, medication, and pain reduction over time. However, the VAS scale of HANT group was significantly higher than that of A-NiTi (P=0.04). CONCLUSION: Results from this investigation suggested that there was no clinical difference in amount of tooth alignment and perception of pain between 0.014″ A-NiTi and 0.016″ HANT wires.

Effect of CO2 Laser and Fluoride Varnish Application on Microhardness of Enamel Surface Around Orthodontic Brackets.

Introduction: Orthodontic treatment has many advantages such as esthetic improvement and self-esteem enhancement; yet it has some disadvantages such as increasing the risk of formation of white spot lesions, because it makes oral hygiene more difficult. It is rational to implement procedures to prevent these lesions. The present study was aimed to assess the effect of CO2 laser and fluoride varnish on the surface of the enamel surface microhardness around the orthodontic braces. Methods: Eighty extracted premolar teeth were selected, scaled, polished with nonfluoridated pumic and metal brackets were bonded to them. Then, they were randomly allocated to 5 groups: control (neither fluoride nor laser is used on enamel surfaces), fluoride (4 minutes fluoride varnish treatment of the enamel surfaces), CO2 laser (10.6 µm CO2 laser irradiation of the teeth), laserfluoride (fluoride application after laser irradiation) and fluoride-laser (fluoride was applied and then teeth were irradiated with laser). After surface treatment around brackets on enamel, the samples were stored in 0.1% thymol for less than 5 days and then they were exposed to a 10-day microbiological caries model. Microhardness values of enamel were evaluated with Vickers test. One sample of each group (5 teeth from 80 samples) was prepared for SEM (scanning electron microscopy) and the data from 75 remaining teeth were analyzed with analysis of variance (ANOVA) and chi-square tests (α =0.05). Results: Microhardness mean values from high to low were as follow: fluoride-laser, laser-fluoride, laser, fluoride and control. Microhardness in fluoride-laser group was significantly higher compared with that of the control group. Distribution adhesive remnant index (ARI) scores were significantly different between groups and most of bond failures occurred at the enamel-adhesive interface in groups 2 to 5 and at the adhesive-bracket interface in the control group. Conclusion: Combination of fluoride varnish and CO2 laser irradiation can reduce enamel demineralization around orthodontic brackets.

Position of impacted mandibular third molar in different skeletal facial types: First radiographic evaluation in a group of Iranian patients.

PURPOSE: This study was performed to evaluate the position of impacted mandibular third molars in different skeletal facial types among a group of Iranian patients. MATERIALS AND METHODS: A total of 400 mandibular third molars in 200 subjects with different types of facial growth were radiographically investigated for their positions according to their types of facial growth on the basis of the ß angle. The subjects were divided into three groups (class I, II, and III) according to ANB angle, representing the anteroposterior relationship of the maxilla to the mandible. Meanwhile, the subjects were also divided into three groups (long, normal, and short face) according to the angle between the stella-nasion and mandibular plane (SNGoGn angle). ANOVA was used for statistical analysis. RESULTS: The mean ß angle showed no significant difference among class I, II, and III malocclusions (df=2, F=0.669, p=0.513). The same results were also found in short, normal, and long faces (df=1.842, F=2, p=0.160). The mesioangular position was the most frequent one in almost all of the facial growth patterns. Distoangular and horizontal positions of impaction were not found in the subjects with class III and normal faces. In the long facial growth pattern, the frequency of vertical and distoangular positions were not different. CONCLUSION: In almost all of the skeletal facial types, the mesioangular impaction of the mandibular third molar was the most prevalent position, followed by the horizontal position. In addition, ß angle showed no significant difference in different types of facial growth.

Implant site development by orthodontic forced eruption of nontreatable teeth: a case report.

BACKGROUND: Loss of bone and soft tissue attachment are common sequelae of periodontitis that may jeopardize the aesthetic outcome and compromise the functional and aesthetic outcomes of treatment. The following case report describes one of the most predictable techniques of vertical ridge augmentation, which is orthodontic extrusion or forced eruption of hopeless teeth. METHOD: A 34-year-old woman who presented with severe attachment loss and deep pockets was diagnosed with generalized aggressive periodontitis. The mobile maxillary incisors were consequently extracted and were replaced with dental implants. However, prior to extraction, orthodontic extrusion of the hopeless incisors was performed to correct vertical ridge defects. Following extrusion and extraction of the maxillary incisors, to prevent soft tissue collapse and to preserve the papillae during socket healing, the crowns of the extracted teeth were used as pontics on a removable partial provisional denture. After 8 weeks, the implants were placed, and an immediate functional restoration was delivered. After 4 months of healing, a fixed definitive partial prosthesis was fabricated and delivered. RESULT: After periodontal treatment, over a 2-year period, the progression of aggressive periodontitis was controlled. The mean vertical movement of marginal bone was 3.6 mm. The use of the crowns of extracted teeth appears to be an effective method to maintain papillae. CONCLUSIONS: Orthodontic extrusion is a predictable method for the correction of vertical ridge defects. Orthodontic treatment does not aggravate or hasten the progression of aggressive periodontitis.