Factors influencing the orthodontic treatment plan in Class II malocclusion.

INTRODUCTION: This study aimed to investigate the influence of orthodontists' demographics and patient characteristics on the orthodontic treatment plan decision for borderline Class II Division 1 malocclusion in growing patients. METHODS: An electronic survey was distributed to orthodontists through the American Association of Orthodontists. Participating orthodontists were asked to select their preferred orthodontic treatment plan for 3 patients with borderline Class II Division 1 malocclusion. The survey also included questions about the patient-related factors contributing to the treatment decision for each patient. RESULTS: A total of 113 orthodontists completed the survey. United States-trained orthodontists were more likely to select growth modification and nonextraction relative to extraction (odds ratio, 3.50; 95% confidence interval, 1.01-12.12; odds ratio, 3.59; 95% confidence interval, 1.18-10.91, respectively). Clinicians with >15 years of experience were 72% less likely to prefer nonextraction relative to extraction in 1 patient and were 67% less likely to prefer growth modification relative to extraction in another patient. Working solely in private practice was associated with higher, but not statistically significant, odds of growth modification and nonextraction. The practice location was also associated with treatment plan decisions; however, findings were inconsistent between the patients. CONCLUSIONS: The orthodontist's experience, place of education, location, and type of practice appear to influence the preferred treatment plan for Class II malocclusion. Overall, the patient's profile and age were the most considered patient-related factors for growth modification, whereas the patient's profile, amount of crowding, and smile esthetics were the most considered factors for preferring extraction and nonextraction treatment modalities.

Morphological features of Class I, II and III malocclusions of Saudi adolescents.

AIMS: This cross-sectional study compared and contrasted the morphological characteristics of Class I, II and III malocclusions in an adolescent Saudi population. METHODS: Adolescent Saudis with Angle's Class I, II and III malocclusions were selected from orthodontic patients' records. Angular and linear measurements were compared between the three groups. Cephalometric analysis was performed using the VistadentOC® software. Multifactorial ANOVA for angular and linear measurements between and within groups. RESULTS: Orthodontic records of 300 patients were included. There was no significant difference between and within groups in age and distribution of Angle's classification, p > 0.05. Multifactorial ANOVA showed that there were significant interactions between gender and malocclusions in skeletal, dental and soft tissue measurements, p < 0.05. There were significant differences in the sagittal and vertical skeletal measurements between groups, p < 0.05. The dental measurements were also significantly different in most of the measurements (p < 0.05). Moreover, there were significantly different readings among the groups in the soft tissue analysis. CONCLUSION: Morphological characteristics of adolescent Saudis show unique differences between gender and malocclusions, more so in Class III malocclusions. Class II and III malocclusions also show skeletal differences amongst the groups.

Distalization in Orthodontics: A Review and Case Series.

Distalization is a conservative method that is utilized in orthodontics to gain space by moving posterior teeth distally. It may be combined with other space gaining strategies, such as expansion, or can be used alone. Many methods have been used for distalization. These methods differ significantly in their place, whether to be extraoral or intraoral, site of action in upper and/or lower arch, and cooperation needed by the patient if it is removable or fixed. This review illustrates some of the most commonly used methods for distalization with a brief presentation of three cases that incorporated successful distalization techniques.

Mandibular symphysis dimensions in different sagittal and vertical skeletal relationships.

BACKGROUND: The aim of this cross-sectional study was to compare the dimensions of mandibular symphysis (MS) between gender and the different sagittal and vertical skeletal relationships. MATERIAL AND METHODS: Pre-treatment records of orthodontic patients were divided according to gender, sagittal (Class I, II and III) and vertical (decreased, average and increased mandibular plane [MP] angle) skeletal relationships. Measurements of MS parameters were performed on lateral cephalograms using IMAGEJ software. Comparisons between MS parameters and gender and the different skeletal relationships was performed using multifactorial and one-way ANOVA, and independent sample t-tests. RESULTS: A total of 104 records (25 males and 79 females) fulfilled the inclusion criteria. Males had significantly greater MS surface area, dentoalveolar length, skeletal symphysis length, total symphysis length, vertical symphysis dimension and symphysis convexity (p < 0.05). Skeletal Class II patients had significantly greater dentoalveolar and skeletal symphysis lengths while Class III had greater chin length, vertical symphysis dimension and symphysis convexity (p < 0.05). Patients with decreased vertical dimension had greater skeletal symphysis length (p = 0.026) and those with an average vertical relationship had greater chin length (p < 0.001). CONCLUSIONS: The morphology of the mandibular symphysis is affected by gender, sagittal and vertical skeletal patterns. Males had increased mandibular symphysis surface area and linear dimensions. Class II patients had greater dentoalveolar length. Chin length was greater in patients with an average MP angle.

Nonsurgical Treatment of Class III Malocclusion with Both Anterior and Posterior Crossbites Combined with Impacted and Congenitally Missed Teeth.

Class III malocclusions present a great challenge for many orthodontists, especially if malocclusions are found in adult patients and alongside other dental problems. This case report shows an adult patient with a skeletal class III anterior crossbite, a unilateral posterior crossbite on the right side, a congenital absence of both lateral incisors and retained deciduous teeth, and shift in the lower midline. The upper retained deciduous teeth and lower premolars were extracted. Leveling and alignment were initiated. Build-up composite resin placed on the first molars allowed for bite opening. The crossbites were corrected by using sequentially larger archwires combined with class III elastics until both the anterior and posterior crossbites were corrected. The impacted upper right canine was exposed using the closed eruption technique and leveled into the position of the upper lateral incisor. Miniscrews were utilized to close the residual spaces. Both canines were reshaped to simulate the upper lateral incisors. At the end of the treatment, good esthetic and functional results were obtained. In conclusion, orthodontic camouflage can be a viable option for treating patients with multiple skeletal and dental problems.

Nonsurgical Orthodontic Intervention of a Severe Class II Case Accompanied by Posterior Crossbite Using a Miniscrew-Assisted Straight Wire Technique.

Class II malocclusion in nongrowing patients is a great challenge in treatment especially if the degree of malocclusion is severe. In such cases, the use of miniscrews for orthodontic camouflage can produce results comparable to that of orthognathic surgery. This case report presents an adult patient with severe Class II malocclusion combined with bilateral posterior crossbite, deep bite, a crowded lower arch, and a history of extraction of the lower right first molar. The treatment involved upper arch expansion by a quad helix appliance followed by the extraction of the right and left upper 1st premolars. A miniscrew-assisted straight wire technique was used to close the extraction space and reduce the overjet. Lower molar protraction was done to close the previous extraction space in the lower arch. At the end of treatment, overjet was reduced, lower arch crowding was relieved, lip competency was established, and the wide buccal corridor was reduced with a pleasing smile and normal facial proportions.

Ultrasound Enhances Dentoalveolar Remodeling in an Ex Vivo Orthodontic, Ovariectomy-Induced Osteoporotic Model.

The aim of the study was to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on dentoalveolar structures during application of force to a cultured mandible slice taken from an ovariectomized rat model of osteoporosis. Rats were divided based on whether they had ovariectomy and/or LIPUS application into four groups: control osteoporosis group, control normal group, ultrasound-treated osteoporosis group and ultrasound-treated normal group. The mandibles were dissected, sliced and cultured before application of a 0.5-N force. Tissue specimens from five rats per group received LIPUS; the remaining rats served as untreated controls. Tissue sections were evaluated histologically and histomorphometrically. Osteoporosis significantly affected the alveolar bone without any effect on the dentin-pulp complex. LIPUS enhanced osteoporotic alveolar bone remodeling and increased cementum and predentin thickness. Furthermore, LIPUS application significantly increased odontoblast and periodontal ligament cell counts (p < 0.05) in both groups. Therefore, LIPUS enhances alveolar bone remolding and increases cementum and predentin formation in osteoporotic rat mandible slice organ cultures.

Prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population.

OBJECTIVES: This study was aimed to investigate the prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population. MATERIALS AND METHODS: The records of the 1066 patients seeking orthodontic treatment were screened for maxillary lateral incisor agenesis (MLIA). The following data were recorded for each subject: age; gender; unilateral or bilateral agenesis of MLI and side. The lateral cephalogram of each subject with MLIA was digitally traced. The data were compared to age-matched control orthodontic patients with skeletal Class I. RESULTS: The prevalence of maxillary lateral incisor agenesis was 4.9% (52 patients) in which 63.5% were females. There was a significant difference between MLIA patients and controls in sagittal relationships (ANB, Wits, AB plane, angle of convexity and Co-A/Co-Gn differential analyses) p < 0.05. CONCLUSIONS: Patients with maxillary lateral incisor agenesis showed a significant tendency for skeletal Class III compared with the Class I control. This could be attributed to maxillary hypoplasia/retrognathia.

Effects of Low-Intensity Pulsed Ultrasound on Orthodontic Tooth Movement and Orthodontically Induced Inflammatory Root Resorption in Ovariectomized Osteoporotic Rats.

This study investigated the effects of low-intensity pulsed ultrasound (LIPUS) on orthodontic tooth movement (OTM) and orthodontically induced inflammatory root resorption (OIRR) in ovariectomized osteoporotic rats. Forty-eight 28-d-old female Wistar rats were divided into ovariectomized and intact groups. In both groups, animals were left untreated; treated with 50 g mesially directed orthodontic force on the maxillary first molars using nickel-titanium closed-coil springs for 28 d; or treated with the same orthodontic protocol along with a 20-min LIPUS application on alternate days for 28 d. Extent of OTM and amount of OIRR of mesial roots were measured on three-dimensionally reconstructed micro-computed tomography images. Ovariectomy increased OIRR (p < 0.05). LIPUS reduced root volumetric loss regardless of ovariectomy status (p < 0.05); only ovariectomized animals had decreased OTM (p < 0.05). LIPUS normalizes OTM and attenuates OIRR in ovariectomized osteoporotic rats. It may therefore be beneficial in women with postmenopausal osteoporosis.

Controlled release of injectable liposomal in situ gel loaded with recombinant human bone morphogenetic protein-2 for the repair of alveolar bone clefts in rabbits.

BACKGROUND AND OBJECTIVE: The aim of the present study was to develop and examine a new non-invasive injectable graft for the repair of alveolar bone clefts using recombinant human bone morphogenetic protein-2 (rhBMP-2) encapsulated within injectable liposomal in situ gel (LIG). METHOD: Different liposomal formulations loaded with rhBMP-2 were prepared, and the effects of the preparation methods and lipid content on the efficiency of rhBMP-2 encapsulation within the liposomes were studied. For the preparation of in situ gel, deacetylated gellan gum (DGG) was used, and the in vitro gelation characteristics of the gel were evaluated. In vivo pharmacokinetics and histology were also assessed. Critical size alveolar defects were surgically created in the maxillae of 30 New Zealand rabbits and treated with different injectable formulae, including rhBMP-2 liposomes and in situ gel (rhBMP-2-LIG). RESULTS: The results indicated that the prepared rhBMP-2-LIG prolonged the release and residence time of BMP-2 within rabbits for more than 7 days. Histomorphometric assessment showed 67% trabecular bone filling of the defects treated using this novel formula. CONCLUSION: BMP-2-LIG is a promising delivery device for the repair of alveolar bone defects associated with cleft deformities.

Reliability of didactic grades to predict practical skills in an undergraduate dental college in Saudi Arabia.

OBJECTIVES: This longitudinal study was aimed to investigate the association between didactic grades and practical skills for dental students and whether didactic grades can reliability predict the dental students' practical performance. MATERIALS AND METHODS: Didactic and practical grades for graduates from the Faculty of Dentistry, King Abdulaziz University, between the years 2009 and 2011 were collected. Four courses were selected: Dental Anatomy, Operative Dentistry, Prosthodontics, and Orthodontics. Pearson product-moment correlation analyses between didactic and practical scores were conducted. RESULTS: There was only a significant correlation between didactic and practical scores for the Dental Anatomy course (P<0.001). There was also a significant correlation between all four subjects in the didactic scores (P<0.001). Only the scores of male students showed a significant correlation in the Operative Dentistry course (P<0.001). There were no correlations between Orthodontic grades. Moreover, a poor degree of reliability was found between didactic and practical scores for all subjects. CONCLUSION: Based on the findings of this study, the relationship between didactic grades and practical performance is course specific. Didactic grades do not reliably predict the students' practical skills. Measuring practical performances should be independent from didactic grading.

Correlation of psychomotor skills and didactic performance among dental students in Saudi Arabia.

OBJECTIVES: The objective of this study is to investigate the correlation between the psychomotor skills and the academic performance of dental students. METHODS: Didactic and preclinical scores were collected for students who graduated from the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, in 2011. Three courses (Dental Anatomy, Removable Prosthodontic Denture, and Orthodontics) were selected. Correlations comparing didactic and practical scores were done for the total samples, then for the males and females separately. RESULTS: There was no significant correlation between the practical and didactic scores for the three courses for the total sample. There was a significant correlation between all three subjects in the didactic scores. For females, the results showed that there was only a significant correlation between the practical and didactic scores for Dental Anatomy. For males, no correlation was observed between the practical and didactic scores for all subjects. CONCLUSION: In the present sample, didactic performance did not correlate well with the students' psychomotor performance.

Surgical Orthodontic Treatment of Severe Skeletal Class II.

This paper describes an adult Saudi male patient who presented with a severe skeletal class II deformity. The case was managed with a combination of presurgical orthodontic treatment followed by a double jaw orthognathic surgery and then another phase of orthodontic treatment for final occlusal detailing. Extraction of the four first premolars was done during the presurgical orthodontic phase of treatment to decompensate upper and lower incisors and to give room for surgical setback of the maxillary anterior segment. Double jaw surgery was performed: bilateral sagittal split ramus osteotomy for 8 mm mandibular advancement combined with three-piece Le Fort I maxillary osteotomy, 6 mm setback of the anterior segment, 8 mm impaction of the maxilla, and 5 mm advancement genioplasty. Although the anteroposterior discrepancy and the facial convexity were so severe, highly acceptable results were obtained, both esthetically as well as occlusally.

The prevalence of dental anomalies in the Western region of saudi arabia.

Objective. The aim of this cross-sectional study was to investigate the prevalence of dental anomalies that could be a cause of malocclusion in the western region of Saudi Arabia. Materials and Methods. A retrospective study of 878 digital orthopantomograms (OPGs) taken of patients, age ranging between 12 and 30 years, who presented to treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between 2002 and 2011. The OPGs and dental records were reviewed for congenitally missing teeth, supernumerary teeth, impactions, ectopic eruption, transposition, germination, fusion, dilacerations, taurodontism, dens in dent, and any other unusual conditions that can be assessed with OPG. Results. The prevalence of patient that exhibited at least one dental anomaly was 396 (45.1%) patients. The prevalence of congenitally missing teeth was 226 (25.7%), impacted teeth 186 (21.1%), dilacerated teeth 10 (1.1%), supernumerary teeth 3 (0.3%), odontoma 1 (0.1%), and taurodontism was also 1 case (0.1%) of the total radiographs reviewed. Conclusions. Congenitally missing teeth were found to be the most prevalent anomaly (25.7%), and the second frequent anomaly was impacted teeth (21.1%), whereas root dilacerations, supernumerary teeth, and taurodontism were the least frequent anomalies (1.1%, 0.3% and 0.1%, resp.).

Unusual treatment of bimaxillary dentoalveolar protrusion via miniscrews and molar extraction.

This case report describes the treatment of a Saudi female patient, aged 13 years 8 months at the start of treatment, with a Class I bimaxillary dentoalveolar protrusion and extracted maxillary first molars. Miniscrews were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. The treatment plan consisted of extraction of both lower first permanent molars, distalization of upper and lower premolars using miniscrews followed by en masse retraction of the upper and lower six anterior teeth. The active treatment period was 2 years 8 months. Arch retention was done using upper wrap-around retainer and lower fixed 3-3 retainer. The use of miniscrews helped to resolve the bimaxillary protrusion regardless of extraction pattern used.